Vasovasostomy and Vasoepididymostomy Clinical Presentation

Updated: Dec 21, 2016
  • Author: Jacob C Parke, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Presentation

History

It is important to obtain a thorough history from all patients requesting VR. Important factors to consider are pre-vasectomy fertility of both the patient and his partner. The age of the partner, previous parity, and any concurrent medical issues she may have that can affect the outcome of future pregnancy. [7] By far, the most important prognostic factor for successful reversal is the occlusion duration. [8]  

Obtaining information about post-vasectomy complications such as infection or hematoma can prepare the surgeon for intra-operative peri-testicular inflammation that can make re-anastomosis more challenging. [8]  

Testosterone replacement therapy (TRT) has been well documented to negatively impact spermatogenesis. Any TRT the patient is currently taking should be discontinued well before VR as it can influence intra-operative decision-making. Inability to identify sperm on intra-operative vasal fluid can lead the surgeon to pursue the more technically challenging VE, which can also negatively impact outcomes and pregnancy rates. [7]

Patients and their partners should be counseled regarding the risk and benefits of surgical reconstruction, as well as the alternatives. In-vitro fertilization, microsurgical testicular sperm extraction, donor sperm insemination, and adoption are all viable options. Should couples proceed with vasectomy reversal, cryopreservation of sperm intra-operatively can provide more options of fertility in the future should vasectomy reversal be inadequate for natural conception. [8]  

Any history of previous inguinal or pelvic surgeries should also be documented for completeness.

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Physical Examination

Physical examination should consist of a thorough testicular exam. Documenting the presence of a palpable vasal defect, sperm granuloma, and if possible, the length of the proximal (testicular) vasal segment can be helpful in operative planning. 

Presence of a varicocele is also an important exam finding which can significantly impact fertility rate and can be surgically corrected at the time of VR. [7]

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