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).

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