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Background: Vasectomy reversal (VR) is the only technique that allows men previously submitted to a vasectomy to conceive by natural pregnancy. We report our experience with microsurgical VR and identify predictive factors of natural pregnancy., Methods: We retrospectively reviewed all patients submitted to VR by a single surgeon from 2008 to 2021 at our single center. Patency and pregnancy rates were evaluated. The main outcomes after surgery were the patency and natural pregnancy rates. Secondary outcomes were the identification of predictive factors of success and patient satisfaction with the natural pregnancy., Results: Forty VRs were performed with a patency rate of 97.1% and, among those who became patent, pregnancy occurred in 13 of 31 couples by natural conception (41.9%). Two-layer anastomosis was significantly associated with a successful procedure (Odds Ratio of 12.428; p = 0.045). We did not identify a significant association between any of the other variables and a successful outcome. Even without a successful surgery, most of the patients were very satisfied with the results and would do the procedure again., Conclusions: VR is a useful technique for men previously submitted to a vasectomy and who pretend to have children by natural conception. Twolayer anastomosis is significantly associated with a successful surgery., Competing Interests: The authors declare no conflict of interest., (©2024 The Author(s). Published by MRE Press.)

Microsurgical reversal surgery for the treatment of vasal and epididymal obstruction represents one of the most challenging procedures in urology. An awareness of the latest information surrounding these procedures is essential to success. This article discusses current techniques in preparation, anastomosis, and investigational methods.

Vasovasostomy after sterilisation vasectomy is the most frequently performed microsurgical intervention in refertilizing surgery. Causes for obstruction other than vasectomy such as juvenile hernia repair and other kinds of surgery affecting the seminal cord appear to be rare. The pre-operative diagnostic approach follows the rules of conventional diagnostics in male infertility. The significance of the intra-operative evaluation of aspirates from the duct and its role in surgical decision-making is controversely debated in the literature. Similar controversies are evident concerning the microsurgical technique that is applied. In particular, the advantages of the two-layered technique (gold standard) of the anastomosis versus the single-layered technique are discussed. Other techniques such as laser applications and fibrin glue are not routinely used in humans. Even difficult microsurgical problems in cases with extended obstructions and cases of re-vasovasostomy can nowadays be managed and have significant success rates. Important prognostic factors appear to be the interval of obstruction, sperm granulomas, and length of the testicular end of the duct. High success rates accompanied by a lower profile in cost make the microsurgical approach (refertilization) superior versus the primary use of ART techniques such as ICSI., (Copyright 2003 S. Karger AG, Basel)

This study evaluates the use of sutureless laser welding for vasovasostomy. In 14 rodents, the left vas deferens underwent vasovasostomy using an albumin-based solder applied to the adventitia of the vas deferens. The solder contained the dye, indocyanine green, to allow selective absorption and denaturation by a fiber-coupled 800-nm diode laser. The right vas deferens served as a control, receiving conventional layered microsurgical repair. We used a removable 4/0 nylon stent and microclamps to appose the vas deferens during repair, with no need for stay sutures. The mean time to perform laser solder repair (23.5 min) and conventional repair (23.3 min) were not significantly different (P=0.91). However, examination after 8 weeks showed that granuloma formation (G) and patency (P) rates for the conventional suture technique (G, 14%; P, 93%) were significantly better than observed for the laser solder technique (G, 57%; P, 50%).

Objectives: To compare fibrin-glued vasovasostomy to a conventional microsurgical technique in a protocol of delayed vasovasostomy., Materials and Methods: Forty male Sprague-Dawley rats underwent bilateral vasectomy through a midline abdominal incision. Two weeks later all animals underwent a bilateral vasectomy reversal through a bilateral inguino-scrotal incision, following two different protocols. Invariably, the proximal segment had a larger lumen. The control group (20 rats) had a conventional modified one-layer sutured vasal anastomosis with 10/0 nylon. The experimental group (20 rats) underwent vasal anastomosis using fibrin glue and consisting of three transmural sutures with 10/0 nylon followed by the application of fibrin glue circumferentially to seal the anastomosis. The fibrin-tissue adhesive was obtained from pooled donor plasma and was virally inactivated by a solvent-detergent treatment. Seven weeks after surgery all animals were killed and the vasal specimens were evaluated for gross patency and the incidence of sperm granuloma., Results: The control group had a patency rate of 85% and half had sperm granuloma. The experimental group had a patency rate of 92% and 40% had sperm granuloma; neither difference was significant. The mean operative time was significantly shorter for the fibrin glue-assisted vasovasostomy (P < 0.001)., Conclusion: This study showed that a delayed fibrin-glued vasovasostomy gave a comparable anatomical success and an incidence of sperm granuloma similar to that using a conventional microsurgical technique, but with the advantages of a shorter operative time and a less technically demanding anastomosis.

To identify another preoperative predictor of surgical outcome in vasal reconstruction, we prospectively measured the post-vasectomy length of the testicular vas deferens from the cauda of the epididymis to the site of the vasectomy in 26 patients undergoing vasal reconstruction. Intraoperatively, the vasal fluid was microscopically inspected and classified as whole sperm present or whole sperm absent. The length of the testicular vasal remnant was correlated with the intraoperative status of the vasal fluid. A testicular vasal remnant length greater than 2.7 cm. predicted the presence of fluid with whole sperm present in 30 of 32 testicles (94%). A testicular vasal length of less than 2.7 cm. predicted the presence of fluid without whole sperm in 17 of 20 testicles (85%). The length of the testicular vasal remnant can be measured preoperatively and knowledge of this length may be used to advise patients regarding the likelihood of successful vasal reconstruction.

An easier technique of microsurgical vasovasostomy, a modified one-layer anastomosis, is compared to double-layer anastomosis. In this preliminary report there is no difference between the modified one-layer and double-layer techniques in per cent of patients postoperatively obtaining normal sperm count and pregnancy. Since the modified one-layer technique is easier, faster, and less expensive, this technique deserves further clinical experience and evaluation.