Vasectomy reversal scientific article of the month - September 2008
Kolettis, PN, Burns, JR, Nangia, AK, Sandlow, JI: Outcomes for vasovasostomy performed when only sperm parts are present in vassal fluid. J Androl 27(4), July/August 2006.
Brief article summary and discussion by Dr. Jeffrey Buch, website editor (permission to publish abstract not granted):
This is a multicenter study that accumulated 34 patients who underwent bilateral (31) or unilateral (3) microsurgical vasovasostomy with either sperm parts bilaterally, or with sperm parts on one side and intravasal absence of any sperm or parts on the other side. Two of these procedures were repeat reversals that had previously failed. Sperm returned to the ejaculate post operatively in 76% of cases with an average interval of obstruction at 10 years. The authors conclude that any finding better than an occasional sperm head in the intravasal fluid at time of reversal should result in performing a bilateral microsurgical vasovasostomy.
Educational comments by Dr. Jeffrey Buch, website editor:
When an accomplished microsurgeon performs bilateral microsurgical vasovasostomy
for the finding of complete sperm in the intravasal fluid on both sides at time of reversal, the patency rates exceed 95% and often approach 98%. When such surgeons perform bilateral epididymovasostomy for the finding of sperm part only in the intravasal fluid at time of reversal, the patency rates exceed 80% and approach 85%. This editor is an accomplished microsurgeon who questions the diligence that the above authors used in searching for fully formed sperm in the intravasal fluid at time of reversal. The editor has personally found that it takes patience in "milking" the vas fluid over a period of 5-10 minutes during the reversal surgery in cases with initially sperm parts only until finally a third check may reveal the occasional fully formed sperm which indicates proper reversal type to be a vasovasostomy. In such cases, with each successive check, the surgeon sees occasional sperm with increasing tail lengths on each successive check, until finally a full tailed sperm is noted.
Furthermore, intraoperative examination of the epididymis adds minimal extra time to the procedure, and can reinforce the surgeon's decision to opt for either vasovasostomy or epididymovasostomy depending on presence or absence of visually recognizable areas of epididymis obstruction. Using the above techniques and decision making algorithm, this editor estimates that the patency rate in this study could have been improved from 76% to greater than 90%. Current average patency rates for this editor with patients who are 10 years removed from time of vasectomy to time of reversal are approximately 98% (Jeffrey P. Buch, MD, unpublished data). In conclusion, not only technical expertise but the experience and judgment of the microsurgeon performing the vasectomy reversal can ultimately affect your vasectomy reversal success rate.