Vasovasostomy

Interventions infobox
Name = Vasovasostomy


Caption =
ICD10 =
ICD9 = 63.82
MeshID = D014669
OtherCodes =

Vasovasostomy (literally connection of the vas to the vas) is the surgery by which vasectomies are reversed in males.

It can be performed in the convoluted or straight portion of the vas deferens.cite journal |author=Patel SR, Sigman M |title=Comparison of outcomes of vasovasostomy performed in the convoluted and straight vas deferens |journal=J. Urol. |volume=179 |issue=1 |pages=256–9 |year=2008 |pmid=18001786 |doi=10.1016/j.juro.2007.08.169 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(07)02349-X]

History

The medical term used to describe the reversal procedure is called vasovasostomy (a form of microsurgery first performed by Earl Owen in 1971).

The physician can reconnect the sperm canal by performing a vas-to-vas connection (vasovasostomy).

The term Vasectomy Reversal (vasovasostomy) is the process of reconnecting the tubes (vas deferens ) that were cut during a vasectomy Vasectomy reversal is usually an outpatient procedure without an overnight stay.

Limitations

In most cases the vas deferens can be reattached but, in many cases, fertility is not achieved. There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal sperm activity. If blockage at the level of the epididymis is suspected, a vaso-epidymostomy (connecting the vas to the epididymis) can be performed.

Return of sperm to the ejaculate ranges from roughly 30 to 90 percent, and may depend greatly on the length of time from the vasectomy. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy is somewhat lower (30 to 60 percent), and can depend on female partner factors.

Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature but, there is agreement that antibodies reduce sperm motility.

The following myth can be displaced by the facts.

Since the body often produces antibodies against sperm, sperm counts are rarely at pre-vasectomy levels pose a significant problem.

The real facts: It is estimated that between 50% to 75% of patients having had a vasectomy have positive blood testing for anti-sperm antibodies. In the 1980's this was thought to be a significant problem. As medical management of these antibodies has greatly improved, it also has become apparent that only antibodies attached to the sperm have a deleterious effect, and the frequency of this as a problem has been much less than suspected 20-25 years ago. Although anti-sperm antibody problems are no longer a major concern, many surgeons without vasectomy reversal skills and most OB/GYN specialists touting IVF, ICSI, etc. repeatedly exaggerate the importance of anti-sperm anti-bodies.

Testing the blood for anti-sperm anti-bodies is meaningless and don't let anybody waste your money on this test. An immuno-assay of sperm is needed to diagnosis an anti-sperm antibody problem and there are not any sperm available for testing pre-op.

What is required for a successful Vasectomy Reversal?

Only two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal by vasovasostomy (VV). The first condition is rather obvious. The patient must have sperm available to pass through at least one reconnection. The second condition is that each reconnection must be as watertight as possible. The surgeon's goal is to achieve a very precise circumferential reconnection of the sperm canal edges by using meticulously placed microsurgical sutures.

Procedure

Vasovasostomy is typically an out-patient procedure (patient goes home the same day).

The medical term used to describe the reversal procedure is called vasovasostomy (a form of microsurgery first performed by Earl Owen in 1971). The physician can reconnect the sperm canal by performing a vas-to-vas connection (vasovasostomy). The term Vasectomy Reversal (vasovasostomy) is the process of reconnecting the tubes (vas deferens ) that were cut during a vasectomy Vasectomy reversal is usually an outpatient procedure without an overnight stay.

The procedure is typically performed by urologists. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia.

[Doctors] can perform this surgery in one of two ways:

[Vasovasostomy] (VV) with this procedure, the surgeon sews the severed ends of the vas deferens back together. However, sometimes this isn't possible and a more complex surgery is needed to restore the flow of sperm.

[Vasoepididymostomy] (VE) is often considered one of the most technically challenging operations in the field of urology. The procedure requires anastomosis of a single epididymal tubule (luminal diameter 150–250 m) to the lumen of the vas deferens (diameter 300–400m), and is reserved for patients with congenital or acquired epididymal obstruction, or patients who have failed previous attempts at surgical reconstruction of the vas deferens. This surgery attaches the vas deferens directly to the epididymis, the coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is connected to the epididymis above the point of blockage.

If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient’s semen only transiently after the reversal, microsurgical vasovasostomy (VV) will very likely be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon absolutely cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections. The failure of a competently performed microsurgical “vasovasostomy” (VV) following the absence of any sperm in the contents of each vas usually is due to “blowouts” in each epididymis. Under these circumstances an operation should be performed only by a micro-surgeon with proven “vasoepididymostomy” (VE) expertise, bypassing the blowouts.

Prognosis

The prognosis for each patient should be determined by a pre-operative examination of the vasectomy sites besides consideration of the time interval between vasectomy and reversal.

If a patient has a sperm granuloma at one of his vasectomy sites, the time interval becomes almost unimportant. If there is no granuloma at either vasectomy site, the prognosis is then based completely on the time interval since the vasectomy. I define a sperm granuloma as a hard knot at least the size of a BB-gun BB, often a little larger, at the tip of the lower vas end, which is usually next to the top of the testicle.

Fact|date=August 2008

Rate of Pregnancy

The rate of pregnancy depends on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. The reversal procedures are frequently impermanent, with occlusion of the vas recurring two or more years after the operation.

A local urologist can easily determine whether you have 0, 1, or 2 sperm granuloma by a painless examination of each vasectomy site. This exam can be fairly inexpensive, if you inform his office in advance that this is the only service you wish and you obtain the cost for only this specific examination. If the interval since your vasectomy is less than fifteen years, your prognosis will be 70% or better and this local examination is probably not needed. A sperm granuloma develops from post-vasectomy sperm leakage and somehow it behaves like a safety valve preventing internal pressure build up and ruptures of the delicate epididymis tubules with subsequent obstructive scarring. [cite web |url= [] | title= [] |accessdate=2008-08-19 |work= |publisher=Dr Don R Pohl, M.D. |date=2006-06-17 ]

Statistics

Between 4 and 6% of vasectomized men consider a vasectomy reversal. Approximately 60% of men consider vasectomy reversal because of remarriage. There are many other reasons that include family planning and the desire to maintain fertility for the future.

Vasectomy reversal can be effective regardless of how long it's been since the original vasectomy. However, if more than 15 years have passed since the original vasectomy, you may have a lower chance of having enough healthy sperm in your semen to father a child.

Questions to Consider?

Doctors usually perform vasectomy reversals at a surgery center or at a hospital. It's a delicate, microsurgical procedure that can be done using a few different surgical techniques.

Things to consider:

Did the surgeon you are considering obtain formal training in microsurgery?

Does this surgeon also practice general urology?

Does this surgeon teach vasectomy reversal?

What type of anesthesia and exactly where has your surgeon chosen for your reversal?

What size sutures does the surgeon you are considering use to reconnect the two vas ends?

Does the surgeon you are considering use the operating microscope to place every suture reconnecting the tiny sperm canals inside each vas end?

How many of his re-connection sutures actually reconnect the edges of the tiny sperm canals inside each vas end?

References

External links

* [http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=154&x=16&y=17 Vasectomy Reversal] American Urological Association sponsored site.
* [http://vasectomy.com/main.asp?siteid=R Vasectomy.com Articles on Vasectomy Reversal.]