Microsurgical vasovasostomy: An option for men with post vasectomy psychological distress

Vasectomy is a practical and straightforward approach to birth control. This paper presented a 31-year-old patient who desired to restore his fertility five years after being vasectomized. He met several obstacles. He developed severe psychological distress with symptoms of stress, anxiety, and aggression. He underwent microsurgical vasovasostomy, and vassal patency was confirmed by return of spermatozoa in semen samples 6 and 10 weeks after surgery, and symptoms of psychological distress disappeared. Preoperative vasectomy counseling should include information about vasectomy reversal. At the most, vasectomy reversal can be considered in selected men with psychological problems due to vasectomy. Microsurgical training should be offered to more urological surgeons, especially those who are interested in andrology.

Predictors of success after bilateral epididymovasostomy performed during vasectomy reversal: A multi-institutional analysis

Introduction: Vasectomy reversal (VR) represents an excellent option for paternity in men who desire to expand their family following vasectomy. Traditional VR via vasovasostomy has a success rate upwards of 90%1,2 but when sperm or sperm parts are not present in vasal fluid, epididymovasostomy (EV) must be performed instead. Our objective was to determine which factors influence success after bilateral EV. Methods: A prospectively maintained database with data from the U.S. and Canada was used to identify men who underwent bilateral EV at time of VR. Success was defined as motile sperm in any postoperative semen analyses. Multivariable logistic regression was used to identify predictors of success. Results: A total of 200 men had at least one postoperative semen analysis, and 171 men were included in the analysis. Average age was 44.7 years, with average followup of seven months. Median time elapsed between vasectomy and EV was 15 years (interquartile ramge [IQR] 10–18). Overall success rate was 50%. Despite the study being adequately powered, factors such as years since vasectomy (odds ratio [OR] 1.01, confidence interval [CI] 0.95–1.06), age (OR 0.96, 0.91–1.01), intraoperative presence of motile sperm (OR 0.81, CI 0.41–1.62), and epidydimal fluid characteristics did not predict success. Conclusions: Bilateral EV at time of VR is successful in 50% of cases in a multi-institutional, North American cohort. Microsurgeons can be reassured that neither time elapsed nor epididymal fluid characteristics negatively impact success rates as long as sperm or sperm parts are present. Surgeons performing VR should be comfortable and prepared to perform EV if indicated.

Outcomes of Macrosurgical Versus Microsurgical Vasovasostomy in Vasectomized Men: a Systematic Review and Meta-analysis

In order to restore fertility by vasectomy reversal, vasovasostomy (VV) is one of the most chosen options. During this procedure, the vas deferens is anastomosed either by a macro- or microscopical technique. Up to date, it is unknown which of these techniques shows best overall post-procedure patency and pregnancy rates. The purpose of this systematic review and meta-analysis is to reach a consensus on which technique is best for vasovasostomy and thereby better counsel patients and practitioners. A systematic review and meta-analysis on macroscopic and microscopic VV for vasectomy reversal was performed. PubMed, The Cochrane Library, Embase, and Web of Science were systematically searched from inception until 2019. Studies and associated data were evaluated by two reviewers. Primary, data on post-operative patency and pregnancy rates, interval to reversal, and post-operative complications were extracted. Proportions (95% CI) and heterogeneity scores (I2) were calculated, using a random effects model. A total of 8305 patients were included by 25 studies. Descriptive analysis showed higher post-operative patency (80.5% vs 91.4%) and pregnancy rates (47.7% vs 73.3%) after microscopic vasovasostomy. Meta-analysis produced post-operative patency proportions of 0.80 (95% CI, 0.76–0.84) and 0.88 (95% CI, 0.83–0.92) after macro- and microscopic VV respectively. Proportions of post-operative pregnancy were 0.43 (95% CI, 0.35–0.50) after macroscopic VV and 0.47 (95% CI, 0.31–0.62) after microsurgical VV. Microscopic VV is associated with higher post-operative patency and pregnancy rates compared to macroscopic vasovasostomy. However, further research is needed because of shortage in high methodological quality and variety.