Other Tests
Vasectomy reversal
See the list below:
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Men who request a vasovasostomy or vasoepididymostomy reversal require no further workup as long as their scrotal examination reveals normal-sized testicles and they have not developed any fertility-impacting medical conditions (eg, history of chemotherapy, radiation therapy) since their original vasectomy.
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In the case of small testes or history of a potentially gonadotoxic insult to the testis, perform a testis biopsy at the time of, or prior to, the procedure to document normal sperm production.
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Approximately 60% of men who undergo bilateral vasectomy develop circulating antisperm antibodies afterward, and the effect of these on conception and pregnancy is controversial. While preoperative antisperm antibody testing is available, its effects on postoperative fertility is of unproven benefit.
Nonvasectomy reversal
See the list below:
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To be a candidate for a vasoepididymostomy, men with normal–semen volume azoospermia must have active sperm production, an epididymal obstruction, and a patent vas deferens. Normal serum gonadotropin levels (eg, follicle-stimulating hormone [FSH]) suggest normal spermatogenesis, although, occasionally, a patient with an interruption in the normal sperm development (maturation arrest) has normal FSH levels.
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Definitive proof of normal sperm production is required and can be provided by a testis biopsy at the same time as the planned reconstruction (or at an earlier date).
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At the time of planned reconstruction, a vasogram is performed to confirm patency of the entire vas deferens and ejaculatory duct. Performing a vasogram at an earlier time may result in scarring of the vas, rendering definitive reconstruction more difficult.
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Sperm is produced in the seminiferous tubules and then transits through the rete testis, through the efferent duct, and into the epididymal tubule. Image reprinted with permission from Cleveland Clinic.
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Vasovasostomy modified one-layer technique: (A) A 9-0 nylon suture is passed through the entire vas wall, traveling full thickness through both ends. (B) Two 8-0 nylon seromuscular sutures are placed on either side of the 9-0 suture. (C) This pattern is repeated in each quadrant of the anastomosis, resulting in a total of 4 luminal sutures and 8 seromuscular sutures.
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Vasovasostomy formal two-layer technique: (A) 9-0 nylon seromuscular sutures are placed in the posterior end of the vas at the 5- and 7-o'clock positions. (B) Six interrupted 10-0 nylon mucosal sutures are then placed to approximate the luminal ends of the deferens. (C) Finally, 4 additional 9-0 nylon seromuscular sutures complete the second layer of the anastomosis.
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Vasoepididymostomy end-to-side technique: (A) Two 9-0 nylon sutures are used to secure the seromuscular layer of the vas to the epididymal tunic. (B) Four 10-0 nylon sutures are then placed to secure the mucosa of the vas to the epididymal tubule. (C) Finally, six to eight 9-0 nylon sutures are used to secure the seromuscular layer of the vas to the epididymal tunic.
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Table 1. Surgically Correctable Causes of Ductal Obstruction
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Table 2. Microsurgical Vasovasostomy
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Table 3. Microsurgical Vasoepididymostomy
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J stent insertion for the treatment of malignant obstruction. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
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Vasectomy reversal. Video courtesy of Dennis G Lusaya, MD, and Edgar V Lerma, MD.
