Does the type of vasectomy performed affect the microscopic vasectomy reversal?

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No Sireee Bob!

All methods of performing a vasectomy include removing a segment of the vas deferens and then doing something to close the two ends of the divided vas. Whether this is done by using electrocautery, clips, suture, or interposing tissue, the ability to remove the damaged areas of he vas ends and do the reversal is not impaired.

In general about an inch of the damaged ends of the vas tubes and scar tissue is removed at the time of a microscopic reversal. There is plenty of “play” in the vas above and below the vasectomy site to perform the reversal without tension.

Vasectomy reversal more cost effective than IVF?

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Vasectomy Reversal Remains More Cost-Effective Than IVF

Urology – October 30, 2008 – Vol. 24 – No. 11
Vasectomy reversal is more cost-effective than sperm aspiration and in vitro fertilization for obstructive azoospermia.
Article Reviewed: A Decision Analysis of Treatments for Obstructive Azoospermia. Lee R, Li PS, et al: Hum Reprod; 2008;23 (September): 2043-2049.
Background: Management of post-vasectomy obstructive azoospermia is either vasectomy reversal or sperm aspiration with in vitro fertilization (IVF) intracytoplasmic sperm injection (ICSI). The cost of IVF and issue of multiples has broad implications for public health policy and allocation of resources. The change in cost of male factor infertility over time with the evolution of new techniques like ICSI has not been studied.

Objective: To investigate and compare the economic impact of IVF versus vasectomy reversal for obstructive azoospermia over time using population data and analytic models. Continue reading Vasectomy reversal more cost effective than IVF?

Age of the female is important to vasectomy reversal success.

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Female Age >=40 Years Affects Pregnancy Success Following Vasectomy Reversal

Urology – October 30, 2007 – Vol. 23 – No. 06

A female partner’s age >=40 years should be considered part of the counseling for vasectomy reversals.

Article Reviewed: Effect of Female Partner Age on Pregnancy Rates after Vasectomy Reversal. Gerrard ER Jr, Sandlow JI, et al: Fertil Steril; 2007; 87 (June): 1340-1344.

Effect of Female Partner Age on Pregnancy Rates after Vasectomy Reversal.

Gerrard ER Jr, Sandlow JI, et al:
Fertil Steril; 2007; 87 (June): 1340-1344

Objective: To determine the effect of female age on pregnancy rates after vasectomy reversal. Design: Retrospective review of men undergoing vasectomy reversal performed by 3 urologic surgeons. Female partners were stratified by age. Participants: 294 men who underwent vasectomy reversal were included. Twenty-one of these men had a female partner aged 20 to 24 years, 80 had a partner aged 25 to 29 years, 117 had a partner 30 to 34 years, 62 had a partner 35 to 39 years old, and 14 of the men had a female partner >=40 years of age. Methods: Microscopic vasovasostomy or vasoepididymostomy was performed under general anesthesia. Pregnancy rates were stratified into the 5 female partner age groups and then collapsed into 2 groups consisting of female partners <40 years old and those >=40 years old. The two-group t test was then performed. The minimum follow-up was 12 months unless pregnancy occurred prior to that. Results: The obstructive interval, type of reversal, mean follow-up time, and patency rates (83% to 99%) were not significantly different when stratified by female age. Pregnancy rates were 14% to 67% and were not significantly different between the 5 female age groups. Stratification into 2 groups showed pregnancy rates with a female partner >=40 years of age were 14% versus 56% for partners <40 years old (P <0.04). Conclusions: A female partner >=40 years of age was a significant factor in pregnancy rates following vasectomy reversal. Reviewer’s Comments: This paper reiterates that it is important to counsel couples about the female partner’s age when discussing vasectomy reversals. This is particularly important in view of similar results in this age group with in vitro fertilization-intracytoplasmic sperm injection and sperm aspiration. One limitation of this study was the small group of cases (n=14) with a female partner >=40 years old. (Reviewer–Ajay K. Nangia, MBBS).

 

Having a microscopic vasectomy reversal will lower the chances of getting prostate cancer. True or false?

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Answer: False-The vasectomy did not increase the chance of prostate cancer in the first place.

Vasectomy Not Associated With Prostate Cancer

Urology – February 28, 2009 – Vol. 25 – No. 04

There is no association between prostate cancer and age at vasectomy or years since vasectomy.

Article Reviewed: Vasectomy and the Risk of Prostate Cancer. Holt SK, Salinas CA, Stanford JL: J Urol; 2008;180 (December): 2565-2568.

Background: The majority of the literature now has shown no association between vasectomy and prostate cancer. The effect of vasectomy on men with a family history of prostate cancer or on those who underwent a vasectomy at a young age or had an extended period of time since the procedure has been poorly studied due to small sample sizes and short study follow-up.

Objective: To assess the risk of prostate cancer in men by age and length of time to exposure from vasectomy to disease.

Design: Population-based, prostate cancer case-controlled study.

Participants: 1327 men aged 35 to 74 years residing in King County, Washington, with a diagnosis of prostate cancer.

Methods: Cases of prostate cancer were identified from the SEER database for this population. Structured in-person interviews were conducted. Eligible controls were identified by random digit telephone dialing. Analysis based on prostate cancer Gleason score and stage was performed. Analysis was also performed based on demographics, age, prostate cancer screening history (within the last 5 years), family history of prostate cancer, and vasectomy parameters.

Results: 1327 men were eligible for study from the SEER database; 1001 completed the personal questionnaire. In total, 1340 controls were identified, of which 942 were interviewed. The control population showed that men who had undergone vasectomy were older, white, married, non-smokers with higher income and education, and had undergone PSA screening. Of men with prostate cancer and controls, 36% had undergone a vasectomy. Mean number of years since vasectomy in cases and controls was 21.1 years. No significant association was seen between prostate cancer and vasectomy status, age at vasectomy, years since vasectomy, or year of vasectomy. There was no evidence of risk estimates across vasectomy parameters. Risk did not change if men with prostate cancer within 2 years of vasectomy and controls with no PSA screening within 5 years (n=136) were excluded.

Conclusions:

No association was found between prostate cancer and vasectomy, even in men who had a vasectomy performed at a young age or had an extended period of time since vasectomy.

Reviewer’s Comments: This paper is a well-conducted, large case-control study that answers the concern about possible limitations of previous work that reported the lack of association between prostate cancer and vasectomy. This criticism often indicated inadequate follow-up since vasectomy to make this claim. In this study, average time since vasectomy in cases of prostate cancer and controls was 21 years. Multiple variables were looked at including vasectomy in the face of prostate cancer family history and screening. This large study should end the criticism on previous work that did not answer the question of prostate cancer and time from vasectomy. (Reviewer–Ajay K. Nangia, MBBS).