Tag Archives: john mchugh md

What does the vasectomy site look like when removed at a microscopic vasectomy reversal?

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If you look at the top right picture you’ll notice that the method used for this vasectomy was a clip. You’ll also notice that the vas to the left of the clip is larger in diameter than the vas extending below the clip. This is because the larger diameter vas is coming from the testicle and is always larger to the pressure of the sperm produced. This is the area of the vas at the time  of the reversal where fluid is checked for its character and the presence or absence of sperm or sperm parts. When the testicular end is cut you almost always see fluid emanate promptly.

This back pressure is what is felt to be responsible for post vasectomy pain syndrome. I have postulated in a previous post that the inflammatory changes around the spot of the vasectomy could also contribute to this syndrome and the pain.

Although not all urological microscopic surgeon remove the entire vasectomy site, I always do. I feel it is cleaner and may help with any pre-reversal symptom issues related to this area of healing/inflammation associated with the vasectomy.

Post Vasectomy Pain Syndrome. Real? Will a vasectomy reversal help?

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Can There Be Complete Resolution of Pain for Men With PVPS?

One of the most complimentary letters I have ever received was from a patient on whom I performed a vasectomy reversal for relief of  chronic testicular pain which started after his vasectomy years previously. Go figure!

Urology – June 15, 2016 – Vol. 34 – No. 3

A subset of men have complete resolution of postvasectomy pain with vasectomy reversal. Most men have some improvement in pain scores with vasectomy reversal.

Article Reviewed: Vasectomy Reversal for Postvasectomy Pain Syndrome: A Study and Literature Review. Polackwich AS, Tadros NN, et al: Urology; 2015;86 (August): 269-272.

Background: Vasectomy is a common and effective procedure for sterility. Although complications are infrequent, postvasectomy pain syndrome (PVPS) does occur in some subset of patients. Most previous studies report that men who have PVPS do not generally seek additional medical treatment and have minimal affect on quality of life. However, a small subset has pain significant enough to require additional care and procedures.

Objective: To determine outcomes of vasectomy reversal (VR) for PVPS.

Design: Retrospective chart review.

Methods: A single surgeon series was reviewed for men who underwent VR for PVPS. Although there was not an algorithmic approach to preoperative pain management, patients were only considered for VR if they had worsening of pain with ejaculation or arousal. The location of vasectomy site along the vas deferens was recorded at time of the procedure in the operative note. Pain scores were evaluated with a non-validated questionnaire by recall.

Results: 31 patients from a pool of 123 potential patients were included. There was a 59% improvement in pain scores, with 34% of patients reporting a complete resolution of pain. Two patients required additional procedures for pain (epididymectomy and orchiectomy), and 84% of patients would recommend VR to a man with PVPS. There was no relationship between location of vasectomy and possibility of PVPS.

Conclusions: VR for PVPS demonstrated significant improvements in pain scores in this study.

Reviewer’s Comments: Although the questionnaire is non-validated and the pain scores are by recall, the fact that men generally reported an improvement in pain scores with VR is reassuring. As roughly one-third of men had total resolution of pain, there is likely an etiology of vasal obstruction leading to pain among these men. I have always wondered if some of the cases captured in studies looking at PVPS are really just the background of orchalgia in the population that we now attribute to the previous vasectomy. Considering how few men seek medical attention and undergo procedures for PVPS, I have always believed there is likely a group of men who have intermittent scrotal pain and a group who clearly have pain from vasectomy-induced obstruction. In their comments, the authors observe how patients seemed to group into complete (or almost complete) resolution of pain or minimal change in pain. As the authors were thoughtful by only considering men for reversal if they had pain with ejaculation or sexual stimulation, one would hope that this would only select men who truly have an obstruction-induced pain syndrome. This is a nice addition to the literature and does point out that there are some men who fully respond to reversal for PVPS. These men, however, may be difficult to identify preoperatively.(Reviewer–Charles Welliver, MD).

 

Tubal ligation vs. Vasectomy-which is more common?

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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.

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.

Continue reading Tubal ligation vs. Vasectomy-which is more common?

Vasectomy Reversal Better With Same Partner as Prior to Vasectomy-Georgia Vasectomy Reversal

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If nothing else…this article is interesting. Although the most common cause of desiring a vasectomy reversal is a male who has had children and a vasectomy has remarried someone with no children. This study showed that %17 of the time a reversal is desired by a couple who have had a vasectomy and now desire more children. Their success rate is higher than if the male remarries and has a reversal.

Vasectomy Reversal Better With Same Partner as Prior to Vasectomy 

Urology – July 30, 2015 – Vol. 32 – No. 12

Vasectomy reversal success in regard to clinical pregnancy is improved if the patient has the same partner before and after vasectomy.

Article Reviewed: Higher Outcomes of Vasectomy Reversal in Men With the Same Female Partner as Before Vasectomy. Ostrowski KA, Polackwich AS, et al: J Urol; 2015;193 (January): 245-247.

Background: Vasectomy reversal is requested by around 6% of men who previously had undergone a vasectomy and desire subsequent fertility. Frequently, this is due to a new relationship; however, some couples desire another child or may have lost a child. Two small prior studies have suggested improved pregnancy rates following vasectomy reversal with the same partner as before vasectomy.

Objective: To determine if clinical pregnancy and birth rates are higher for men undergoing vasectomy reversal with the same female partner.

Design: Retrospective review of a prospectively collected database.

Methods: All patients from a single surgeon were reviewed from 1978 to 2011. Obstructive interval, surgery type, vasal fluid character, and sperm character were recorded. Men either self-reported pregnancy and birth rates or completed a survey response. All patients had at least 12 months of follow-up data.

Results: Over the time frame, 3135 men underwent vasectomy reversal; 17% (524 men) undergoing vasectomy reversal had the same female partner. A total of 258 (49%) responded to the survey, and 89% (229) underwent bilateral vasectomy reversal. The average patient and partner age was significantly higher in the same partner group compared to the new partner group, although the same partner group had a significantly shorter obstructive interval at 5.65 years versus 9.23 years. Overall, the clinical pregnancy rate for men with the same partner was 83% compared with 60% in men with a new partner. After regression, this maintained an odds ratio of 2 and was significant.

Conclusions: Men undergoing vasectomy reversal with the same partner experience a higher pregnancy rate compared men with a new partner.

Reviewer’s Comments: This article supports prior articles by Kolettis et al and Goldstein et al. The larger number of patients provides an excellent dataset even though it is a single surgeon. The success rates are substantially higher and maintain significance, even after controlling for ages and obstructive interval. It is also useful to have typical data of a 60% pregnancy rate for those with a new partner. Many patients are interested in “success” following surgery, and this is not solely a desire to have sperm return to the ejaculate. There are limitations, however, because the survey results were returned by only 49% of patients, leaving the potential for reporting bias. Overall, this information is useful when counseling patients with the same partner as prior to vasectomy.(Reviewer–Gregory Lowe, MD).

 

Author: Ostrowski KA, Polackwich AS, et al
Author Email: hedgesja@ohsu.edu

The most cost effective vasectomy reversal in Georgia.

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Cost-Effectiveness Analysis of Vasovasostomy Techniques

Urology – September 30, 2016 – Vol. 34 – No. 7

The authors found decreased costs without compromises to surgical outcomes with the modified 1-layer vasovasostomy technique.

Article Reviewed: Comparative Cost-Effectiveness Analysis of Modified 1-Layer Versus Formal 2-Layer Vasovasostomy Technique. Nyame YA, Babbar P, et al: J Urol; 2016;195 (February): 434-438.

Continue reading The most cost effective vasectomy reversal in Georgia.

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