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PubMed2003

Microsurgical vasovasostomy after failed vasovasostomy.

PURPOSE: We analyzed our experience with repeat microsurgical vasovasostomy after failed vasovasostomy and elucidate the possible predictors of surgical outcome. MATERIALS AND METHODS: We evaluated 62 repeat vasectomy reversal cases with followup data available. Regardless of the intraoperative observation of sperm in the vasal fluid bilateral microsurgical 2-layer vasovasostomy was performed when surgically possible. Of these 62 patients 60 (97%) underwent bilateral (58) or unilateral (2) vasovasostomy and 2 (3%) underwent unilateral vasovasostomy with contralateral epididymovasostomy. RESULTS: Patency and pregnancy followup data were available on 62 and 42 patients, respectively. The overall patency and pregnancy rates achieved were 92% and 57%, respectively, and the natural birth rate was 52%. Increased age of the wife proved a negative prognostic factor for pregnancy (p = 0.018). The intraoperative detection of sperm and other factors, including obstructive interval, reconstruction type, anastomotic site, patient age and postoperative semen parameters, did not influence the surgical outcome. CONCLUSIONS: Regardless of the detection of sperm in the intravasal fluid during the operation repeat microsurgical vasovasostomy resulted in a better outcome than in other studies, in which adopted epididymovasostomy was done when sperm was absent from the vas fluid. Our study suggests that compromised anastomosis after previous surgery is the most common cause of failed vasovasostomy. We recommend that microsurgical vasovasostomy should be performed preferentially in failed vasovasostomy cases.

Adult↗
PubMed2004

Toward a sutureless vasovasostomy: use of biomaterials and surgical sealants in a rodent vasovasostomy model.

PURPOSE: With 500,000 to 800,000 vasectomies performed annually and a reversal rate of 3% to 8% vasectomy reversal has become a commonly performed procedure. Two-layer microsurgical vasovasostomy remains the gold standard for surgical reconstruction of the vas. However, this procedure is technically demanding and time-consuming. We determined the ability of biomaterials and surgical sealants to decrease the number of sutures used, enhance anastomosis watertightness and decrease operative time. MATERIALS AND METHODS: Adult male Wistar rats underwent vasectomy 2 weeks prior to vasovasostomy. Standard 2-layer microsurgical repair was performed in control animals. Experimental groups underwent 3-suture mucosal approximation and then completion of the anastomosis with a biomaterial membrane and/or synthetic sealant. The rats were sacrificed 9 weeks after vasovasostomy. Anastomotic patency was assessed functionally by the presence of motile sperm in the vas distal to the testes and anastomosis, and mechanically by methylene blue vasogram. The presence and size of sperm granulomas were also recorded. RESULTS: Microsurgical vasovasostomy required significantly less time when biomaterial (42.7 minutes) or sealant (40 minutes) was used compared to the standard sutured group (102.5 minutes, each p < 0.001). There was no difference in patency between the standard sutured and biomaterial groups (90% vs 92%). Patency was significantly lower in the sealant groups, that is 70% in the suture, biomaterial and sealant group, and 75% in the suture and sealant group. The biomaterial group had only 1 sperm granuloma in 12 procedures, which was significantly better than the 7 in the control group (p <0.001). CONCLUSIONS: Using a biomaterial wrap during vasovasostomy resulted in significantly decreased operative time and fewer sperm granulomas than in the control group. Sealants were not effective. Biomaterial wrap may support vasovasostomy and by decreasing leakage improve the outcome.

Animals↗
PubMed1976

Vasectomy and vasovasostomy. II. A comparison of two methods of vasovasostomy: silastic versus chromic stents.

Twelve adult, bilaterally vasectomized dogs were used to compare two different procedures for reuniting the severed vas deferens. Approximately 5 months postvasectomy six dogs had vasovasostomies utilizing Silastic stents and the vasa deferentia of six additional dogs were rejoined with intravasal chromic stents. Ejaculates were subsequently obtained at 2-week intervals and evaluated for sperm count, motility, viability, and seminal ion concentrations. All of the dogs in which Silastic had been utilized as the stent had sperm reappear in the ejaculate, whereas only 40% of the dogs in which chromic catgut had been utilized had reappearance of spermatozoa. The over-all quality of the ejaculate was also better in the animals in which Silastic had been utilized. Testicular and epididymal histology was normal in most dogs of both groups, but three of the dogs with chromic stents in which the anastomosis had not been a success had abnormal histology, with reduced numbers of spermatocytes, spermatids, and spermatozoa. The data suggest that Silastic stents are better than chromic stents for vas reanastomosis. They also suggest that some dog testes react negatively to vasectomy and do not recover by 1 year postvasectomy when vas patency is not reversed.

Animals↗
PubMed2004

Robotic microsurgical vasovasostomy and vasoepididymostomy: a prospective randomized study in a rat model.

PURPOSE: Microsurgical vasovasostomy and vasoepididymostomy remain technically challenging procedures. Refinements in technique have continually improved patency and pregnancy rates for the 2 procedures in experienced hands. Advances in surgical robotics produced the Da Vinci robot (Intuitive Surgical, Inc., Sunnyvale, California) with motion reduction and no tremor, features that may improve outcomes in microsurgery. We report a randomized prospective study of vasoepididymostomy and vasovasostomy using the Da Vinci robot in rats. MATERIALS AND METHODS: A total of 24 adult male Wistar rats underwent vasectomy through a midline abdominal incision. Two weeks later the animals were randomized to microsurgical multilayer vasovasostomy, longitudinal vasoepididymostomy or robotic vasovasostomy and vasoepididymostomy groups. Outcomes measured included surgical time, complications, patency and sperm granuloma formation at 9 weeks. RESULTS: Animals were sacrificed 9 weeks after microsurgery. There were no significant differences in complications among the groups. Robotic vasovasostomy was significantly faster than the conventional microsurgical technique (68.5 vs 102.5 minutes, p = 0.002). The robotic and microsurgical vasoepididymostomy groups did not differ significantly in time. Patency rates were 100% for the robotic vasovasostomy and vasoepididymostomy groups, and 90% in the microsurgical vasovasostomy and vasoepididymostomy groups. These differences were not significant. Sperm granulomas were found in 70% of microsurgical vasovasostomy anastomoses and 27% of robotic vasovasostomy anastomoses (p = 0.001). No significant difference in the sperm granuloma rate was found between the robotic or microsurgical vasoepididymostomy groups (42% and 50%, respectively, p = 0.37). CONCLUSIONS: To our knowledge we report the first randomized prospective study using the Da Vinci robot for microsurgery. We believe that the improved stability and motion reduction during microsurgical suturing with the robot helped achieve excellent patency rates for vasovasostomy and vasoepididymostomy. The robot may also allow experienced microsurgeons to perform microsurgical procedures in patients at remote locations where no experienced microsurgeons are available.

Animals↗
PubMed2000

Population-based outcomes after 28,246 in-hospital vasectomies and 1,902 vasovasostomies in Western Australia.

OBJECTIVES: To examine trends in vasectomy and vasovasostomy, and the surgical complications and factors associated with reversal after vasectomy, and paternity after vasovasostomy. PATIENTS AND METHODS: Procedure rates were estimated from 1980 to 1996 in the population of Western Australia. Linked hospital morbidity records were used in the follow-up of men after vasectomy to estimate the risks of complications and reversals. Records of vasovasostomies were linked to the paternity field on birth registrations. Independent effects of the study factors were examined using Cox regression. RESULTS: There was little net change in vasectomy rates, whereas vasovasostomy rates increased in men aged 30-49 years. Risks of surgical complications were low and decreased for vasovasostomy. At 12-15 years after vasectomy, the risk of reversal levelled at 2. 4% in the total cohort and at 11.1% in men aged 20-24 years. The risk of vasovasostomy was 69% greater after vasectomy performed in 1994-96 than in 1980-84 (P = 0.011). The factors strongly associated with reversal were age < 30 years and being single, divorced or separated at the time of vasectomy. Paternity was achieved after an estimated 53% of vasovasostomies. Successful reversal was more likely if the man was younger at vasectomy and the time elapsed was comparatively short. Compared with vasovasostomies performed in 1980-84, the success rate of those in 1994-96 was almost four times higher. CONCLUSION: Population rates of vasectomy are stable but the risk of seeking a reversal has increased. Outcomes after vasovasostomy have improved. Care should be taken during the counselling of men before vasectomy, and especially in those aged <30 years.

Adult↗
PubMed1989

The influence of vasovasostomy on antisperm antibodies in rats.

Serum antisperm antibodies were studied in Sprague-Dawley rats after vasectomy and vasovasostomy. Animals received a bilateral vasectomy, a vasectomy followed 3 mo later by vasovasostomy, or sham operations. Blood samples were obtained at 1, 3, 4, and 7 mo, and antisperm antibodies were assayed by an enzyme-linked immunosorbent assay. After vasectomy reversal was performed at 3 mo, antisperm antibodies were significantly higher in rats in the vasovasostomy group at 4 mo than in animals that had a persisting vasectomy or sham operations. At 7 mo, the antisperm antibody level for the vasovasostomy group was approximately double that for the vasectomized rats. Spermatic granulomas occurred in 76% of rats after vasovasostomy. Antisperm antibody levels were higher in vasovasostomized animals with granulomas than in those lacking granulomas. The results suggest that vasovasostomy may stimulate an antibody response to sperm rather than lead to a reduced response, as was anticipated upon removal of the obstruction. Spermatic granulomas may serve as sires for continued antigenic challenge. The observed increase in antisperm antibodies after vasovasostomy in Sprague-Dawley rats may be related to their relatively low immunologic responsiveness to vasectomy, with vasovasostomy serving as a second major immunologic challenge, aided by the formation of an additional granuloma. In the more responsive Lewis strain, we previously observed a rise in antisperm antibodies after the initial vasectomy, with no further increase after vasovasostomy.

Animals↗
PubMed1995

Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations.

PURPOSE: We evaluate the temporal parameters of patency following vasoepididymostomy and vasovasostomy. MATERIALS AND METHODS: A series of consecutive and concurrent vasoepididymostomies (100) and vasovasostomies (100) performed by a single surgeon (M. G.) was reviewed. RESULTS: Patency rates following vasoepididymostomy and vasovasostomy were 65% and 99%, respectively (p < 0.001). Motile sperm were observed at a mean of 5.8 +/- 0.8 months (standard error) following vasoepididymostomy and 2.1 +/- 0.2 months following vasovasostomy (p < 0.01). Late failure rates were 21% for vasoepididymostomy and 12% for vasovasostomy. Pregnancy rates following vasoepididymostomy and vasovasostomy were 21% and 52%, respectively. CONCLUSIONS: Patency is rapid following vasovasostomy but requires 12 or more months following vasoepididymostomy. Intervention for azoospermia is appropriate 6 months after vasovasostomy and 1 year after vasoepididymostomy. Intraoperative cryopreservation of sperm in men undergoing vasoepididymostomy and postoperatively in all men with motile sperm will maximize fertility options.

Anastomosis, Surgical↗
PubMed1990

Vasovasostomy in dogs using the carbon dioxide milliwatt laser: Part II.

This is the second study of a two-prong investigation conducted to learn two different aspects of vasovasostomy in dog vas deferens by using the carbon dioxide milliwatt laser. This investigation involves the evaluation of patency and analysis of sperm. Six dogs underwent vasectomy, followed by vasovasostomies performed between 4 and 12 weeks later, utilizing two approximating sutures and welding with the carbon dioxide milliwatt laser. Metal clips were used both for x-ray analysis and localization of the vasovasostomy site. All dogs had pre-vasectomy semen analysis. Following vasectomy each dog underwent ejaculation until azoospermia was obtained. Vasovasostomy was performed and semen was examined. Prior to harvesting, vasography was also obtained. All ejaculates had active sperm noted and 12 of 12 vasograms (100%) revealed patency. The dogs were sacrificed at 4 weeks, 6 weeks, and 8 weeks post-vasovasostomy. The vasovasostomy specimens were studied with electron microscopy and by histological evaluation. The vasovasostomy was completed in under 90 minutes by using this laser-assisted technique. This procedure offers to the urologist a more simplified and reproducible operation that can be performed easily and with a potential decrease in hospital costs.

Anastomosis, Surgical↗
PubMed1989

Studies of polyglycolic acid hollow self-retaining vasal stent in vasovasostomy.

A simple method of vasovasostomy using a unique hollow, biflanged, hydrolyzable, self-retaining intraluminal stent made of polyglycolic acid (PGA) was evaluated in rat and dog animal models. The stented vasovasostomy was compared with a modified two-layer technique in a randomized prospective trial in rats. Twenty of 22 vasovasostomies using the 0.8890 mm and 0.9398 mm stents were patent, whereas only 4 of 22 vasovasostomies using a modified two-layer anastomosis without a stent were patent (P less than 0.01). Eight dogs underwent implantation of the absorbable vasovasostomy stent on one side and two-layer vasovasostomy on the other. Scanning electron microscopy showed superior re-epithelialization and closer return to normal morphology in the stented vasovasostomies than with the conventional two-layer technique.

Animals↗
PubMedDate not supplied

Sutureless vasovasostomy using new vascular closure staples in rats.

To evaluate the efficacy of sutureless vasovasostomy using vascular closure staples, 20 male Sprague-Dawley rats were used for the study. In each rat, a sutureless vasovasostomy using vascular closure staples was performed on a randomly selected side, and a conventional end-to-end microsutured anastomosis was performed on the opposite side. Operation time was significantly shorter for sutureless vasovasostomy using vascular staples (p < .001). Four weeks after the surgery, however, patency rate and granuloma formation were not different for conventional end-to-end vasovasostomy vs. sutureless vasovasostomy. These findings suggest that sutureless vasovasostomy is simple to perform and requires fewer special technical skills. This procedure may provide an alternative to the conventional vasovasostomy.

Animals↗
PubMed1977

Vasectomy and vasovasostomy in rhesus monkeys: the effect of circulating antisperm antibodies on fertility.

Rhesus monkeys develop agglutinating and complement-dependent antisperm antibodies after vasectomy. In order to study whether these antibodies affect fertility after vasovasostomy, 15 animals were given vasectomies and 6 months later vasovasostomies. Subsequently, each was mated with females of proven fertility. Five controls were given sham operations and similarly treated. During this period, each aimal was bled for serum to monitor the humoral immune response, ejaculated for semen analyses, and palpated for granuloma or fistula development. All control animals had a transient decrease in sperm density after sham vasectomy and vasovasostomy operations. The surgical procedures of vasectomy and subsequent vasovasostomy resulted in more animals having sperm of poor motility and quality. All of vasovasostomies were surgically successful in that sperm were again present in the ejaculate of each animal. The amount of sperm in the ejaculate could not be correlated with the ease of surgical procedure, presence or absence of macrophages in the ejaculum, motility, or forward progression. Only animals that had been vasectomized developed circulating antisperm antibodies. Sustained, elevated levels of antisperm antibodies most commonly occurred in monkeys that had high initial total sperm counts. Six of the experimental animals retained high levels of sperm-immobilizing antibodies after vasovasostomy. Of these, two were found to be infertile and two were classed as subfertile. Of the nine experimental animals without sustained antisperm antibody production, only one was classed as subfertile. This suggests that antisperm antibodies may in some cases impair the restoration of fertility after vasovasostomy.

Animals↗
PubMed1990

Carbon dioxide milliwatt laser in the vasovasostomy of vas deferens in dogs: Part I.

This is the first arm of a two prong study conducted to learn two different aspects of vasovasostomy in dog vas deferens using the milliwatt carbon dioxide laser. The first study involved the evaluation of patency without collection of sperm. Six dogs were evaluated and all underwent vasectomy and subsequently had vasovasostomies performed between 4 and 12 weeks utilizing two approximating sutures and welding with the milliwatt carbon dioxide laser. Metal clips were used for both X-ray analysis and localization of the vasovasostomy site. In this investigation a vasogram was performed. Dogs were sacrificed at 4, 6, and 8 weeks postvasovasostomy. The vasovasostomy specimens were studied with electron microscopy and histological evaluation. The vasovasostomy was completed in under 120 minutes using this laser-assisted technique and was found to be a viable and promising technique for vasovasostomy.

Animals↗
PubMed1991

Fibrin glue vasal anastomosis compared to conventional sutured vasovasostomy in the rat.

Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue ("Tisseel", Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (less than 3 mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy. The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.

Anastomosis, Surgical↗
PubMedDate not supplied

Postvasectomy alterations in protein synthesis and secretion in the rat caput epididymidis are not repaired after vasovasostomy.

Many men who have undergone vasectomy later request vasovasostomy. Unfortunately, significant numbers of these men remain infertile despite the reestablishment of patent ducts. This report examines the possibility that epididymal function remains compromised after vasovasostomy in the rat by examination of quantifiable, in vivo protein synthesis and secretion in the caput epididymidis. Rats were studied 30 days after vasectomy, 30 days after a vasovasostomy (which was performed 30 days after vasectomy), or after sham operations. Epididymal lumen fluids (LF) were collected by micropuncture after 3 hours' in vivo microperifusion of tubules with 35S-amino acids. Proteins were separated by 2-dimensional electrophoresis and were detected by Coomassie blue staining. Synthesized proteins in tubule extract and synthesized and secreted proteins in LF were detected by autoradiography and image analysis. Specific proteins that appeared to be affected by vasectomy-vasovasostomy were identified by internal sequence analysis. LF contained an average of 87 detectable proteins synthesized and secreted in the control caput. Nineteen of the most prominent LF proteins were selected for more focused study. The most prominent proteins were clusterin, cysteine-rich secretory protein (CRISP)-1, and epididymal retinoic acid-binding protein. Among these, CRISP-1 remained reduced in LF after vasovasostomy. Two more minor proteins that remained reduced after vasovasostomy were identified as prostaglandin D2 synthase and phosphatidylethanolamine-binding protein. All 3 of these proteins occur in the epididymides of multiple species and have been associated with sperm fertilizing capacity.

Animals↗
PubMed2000

Sperm function tests after vasovasostomy.

AIM: To evaluate the sperm function after vasovasostomy. METHODS: Semen samples from 42 subjects after vasovasostomy (Group A: 1-6 months, Group B: 6-12 months; Group C: 12-18 months after vasectomy reversal) were investigated. Semen from 34 normal fertile men was used as controls. Sperm function tests, including hypoosmotic swelling test (HOST), acridine orange (AO) fluorescence, acrosome reaction (triple-stain), cervical mucus penetration test (CMPT), etc were done. RESULTS: After vasectomy reversal, the percentage of HOST was significantly lower than that of the normal fertile men. In regard to AO, there were no significant differences between the three vasovasostomy groups and between these 3 groups and the controls. With triple-stain, the percentage of normal acrosome reaction was significantly lower in Group A as compared with the controls, but not in Groups B and C. There were no significant differences in the results of CMPT between the vasovasostomy groups and the controls. However, the number of "poor" type was significantly higher in Groups A and C than in the controls; the percentage of "negative" type were higher in Groups A and B than in the controls. CONCLUSION: After vasovasostomy a lower level of HOST remained for one year and gradually recovered after one year. Six months after vasectomy reversal, the percentage of acrosome reaction could be changed from lower level to normal range. The data of AO indicated that the genetic material (double-stranded DNA) in spermatozoa was not affected by vasovasostomy. To evaluate the result of CMPT after vasectomy reversal, not only the normal results but also the abnormal results ("poor" and "negative" types) should also be considered.

Adult↗
PubMed1987

The influence of vasovasostomy on testicular alterations after vasectomy in Lewis rats.

The occurrence of alterations in testicular weight and morphology after vasectomy and vasectomy reversal by vasovasostomy was studied in Lewis rats. Animals were studied 3, 4, and 7 months after bilateral vasectomy or a vasectomy followed 3 months later by vasovasostomy. Other rats served as sham-operated controls. The weights of the testes in vasectomy and vasovasostomy animals fell into two groups-small testes weighing less than 0.88 g and normal-sized testes of 1.2 g or more. When the extent of testicular alterations was estimated in sections for light microscopy by use of a semiquantitative testicular biopsy score count (TBSC), the morphology of the testes corresponded closely to the testis weight (r = .94), small testes having correspondingly low TBSC scores. In severely altered small testes, the seminiferous tubules were narrower than in sham-operated rats, and numbers of germ cells were greatly depleted. Many tubules contained only Sertoli cells and spermatogonia, although spermatocytes were present in a minority of tubules. A few seminiferous tubules contained multinucleate spermatids. Electron microscopy of severely altered tubules revealed closely apposed processes of Sertoli cells, which contained filaments, microtubules, and endoplasmic reticulum. In contrast, testes with normal weight in vasectomy and vasovasostomy groups resembled those of the sham-operated animals. Comparison of distributions of testicular biopsy score counts demonstrated differences between vasectomy and vasovasostomy groups as time after operation increased. At the 3-4-month intervals, approximately one-third of the testes were severely altered in both vasectomy and vasovasostomy groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗