Vasovasostomy vs. Vasoepididymostomy-Nuance #1

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Many institutions recommend a vasoepdidymostomy if no sperm are seen in the fluid of the transected vas deferens at the time of the reversal. The article below begs to differ.

Vasovasostomy Recommended When Only Sperm Parts Noted

Urology – November 30, 2006 – Vol. 22 – No. 04

Vasovasostomy can and should be performed when only sperm parts are noted intraoperatively in the transected vas.

Article Reviewed: Outcomes for Vasovasostomy Performed When Only Sperm Parts Are Present in the Vasal Fluid. Kolettis PN, Burns JR, et al: J Androl; 2006; 27 (July/August): 565-567.

Outcomes for Vasovasostomy Performed When Only Sperm Parts Are Present in the Vasal Fluid.

Kolettis PN, Burns JR, et al:
J Androl; 2006; 27 (July/August): 565-567

Objective: To determine vasovasostomy outcomes in instances in which only sperm parts are present intraoperatively in the vasal fluid, rather than in full sperm. Design: Retrospective review of outcomes from 3 institutions with experienced male reproductive microsurgeons for men undergoing vasovasostomy in cases where only sperm parts were noted in fluid from the transected vas.Participants: 34 men who underwent bilateral (n=31) or unilateral (n=3) vasovasostomy. Methods: Men who were identified with sperm parts (sperm heads or sperm with partial tails) in the vasal fluid bilaterally or sperm parts on 1 side with intravasal azoospermia on the contralateral side when the vas was transected during vasovasostomy were included in the study. Microsurgical vasovasostomy was performed using either a modified 1-layer technique or a formal 2-layer technique. Results: The overall patency rate was 76% (26 of 34 men), and the pregnancy rate was 35% (7 of 20). Analyzing 8 procedures that did not result in sperm in the ejaculate, 2 had only an occasional sperm head bilaterally from the transected vasa, and 1 had observed an occasional sperm head on 1 side and contralateral intravasal azoospermia. Excluding these 2 cases, the patency rate was 84% (26 of 31). Conclusions: These results are similar to or better than those of epididymovasostomy outcomes, and argue that vasovasostomy should be performed in cases where only sperm parts are noted intraoperatively in the transected vas. Reviewer’s Comments: Mounting evidence supports that vasovasostomy can and should be performed when only sperm parts or even clear fluid is noted intraoperatively in the transected vas. (Reviewer–Craig S. Niederberger, MD).

Getting a vasectomy increases sexual intercourse…true or false?

Over the years men have told me they were having a vasectomy because their wife told them that, “I’ll want to have sex more if I don’t have to worry about getting pregnant.” One such patient, a neighbor, stopped me in my drive way three months after his vasectomy to tell me,  “She lied!”

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Vasectomy May Lead to Increased Sexual Intercourse Frequency 

Urology – April 30, 2016 – Vol. 34 – No. 1

Vasectomy is not associated with decreased frequency of sexual intercourse.

Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.

Background: Men often report the concern that having a vasectomy will impair their future sexual function.

Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.

Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.

Methods: Data were extracted from 2 cycles of the NSFG (2002 and 2006-2008) and analyzed. Men were included if they were previously sexually active and were aged >25 years. Female partners were also surveyed in the NSFG and were included if they were between 25 and 45 years of age. Sexual frequency was compared between men (or male partners of female respondents) who had a vasectomy and those who did not. The database captured sexual intercourse frequency over the preceding 4 weeks.

Results: A total of 5838 men met inclusion criteria, with 353 of these having a previous vasectomy. Men who had a vasectomy engaged in intercourse at a mean rate of 5.9 times per month compared to 4.9 times in men who had not had a vasectomy (P =0.0004). Additionally, men who had a vasectomy were less likely to have not engaged in any sexual intercourse in the preceding month. In the survey of female partners, 5211 women responded regarding their male partners, and 670 partners had a previous vasectomy. Again, men with a previous vasectomy had a higher frequency of sexual intercourse during the previous month (6.3 vs 6.0), although this difference was not statistically different (P =0.1341).

Conclusions: Vasectomy does not appear to negatively influence sexual frequency.

Reviewer’s Comments: The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy. Previous reports have investigated if vasectomy has any effect on sexual function and satisfaction, with most finding minimal to no effect on sexual function. In fact, some reports have demonstrated improved sexual function with improved sexual satisfaction, likely due to the loss of anxiety about unwanted pregnancy. The authors of this article demonstrate through objective survey results that sexual frequency does not decrease and may increase with vasectomy. While no explanation can be extracted from these data, the results are encouraging and can certainly be mentioned while counseling men before vasectomy.(Reviewer–Charles Welliver, MD).

Who’d a thought? Heart healthy diets improve sperm health.

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Heart-Healthy Foods With Lower Saturated Fat Equals Sperm Health

Urology – May 30, 2013 – Vol. 30 – No. 5

Ongoing indirect evidence suggests that heart-healthy diets are associated with the potential to improve sperm parameters.

Article Reviewed: High Dietary Intake of Saturated Fat Is Associated With Reduced Semen Quality Among 701 Young Danish Men From the General Population. Jensen TK, Heitmann BL, et al: Am J Clin Nutr; 2013;97 (February): 411-418.

Background: Saturated fat consumption has been correlated with some cancers and cardiovascular disease. Yet, whether saturated fat is correlated with abnormal sperm parameters needs more research.

Objective: To determine the impact of dietary fat on semen parameters among 701 young Danish men without azoospermia.

Design/Methods: This was a cross-sectional study of men recruited from their military fitness exam (2008 to 2010). Three-month recall-validated 136-item food frequency questionnaire, single semen sample, and physical examination were conducted for each participant. Median age was 19 years and median body mass index (BMI) was 22.5.

Results: Men with a high intake of saturated fat had lower total sperm counts. Men in the highest quartile of saturated fat intake had a 38% significantly lower concentration and a 41% significantly lower total sperm count compared to men in the lowest quartile. There were no other significant correlations found between semen parameters and other forms of dietary fat intake.

Conclusions: Diet may be a partial explanation for the reported greater abnormalities observed in sperm counts from other studies of the general population. Reducing the intake of saturated fat may improve reproductive and overall health parameters.

Reviewer’s Comments: This is part of a continuing series of studies that suggest you are what you consume in your diet regarding certain areas of health and – to some extent – fertility. Second, this is a cross-sectional study, whether it is a semen sample or dietary questionnaire is not level 1 evidence. In fact, the correlation between food frequency questionnaires and reality is still far apart. I do not remember what I ate yesterday, let alone months ago. Yet, the beauty of a large questionnaire and this study is that these snapshots might reveal a hidden general pattern or overall behavior that can provide some answers. I found it interesting that a higher percentage of men with a very low BMI were more likely to consume more saturated fat (seems counterintuitive, right?). Yet, men consuming more saturated fat were slightly more likely to smoke, drink more alcohol, report a sexually transmitted disease, consume more overall calories, eat more omega-6 fatty acids, and probably had less muscle mass. And, although the authors did adjust for most of these parameters in their study – which they believe makes the theory of saturated fat being a marker of unhealthy overall behavior less likely – I disagree (>30% of the saturated fat was coming from cheese and dairy products). There is a pattern of behavior to suggest a less healthy lifestyle in those who consume more saturated fat, which is similar to what has been found in many prostate cancer studies and cardiovascular reviews.(Reviewer–Mark Moyad, MD, MPH).

 

Vasectomy Reversal Complications

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Although vasectomy reversal complications are rare, any surgery carries some degree of risk. Because vasectomy reversal is a longer and more complicated procedure than an original vasectomy, it has a greater chance of side effects.

In spite of the low risk factor, it is important to be aware of the potential complications associated with a vasectomy reversal. Before undergoing the surgery, ask a physician to go over these. Read More…

Vasectomy Reversal Cost-Georgia Vasectomy Reversal

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The cost of vasectomy reversal varies depending on the physician’s office, your geographic location, and the type of procedure performed. It is not inexpensive, but there are a few options that may help you fit it into your family budget.

Most insurance plans won’t cover the cost of reversal surgery, which can range anywhere from $5,000 to $15,000. (However, now that success rates have increased, some insurers are reconsidering this policy so be sure to check with your provider.) For now, reversal is usually an elective, fee-for-service procedure and it is still less expensive than many of the alternatives. Read More…

Microscopic Vasectomy Reversal Cost with General Anesthesia at Northeast Georgia Urological Associates