Vasectomy reversal in China during the recent decade: insights from a multicenter retrospective investigation / 亚洲男科学杂志(英文版)

To date, there is little information about the demography of vasectomy reversal (VR) patients or the factors currently influencing VR effectiveness in China, especially after the universal two-child policy was released in 2015. In this research, demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China. Meanwhile, a telephone survey of the patients was conducted to collect follow-up information. Eventually, 448 VR cases from the past 13 years were included. The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate. Appropriately statistical methods were used, and all of the protocols were approved by the Ethics Committees of the institutes in this research. The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented. Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate. A follow-up survey showed that the general postoperative pregnancy rate was 27.2%. For female partners over the age of 35 years, the postoperative pregnancy rate showed a more severe decline, but only 35.5% of them had been given a fertility examination before their husbands' VR surgery. Our work revealed that more patients in China have been demanding VR in recent years. High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR. Clinical andrologists should perform a preoperative fertility evaluation of the patients' female partners.

Vasectomy reversal: A clinical update / 亚洲男科学杂志(英文版)

Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.

Recovery of spermatogenesis following testosterone replacement therapy or anabolic-androgenic steroid use / 亚洲男科学杂志(英文版)

The use of testosterone replacement therapy (TRT) for hypogonadism continues to rise, particularly in younger men who may wish to remain fertile. Concurrently, awareness of a more pervasive use of anabolic-androgenic steroids (AAS) within the general population has been appreciated. Both TRT and AAS can suppress the hypothalamic-pituitary-gonadal (HPG) axis resulting in diminution of spermatogenesis. Therefore, it is important that clinicians recognize previous TRT or AAS use in patients presenting for infertility treatment. Cessation of TRT or AAS use may result in spontaneous recovery of normal spermatogenesis in a reasonable number of patients if allowed sufficient time for recovery. However, some patients may not recover normal spermatogenesis or tolerate waiting for spontaneous recovery. In such cases, clinicians must be aware of the pathophysiologic derangements of the HPG axis related to TRT or AAS use and the pharmacologic agents available to reverse them. The available agents include injectable gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors, but their off-label use is poorly described in the literature, potentially creating a knowledge gap for the clinician. Reviewing their use clinically for the treatment of hypogonadotropic hypogonadism and other HPG axis abnormalities can familiarize the clinician with the manner in which they can be used to recover spermatogenesis after TRT or AAS use.

An overview of the management of post-vasectomy pain syndrome / 亚洲男科学杂志(英文版)

Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.

Vasovasostomía microquirúrgica posvasectomía: una técnica efectiva y segura / Microsurgical postvasectomy vaso-vasostomy: an effective and safe technique

Introducción: La vasectomía es un procedimiento quirúrgico electivo que pretende obstruir o eliminar un segmento de ambos vasos deferentes. Es actualmente la causa más frecuente de azoospermia obstructiva. Se estima que hasta el 6 por ciento de los hombres que se han sometido a ella desean que sea revertida1. El objetivo del estudio fue presentar una serie de vasovasostomías (VV), y demostrar que constituye una técnica microquirúgica efectiva y segura. Material y métodos: Se han revisado 18 casos de VV practicadas en pacientes con vasectomía previa. Todas estas cirugías fueron realizadas por el mismo cirujano en un periodo de un año. Se registraron datos clínicos preoperatorios relevantes, así como datos del intra y posoperatorio. Se evaluaron los desenlaces con parámetros estándar y validados para esos efectos. Resultados: El seguimiento medio fue de 12 meses (rango 8-17). La edad media de los pacientes fue de 44,5 años (37-56); la edad media de la pareja fue de 30 años (24-43); el tiempo desde la vasectomía8 años (2-21) y la media de hijos previos fue del 2,1 (1-4). En el primer control de espermiograma alos 3 meses de la intervención, 16 de los 17 pacientes presentaron espermios en el recuento (94 por ciento).La concentración media de espermatozoides fue de 25x10

Introduction: Vasectomy is an elective surgical procedure, which aims to obstruct or to eliminate a segment of both vas deferens. It is currently considered the most frequent cause of obstructive azoospermia. It is estimated that up to 6 percent of male who have undergone one, is seeking to have it reversed (1). The target of this study is to present a series of vasovasostomy (VV), and to prove it as an effective and secure microsurgical technique. Material and methods: 18 VV cases of patients with a previous vasectomy have been revised. The same surgeon practiced all surgeries during one year. Relevant clinic data, pre-operatory as well as intra and post operatory, were registered. The outcomes were assessed with standard and validated parameters. Results: The average follow up was 12 months (range 8-17). The patients’ average age was 44,5years (37-56); their partners’ average age was 30 years (24-43); time since vasectomy was 8 years (2-21) and the mean of previous children was 2,1 (1-4). 16 out of 17 patients (94 percent) had sperm in the ejaculate at 3 months following the procedure with a mean sperm concentration of 25x10

Correlation Between Histological Changes of Human Testis after and Fertility after Subsequent Vasectomy Reversal Vasectomy / 대한비뇨기과학회지

The aim of this study is to determine the correlation between any histological changes in the human testis after vasectomy and fertility after subsequent vasectomy reversal. A sample of 21 previous fertile, vasectomized, healthy volunteers with a mean age 35 years( range, 29 to 47) underwent open, unilateral testicular biopsy at the time of vasectomy reversal. The mean duration of obstruction was 3.8 years(range, 1 to 12). The vasovasostomy was performed by means of same technique. The qualitative and morphometric quantitative analysis were performed for the data obtained. Vasal patency was determined by the presence of sperm in the postoperative semen analysis in 18 patients. Pregnancy occurred in 9 of 18 couples( 50%). Statistical analysis was performed to compare the morphological findings in both fertile and infertile patients. No significant correlation was observed between the histologic changes and fertility in two groups. Similarily there was no significant correlation between the obstructive interval. We concluded that morphologic changes occurred in the human testis after vasectomy does not affect the fertility rate after successful vasectomy reversal.

Antisperm Antibody Detection by Immunobead Test (IBT) after Vasectomy Reversal: A Preliminary Study / 대한비뇨기과학회지

A group of 32 men, who had undergone vasectomy reversal and had been infertile for at least 1 year in spite of normal semen characteristics, were tested with direct immunobead test ( IBT) for immunoglobulin (Ig) A and IgG antisperm antibodies bound to sperm surface. A test was positive if 50 % of the motile sperm had 2 attached beads. The overall positive rate of antisperm antibodies was 25% (8/32) and the positive rate of direct test for IgA and IgG antisperm antibodies was as follows: for IgA 12.5% ( 4/32) and IgG 25% (8/32). Of the 8 IBT positive patients, IgG antisperm antibodies were present in all patients with positive direct IBT. So it was suggested that presence of localized IgG antisperm antibodies made a important role in infertility after vasectomy reversal. The majority of IgA and IgG binding was directed to the head and entire sperm surface with a minor incidence to the tail. Clinical definition of direct IBT results and exact role of antisperm antibodies need to be developed in conjunction with future fertility rates of IBT positive patients.