Crosnoe L.E.,Alcoa |
Kim E.D.,Alcoa |
Perkins A.R.,Arizona Andrology Laboratory and Cryobank |
Marks M.B.,Arizona Andrology Laboratory and Cryobank |
And 6 more authors.
Fertility and Sterility | Year: 2014
Objective To describe the technique and results of bilateral vasovasostomy using a 3-mm vas cutting forceps angled at 15 (catalog no. NHF-3.15; ASSI) for vasal transection. Design Retrospective chart review. Institutional review board approval was granted by Western Institutional Review Board. Setting Single vasectomy reversal center. Patient(s) Men who underwent a bilateral vasovasostomy at a single institution by a single surgeon between 2001 and 2012 and had a minimum of one semen analysis postoperatively or a reported natural conception. Intervention(s) Before September 14, 2010, a straight-edge vas cutter was used on all vasovasostomy connections; 375 men received a bilateral vasovasostomy and met follow-up criteria. Beginning on September 14, 2010, an angled cutter was used on all vasovasostomy patients, with 194 men meeting the exclusion criteria. Main Outcome Measure(s) A minimum of 1 × 10 6 sperm reported on a postoperative semen analysis, or a reported natural conception was used to establish patency. Result(s) The overall vasovasostomy patency rate using the angled vas cutter was 99.5% and was 95.7% using the straight vas cutter. Conclusion(s) The development of an angled vas cutter provides an increased surface area for vasal wound healing to allow for larger tissue diameter for better healing, resulting in high patency rates after vasovasostomy. © 2014 American Society for Reproductive Medicine, Published by Elsevier Inc.
Ramasamy R.,Baylor College of Medicine |
Mata D.A.,Harvard University |
Jain L.,Baylor College of Medicine |
Perkins A.R.,International Center for Vasectomy Reversal |
And 2 more authors.
Andrology | Year: 2015
We evaluated pre-operative and intraoperative factors associated with successful patency following bilateral microsurgical vasovasostomy (VV). We retrospectively reviewed the charts of 1331 men who underwent bilateral VV by two surgeons between 2006 and 2013. Vasal fluid was examined intraoperatively for gross quality (i.e., clear or opaque and creamy/thick) and for the presence of spermatozoa on microscopy (i.e., whole spermatozoa, sperm fragments, or azoospermia). Post-operative patency was assessed by semen analysis or patient report of conception. Perioperative factors were explored using descriptive statistics and examined in logistic regression models for associations with post-operative patency. The median age at VV was 39 years [interquartile range (IQR): 35-44] and the median obstructive interval (OI) was 7 years (IQR: 4-11). Overall, 1307 patients achieved post-operative patency (98%) while 24 remained obstructed (2%). Among those who became patent, 410 reported conception. After adjustment for potential confounders, only microscopic examination of the intravasal fluid for the presence of spermatozoa (bilateral or unilateral whole spermatozoa vs. sperm parts/azoospermia) at the time of VV was significantly associated with post-operative patency with an odds ratio (OR) of 14.2 (95% CI: 5.8-34.9; p = <1 × 10-8). Identification of bilateral or unilateral sperm fragments vs. azoospermia was also associated with increased odds of post-operative patency with an OR of 3.5 (95% CI: 0.9-13.6; p = 0.08). There was no statistically significant association between age at VV, OI, presence of granuloma, gross fluid quality, or surgeon and post-operative patency after controlling for potential confounders. Identification of whole spermatozoa in the vasal fluid at the time of VV was positively associated with post-operative patency. Our findings stress the need for intraoperative microscopy to aid in post-operative patient counseling. © 2015 American Society of Andrology and European Academy of Andrology.
Mui P.,The Turek Clinic |
Perkins A.,International Center for Vasectomy Reversal |
Burrows P.J.,International Center for Vasectomy Reversal |
Marks S.F.,International Center for Vasectomy Reversal |
Turek P.J.,The Turek Clinic
Andrology | Year: 2014
Vasectomy reversal involves either vasovasostomy (VV) or epididymovasostomy (EV), and rates of epididymal obstruction and EV increase with time after vasectomy. However, as older vasectomies may not require EV for successful reversal, we hypothesized that sperm production falls after vasectomy and can protect the system from epididymal blowout. Our objective was to define how the need for EV at reversal changes with time after vasectomy through a retrospective review of consecutive reversals performed by three surgeons over a 10-year period. Vasovasotomy was performed with Silber score 1-3 vasal fluid. EVs were performed with Silber score 4 (sperm fragments; creamy fluid) or 5 (sperm absence) fluid. Reversal procedure type was correlated with vasectomy and patient age. Post-operative patency rates, total spermatozoa and motile sperm counts in younger (<15 years) and older (>15 years) vasectomies were assessed. Simple descriptive statistics determined outcome relevance. Among 1229 patients, 406 had either unilateral (n = 252) or bilateral EV's (n = 154) constituting 33% (406/1229) of reversals. Mean patient age was 41.4±7 years (range 22-72). Median vasectomy interval was 10 years (range 1-38). Overall sperm patency rate after reversal was 84%. The rate of unilateral (EV/VV) or bilateral EV increased linearly in vasectomy intervals of 1-22 years at 3% per year, but plateaued at 72% in vasectomy intervals of 24-38 years. Sperm counts were maintained with increasing time after vasectomy, but motile sperm counts decreased significantly (p < 0.001). Pregnancy, secondary azoospermia, varicocoele and sperm granuloma were not assessed. In conclusion, and contrary to conventional thinking, the need for EV at reversal increases with time after vasectomy, but this relationship is not linear. EV rates plateau 22 years after vasectomy, suggesting that protective mechanisms ameliorate epididymal 'blowout'. Upon reversal, sperm output is maintained with time after vasectomy, but motile sperm counts decrease linearly, suggesting epididymal dysfunction influences semen quality after reversal. © 2013 The Authors Andrology published by John Wiley & Sons Ltd on behalf of American Society of Andrology.