[Advances in the study of vasovasostomy under the microscope].

Approximately 10－15% of the cases of male infertility worldwide are caused by obstructive azoospermia. Vasovasostomy (VV) is a gold-standard treatment of this disease, but the success rate of conventional VV remains low for failure to anastomose the vas deferens accurately. Fortunately, microscopy makes the field of vision clearer and greatly increases the success rate of vas deferens recanalization and pregnancy. VV under the microscope, including microsurgical VV, robot-assisted microsurgical VV, and laparoscope-assisted microsurgical VV, is of great importance for the treatment of male infertility. This article reviews the progress in the study of VV under the microscope.

Vasectomy and vasectomy reversal: a comprehensive approach to the evolving spectrum of care.

Male reproduction and male contraception form an important spectrum within men's health. In this issue's Views and Reviews, four author groups detail important new developments in vasectomy clinical practice guidelines, emerging and investigational techniques in the fields of hormonal and nonhormonal male contraception, useful paradigms for patient care when deciding between sperm extraction with in vitro fertilization and vasectomy reversal, and finally, a state-of-the-art overview of recent developments in vasectomy reversal microsurgery. These articles will provide readers with a contemporary understanding of the rapidly evolving spectrum of male reproductive and contraceptive health care.

Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis.

OBJECTIVE: To explore the primary options available to men who desire fertility after a vasectomy. DESIGN: Literature review. SETTING: University of Miami Miller School of Medicine. PATIENT(S): Men with a previous vasectomy now seeking fertility. INTERVENTION(S): The two main options to achieve paternity for men following vasectomy include vasectomy reversal (VR) and surgical sperm retrieval with subsequent in vitro fertilization (IVF). MAIN OUTCOME MEASURE(S): We reviewed and compared the important considerations for men deciding between these 2 options, including: obstructive interval, female partner age, antisperm antibodies, male partner age, female infertility factors, and cost. RESULT(S): Both VR and IVF represent reasonable options for the couple seeking fertility after vasectomy. Specific circumstances may favor one modality over another, depending on obstructive interval, possible female fertility factors, female partner age, male partner age, and cost. In the absence of insurance coverage, VR is often more cost-effective than IVF. Alternatively, when a female factor may contribute to infertility in addition to vasectomy, IVF is often the better choice. Antisperm antibodies are unlikely to contribute to infertility following a successful VR. CONCLUSION(S): VR or surgical sperm retrieval with IVF are reasonable options for couples seeking children after vasectomy. Pregnancy rates for both options are overall similar, so prior to pursuing either option, a thorough discussion with a reproductive urologist who possesses microsurgical skills in VR and a reproductive endocrinologist with expertise in IVF is imperative. Making a final choice through shared decision-making while considering these points is ideal.

Vasovasostomy and vasoepididymostomy: indications, operative technique, and outcomes.

The basic principles of vasal reconstruction have endured since their initial description over a century ago, yet the nuances and technical approaches have evolved. Prior to performing vasectomy reversal, the clinician should perform a focused history, physical and laboratory assessment, all of which are critical for patient counseling and preoperative planning. Operative success is contingent on appropriate intraoperative decision making and technical precision in completing a tension-free, watertight, and patent anastomosis. Outcomes of vasectomy reversal differ on the basis of the type of reconstruction required, reconstructive technique, and patient-specific factors. Here we review the indications, surgical techniques, and outcomes of vasectomy reversal.

The Utility of Sperm Cryopreservation at the Time of Vasectomy Reversal.

PURPOSE: We retrospectively evaluated the utility of sperm cryopreservation at the time of vasectomy reversal. MATERIALS AND METHODS: From April 2016 through December 2018 a total of 26 men underwent vasectomy reversal. Sperm cryopreservation is routinely offered at the time of vasectomy reversal at our institution. We sought to assess utilization of cryopreserved sperm by those men with early or late vasectomy reversal failure. RESULTS: Of 26 patients presenting for vasectomy reversal 22 (85%) elected to cryopreserve sperm. Sperm were obtained for freezing from the vasal (7 patients) or epididymal fluid (3), or via testicular biopsy (12). Three patients were lost to followup postoperatively. Of the 23 who presented for post-procedure followup 19 either had semen analyses with motile sperm or a live birth (83% success rate). There were 4 early failures and 2 late failures; all patients with failures had elected to cryopreserve sperm at the time of initial reversal. Three of the 6 individuals (50%) with vasectomy reversal failure elected to use cryopreserved sperm for in vitro fertilization/intracytoplasmic sperm injection, with 2 of these (67%) resulting in live births. CONCLUSIONS: Of those patients who experienced vasectomy reversal failure 50% elected to use cryopreserved sperm that had been procured at the time of initial reversal. Given the potential for early or late failure, cryopreservation of sperm at the time of vasectomy reversal should be routinely offered as a means of avoiding the added expense and potential morbidity of future surgical sperm retrieval.

Do assisted reproduction outcomes differ according to aetiology of obstructive azoospermia?

Azoospermia is defined as absence of spermatozoa and may be secondary to blocked seminal ducts, known as obstructive azoospermia. Semen quality may be impaired due to factors such as sperm cell DNA fragmentation and presence of antisperm antibodies. The objective of this article was to investigate potential differences in outcomes of in vitro fertilisation and intracytoplasmic sperm injection between groups with different obstruction aetiology, as well as between the use of different techniques and sperm cells of different origins. Retrospective, multi-centre analysis of 621 first cycles was carried out between 2008 and 2015: Group I, congenital obstruction, 45 patients and Group 2, vasectomy, 576 patients. Sperm cell retrieval was achieved in all cases. Results were similar for Group I and II fertilisation rates, 70% versus 66.85% (p = .786); pregnancy rates, 42.5% versus 41.46% (p = .896); and live birth rates, 29.73% versus 17.69% (p = .071). According to sperm cell origin (579 epididymal vs. 42 testicular), pregnancy rates, 41.47% versus 43.9% (p = .760); and live birth rates, 18.3% versus 27.78% (p = .163) had no difference. Fertilisation, pregnancy and live birth rates did not differ according to obstruction aetiology. Outcomes did not differ between groups according to sperm cell origin.

Microsurgical vasectomy reversal: contemporary techniques, intraoperative decision making, and surgical training for the next generation.

Men seeking fertility after elective sterilization can be treated with a wide array of interventions. Reconstruction of the reproductive tract remains the gold standard and most cost-effective option for the appropriately selected candidate. In the following review, the treatment algorithm for men desiring vasectomy reversal is outlined. Specifically, the current evidence basis for preoperative evaluation, intraoperative decision making, postsurgical management, and emerging advances to optimize outcomes will be discussed. Finally, the important role of microsurgical training and how the field can improve quality of care will be reviewed.

Reconsidering vasectomy reversal over assisted reproduction in older couples.

OBJECTIVE: To provide pregnancy and live birth rates from a contemporary series of vasectomy reversals in men with female partners aged ≥35 years and to correlate the results with IVF. SETTING: Tertiary academic referral center. DESIGN: Retrospective comparative study of prospectively collected database. PATIENT(S): Two hundred forty-six men who underwent vasectomy reversal for fertility with female partner aged ≥35 years. INTERVENTION(S): Vasovasostomy or vasoepididymostomy. MAIN OUTCOME MEASURE(S): Correlation of pregnancy and live birth rate of this cohort by age groups with most recently published pregnancy and live birth rate per IVF cycle. RESULT(S): One hundred thirty-six men who underwent vasectomy reversal between 2006 and 2014 met our inclusion criteria. Overall pregnancy and live birth rates were 35% and 30%, respectively. Subgroup analysis by female age groups (35-37, 38-40, >40 years) demonstrated pregnancy and live birth rates comparable to those per IVF cycle by age groups according to a recently published (2015) national report. CONCLUSION(S): Vasectomy reversal should be strongly considered in men with a partner aged ≤40 years. Additionally, vasectomy reversal can be considered in carefully selected patients even with a partner aged >40 years.

Vasectomy reversal semen analysis: new reference ranges predict pregnancy.

OBJECTIVE: To study the semen analysis values required to cause a pregnancy after vasectomy reversal (VR). Vasectomy reversal is increasingly performed on men who wish to regain fertility after elective sterilization. Despite a thorough understanding of predictors of vasal patency after surgery, little is known about the patients' semen parameters and pregnancy potential. DESIGN: Retrospective case-control study. SETTING: Tertiary-care hospital. PATIENT(S): A total of 139 patients who underwent VR at the Cleveland Clinic from 2010 to 2014. INTERVENTION(S): Vasectomy reversal. MAIN OUTCOME MEASURE(S): Pregnancy, semen parameters. Data regarding patient and spouse ages, obstructive interval, intraoperative findings, procedure performed, postoperative semen results, and spontaneous pregnancy outcome were collected. Pearson and t tests were used to analyze categoric and numeric data, respectively. Average semen reference values were developed. RESULT(S): The mean obstructive interval was 9.5 ± 1.2 years. Spontaneous pregnancy was achieved by 49.6% of patients (69/139) and was directly related to better intraoperative vasal fluid quality and postoperative sperm concentration, motility, and strict morphology. The reference ranges of postoperative semen parameters of patients with spontaneous pregnancy were substantially lower than normal values published by the World Health Organization (WHO) in 2010. Spontaneous pregnancy was reported in 15%, 21.3%, and 14.8% of patients with a sperm concentration of <5 million/mL, a sperm motility of <10%, and a normal morphology of <1%, respectively. CONCLUSION(S): Normal ranges of semen parameters as established by the 2010 WHO standards may not adequately predict post-vasectomy reversal fertility. Significantly lower post-reversal semen parameters may be considered to be sufficient in previously fertile patients after reversal compared with the normal population.

Incidence of Y-chromosome microdeletions in children whose fathers underwent vasectomy reversal or in vitro fertilization with epididymal sperm aspiration: a case-control study / Incidência de microdeleções do cromossomo Y em filhos de pais que passaram por reversão de vasectomia ou fertilização in vitro com aspiração do epidídimo: um estudo caso-controle

ABSTRACT Objective To evaluate the incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with sperm retrieval by epididymal aspiration (percutaneous epididymal sperm aspiration). Methods A case-control study comprising male children of couples in which the man had been previously vasectomized and chose vasectomy reversal (n=31) or in vitro fertilization with sperm retrieval by percutaneous epididymal sperm aspiration (n=30) to conceive new children, and a Control Group of male children of fertile men who had programmed vasectomies (n=60). Y-chromosome microdeletions research was performed by polymerase chain reaction on fathers and children, evaluating 20 regions of the chromosome. Results The results showed no Y-chromosome microdeletions in any of the studied subjects. The incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with spermatozoa recovered by percutaneous epididymal sperm aspiration did not differ between the groups, and there was no difference between control subjects born from natural pregnancies or population incidence in fertile men. Conclusion We found no association considering microdeletions in the azoospermia factor region of the Y chromosome and assisted reproduction. We also found no correlation between these Y-chromosome microdeletions and vasectomies, which suggests that the assisted reproduction techniques do not increase the incidence of Y-chromosome microdeletions.

RESUMO Objetivo Avaliar a incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados submetidos à reversão de vasectomia ou fertilização in vitro com recuperação de espermatozoides por aspiração do epidídimo (aspiração percutânea de espermatozoides do epidídimo). Métodos Estudo caso-controle que compreende crianças do sexo masculino de casais em que o homem havia sido previamente vasectomizado e escolheu reversão da vasectomia (n=31) ou fertilização in vitro com recuperação espermática por aspiração percutânea de espermatozoides do epidídimo (n=30) para obtenção de novos filhos, e um Grupo Controle de crianças do sexo masculino de homens férteis com vasectomia programada (n=60). A pesquisa de microdeleções do cromossomo Y foi realizada por reação em cadeia da polimerase nos pais e filhos, avaliando 20 regiões do cromossomo. Resultados O resultado não revelou microdeleções do cromossomo Y em qualquer indivíduo estudado. A incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados que sofreram reversão de vasectomia ou fertilização in vitro com espermatozoides recuperados pela aspiração percutânea de espermatozoides do epidídimo não diferiu entre os grupos, e não houve nenhuma diferença entre indivíduos controle nascidos de gestações naturais ou incidência populacional em homens férteis. Conclusão Não foi encontrada nenhuma associação considerando microdeleções da região do fator de azoospermia no cromossomo Y e reprodução assistida. Não houve correlação entre microdeleções do cromossomo Y e vasectomia, o que sugere que as técnicas de reprodução assistida não aumentam a incidência de microdeleções do cromossomo Y.

Incidence of Y-chromosome microdeletions in children whose fathers underwent vasectomy reversal or in vitro fertilization with epididymal sperm aspiration: a case-control study.

OBJECTIVE: To evaluate the incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with sperm retrieval by epididymal aspiration (percutaneous epididymal sperm aspiration). METHODS: A case-control study comprising male children of couples in which the man had been previously vasectomized and chose vasectomy reversal (n=31) or in vitro fertilization with sperm retrieval by percutaneous epididymal sperm aspiration (n=30) to conceive new children, and a Control Group of male children of fertile men who had programmed vasectomies (n=60). Y-chromosome microdeletions research was performed by polymerase chain reaction on fathers and children, evaluating 20 regions of the chromosome. RESULTS: The results showed no Y-chromosome microdeletions in any of the studied subjects. The incidence of Y-chromosome microdeletions in individuals born from vasectomized fathers who underwent vasectomy reversal or in vitro fertilization with spermatozoa recovered by percutaneous epididymal sperm aspiration did not differ between the groups, and there was no difference between control subjects born from natural pregnancies or population incidence in fertile men. CONCLUSION: We found no association considering microdeletions in the azoospermia factor region of the Y chromosome and assisted reproduction. We also found no correlation between these Y-chromosome microdeletions and vasectomies, which suggests that the assisted reproduction techniques do not increase the incidence of Y-chromosome microdeletions. OBJETIVO: Avaliar a incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados submetidos à reversão de vasectomia ou fertilização in vitro com recuperação de espermatozoides por aspiração do epidídimo (aspiração percutânea de espermatozoides do epidídimo). MÉTODOS: Estudo caso-controle que compreende crianças do sexo masculino de casais em que o homem havia sido previamente vasectomizado e escolheu reversão da vasectomia (n=31) ou fertilização in vitro com recuperação espermática por aspiração percutânea de espermatozoides do epidídimo (n=30) para obtenção de novos filhos, e um Grupo Controle de crianças do sexo masculino de homens férteis com vasectomia programada (n=60). A pesquisa de microdeleções do cromossomo Y foi realizada por reação em cadeia da polimerase nos pais e filhos, avaliando 20 regiões do cromossomo. RESULTADOS: O resultado não revelou microdeleções do cromossomo Y em qualquer indivíduo estudado. A incidência de microdeleções do cromossomo Y em indivíduos nascidos de pais vasectomizados que sofreram reversão de vasectomia ou fertilização in vitro com espermatozoides recuperados pela aspiração percutânea de espermatozoides do epidídimo não diferiu entre os grupos, e não houve nenhuma diferença entre indivíduos controle nascidos de gestações naturais ou incidência populacional em homens férteis. CONCLUSÃO: Não foi encontrada nenhuma associação considerando microdeleções da região do fator de azoospermia no cromossomo Y e reprodução assistida. Não houve correlação entre microdeleções do cromossomo Y e vasectomia, o que sugere que as técnicas de reprodução assistida não aumentam a incidência de microdeleções do cromossomo Y.

Outcomes of microsurgical vasovasostomy for vasectomy reversal: a meta-analysis and systematic review.

OBJECTIVE: To perform a systematic review and meta-analysis of the published literature evaluating vasovasostomy for vasectomy reversal outcomes. METHODS: We conducted a review of English language articles describing results of microscopic vasovasostomy for vasectomy reversal. Two reviewers independently examined the studies for eligibility and evaluated data from each study. Meta-analysis was performed using a random effects model. RESULTS: Thirty-one studies with 6633 patients met inclusion criteria. Mean patient age at time of vasectomy reversal was 38.9 years with a mean obstructive interval of 7.2 years. The mean postprocedure patency and pregnancy rates weighted by sample size were 89.4% and 73.0%, respectively. A meta-analysis comparing an obstructive interval (OI) of <10 years to an OI of at least 10 years duration produced a pooled incidence ratios (IR; meta-IR) of 1.17 (95% confidence interval [CI], 1.09-1.25) for patency and 1.24 (95% CI, 1.12-1.38) for pregnancy. Incidence of patency for modified 1-layer technique was similar to that after a 2-layer procedure with a meta-IR of 1.04 (95% CI, 1.00-1.08). Because of a small number of relevant studies, a meta-analysis for other predictors of success such as sperm granuloma, quality of vasal fluid, and female factors was not feasible. CONCLUSION: We found no statistically significant difference in vasovasostomy outcomes when comparing the impact of single vs multilayer anastomoses. Patients with an OI <10 years showed higher patency and pregnancy rates compared with those with an OI ≥10 years. Uniform definitions of patency are necessary to characterize success and standardize outcome reporting.

Vasectomy as a reversible form of contraception for select patients.

INTRODUCTION: To provide an effective form of birth control, men may choose a reversible or permanent form of contraception. Vasectomy is presently offered as a permanent option for male contraception. We have had patients who were interested in vasectomy and reversal as a temporary birth control option. The purpose of this paper is to determine if vasectomy should be offered for selected couples as a temporary form of contraception and under which circumstances. MATERIALS AND METHODS: A literature review was conducted to determine the available reversible contraceptive options, risks, failure rates and contraindications to each, and the risks and success rates of vasectomy and vasectomy reversal. RESULTS: Reversible contraceptives include hormonally based methods for women, non-hormonal anatomic barrier devices and spermatocidal agents. Hormone based therapies may be contraindicated in women with cardiovascular disease, hypertension, and some cancers. Non-hormonal contraceptives are generally less effective and may be unacceptable for some couples due to higher failure rates, difficulty of use and lack of acceptance. Both vasectomy and vasectomy reversal are low risk procedures. Reversal may be performed with a high degree of success, particularly with a short obstructive interval (97% patency if performed < 3 years following vasectomy). CONCLUSION: While vasectomy should be considered a permanent form of sterilization for most couples, there are select couples, unable or unwilling to use other forms of birth control, who would benefit from an informed discussion about using a vasectomy as a reversible form of contraception.

Comparison of macroscopic one-layer over number 1 nylon suture vasovasostomy with the standard two-layer microsurgical procedure.

OBJECTIVE: To compare the outcomes of macroscopic one-layer vasovasostomy (MOLVV) with those of two-layer microsurgical vasovasostomy (TLMVV). METHODS: Standard TLMVV was performed in 112 men (Group 1), while MOLVV was performed in 94 patients. All of the MOLVVs were performed with number 1 nylon suture as a temporary stent. The outcome measures were as follows: patency rate, pregnancy rate, operation time, total procedure cost, and complications. RESULTS: The mean operation duration was 114 ± 10 min for the TLMVV technique, and 74 ± 5 min for the MOLVV procedure (P = 0.024). In patients who underwent vasal patency at 6-month postoperative period, the median sperm density (106/mL) was 28.3 and 27.7 in Groups 1 and 2, respectively (P = 0.62). At the same time, the median total motile sperm count (× 106) was 39.4 and 32.6 in two-layer microsurgical and one-layer macroscopic groups, respectively (P = 0.47). Patency rates were 82.1% in Group 1 and 77.7% in Group 2, which were not significantly different (P = 0.21). The pregnancy rate was 28.4% for patients in Group 1 and 26.7% for patients in Group 2 (P = 0.38). CONCLUSIONS: There were no significant differences in terms of patency and pregnancy rates between MOLVV and TLMVV methods, but the MOLVV technique offers a decreased cost and operative time, and a simplified procedure.

Percutaneous epididymal sperm aspiration for men with obstructive azoospermia: predictors of successful sperm retrieval.

OBJECTIVE: To evaluate the predictors of successful sperm retrieval using percutaneous epididymal sperm aspiration (PESA) in men with obstructive azoospermia (OA). MATERIALS AND METHODS: Data were collected retrospectively from 255 patients with OA who underwent PESA between March 2007 and September 2012. Sperm retrieval outcomes were reported as motile sperm (>1% motile), rare motile sperm (≤1% motile), nonmotile sperm, and no sperm found. Variables included in our analysis were patient age, testicular volume, and diagnosis (congenital bilateral absence of the vas deferens, vasectomy, failed vasovasostomy, or other). Multivariate logistic regression models were constructed to detect variables prognostic for successful PESA outcomes. RESULTS: After PESA, motile sperm were detected in 192 patients (75.3%), rare motile sperm in 24 (9.4%), nonmotile sperm in 27 (10.6%), and no sperm in 12 (4.7%). There was no difference among the groups in terms of median testicular volume or diagnosis. However, there was a significantly higher median age (P = .0234) in men who had no sperm (45 years) or nonmotile sperm (46 years) compared with those who had motile (41 years) or rare motile sperm (40 years). On multivariate analysis, larger testicular volume was independently prognostic for improved motile sperm retrieval rates (P = .0056) whereas increased paternal age strongly trended toward lower rates (P = .0589). CONCLUSION: The data suggest that PESA yields good motile sperm retrieval rates in patients with OA. Younger paternal age and larger testicular volume appear to be predictive of higher motile sperm retrieval rates.

Vasectomy demographics and postvasectomy desire for future children: results from a contemporary national survey.

OBJECTIVE: To describe the longitudinal demographics and family planning attitudes of vasectomized men with the use of the National Survey for Family Growth (NSFG). DESIGN: Retrospective cohort analysis of the NSFG with the use of national projections and multivariable regressions. SETTING: In-home survey. PATIENT(S): The NSFG sampled 10,403 men aged 15-45 years from 2006 to 2010 regarding family planning attitudes. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Vasectomy and desire for children. RESULT(S): There were 3,646,339 (6.6%) vasectomized men aged 18-45 years in the U.S. On multivariable regression the following factors increased the odds of having a vasectomy: currently married (odds ratio [OR] 7.814), previously married (OR 5.865), and increased age (OR 1.122) and income (OR 1.003). The odds of having a vasectomy increased with number of children. The following factors decreased the odds of having a vasectomy: immigrant status (OR 0.186), African American (OR 0.226), Hispanic (OR 0.543), Catholic (OR 0.549), and other non-Protestant religion (OR 0.109). Surprisingly, an estimated 714,682 (19.6%) vasectomized men in the U.S. desire future children. Men practicing a religion (OR 8.575-15.843) were more likely than atheists to desire children after vasectomy. 71,886 (2.0%) vasectomized men reported having a vasectomy reversal. CONCLUSION(S): This study highlights the importance of preoperative counseling for permanency of vasectomy and reveals an opportunity to counsel couples about vasectomy versus tubal ligation.

Mini-incision vasectomy reversal using no-scalpel vasectomy principles: efficacy and postoperative pain compared with traditional approaches to vasectomy reversal.

OBJECTIVES: To evaluate the efficacy and postoperative morbidity of a mini-incision vasectomy reversal (MIVR) using no-scalpel vasectomy principles compared with traditional incisional approaches to vasectomy reversal (VR). METHODS: Of 164 patients undergoing consecutive VR, 139 underwent bilateral vasovasostomy (55% bilateral MIVR, 24% mixed MIVR/traditional incision VR, and 21% bilateral traditional incision VR). The MIVRs were performed using a subcentimeter incision after the vas deferens was captured and delivered through the skin using the no-scalpel vasectomy principles and instruments. Semen analyses were obtained at 3-month intervals postoperatively until pregnancy was achieved. Motile sperm in the ejaculate after VR defined patency. Pain and functional recovery after surgery were evaluated using a previously validated 10-point pain scale adapted to VR. The no-scalpel vasectomy patients served as controls for the postoperative pain assessments. RESULTS: The median follow-up was 11.6 months. The patency rate was 96%, 100%, and 91% for the MIVR, mixed MIVR/traditional incision, and bilateral traditional incision VR, respectively (P = .4). The semen parameters did not significantly differ among the VR approaches. The pain severity during the first 48 hours after surgery was significantly less (P < .05) for the patients who had undergone bilateral MIVR than for the patients who had undergone traditional incision VR and did not significantly differ from that of the men who had undergone no-scalpel vasectomy. The patients returned to normal activities an average of 2 days earlier after MIVR than after traditional incision VR. CONCLUSIONS: The results of our study have shown that MIVR does not compromise patency outcomes or semen parameters compared with more traditional approaches to VR and results in less pain during the early period of recovery after surgery and quicker functional recovery.

One-layer vasovasostomy: microsurgical versus loupe-assisted.

OBJECTIVE: To compare the outcomes of microsurgical versus loupe-assisted technique for vasectomy reversal. DESIGN: Retrospective comparative study with randomization. SETTING: University hospital male infertility clinic. PATIENT(S): Fifty men with obstructive azoospermia after vasectomy. INTERVENTION(S): One-layer vasovasostomy with microscope (group I) or optical loupe (group II). MAIN OUTCOME MEASURE(S): Patency, pregnancy, operation time, postoperative stricture. RESULT(S): Mean operation time was 106.4±10.3 minutes in group I and 78.3±5.7 minutes in group II, showing a statistically significant difference. Analysis of semen sampled from men, who succeeded in getting vasal patency, was performed finally at the sixth month after surgery and showed sperm concentrations of 21.5 million/mL and 20.7 million/mL and sperm motilities of 32.5% and 30.8% in groups I and II, respectively, without a statistical significance. Patency rates were 96% (24 out of 25) in group I and 72% (18 out of 25) in group II, showing a statistically significant difference. Pregnancy rates were 40% (10 out of 25) in group I and 28% (7 out of 25) in group II. There was no statistically significant difference in pregnancy rate between the two groups. Postoperative vasal stricture occurred in four patients, all of them from group II. There was no operation-related complication, such as hematoma or wound infection. CONCLUSION(S): Microscopic technique yielded a higher patency rate than loupe-assisted technique, possibly by reducing the chance of postoperative vasal stricture.

Vasectomy reversal: a seven-year experience.

INTRODUCTION: Since the demand for vasectomy reversal is increasing and many populations in Brazil and other countries show distinct characteristics, this study was carried out as an effort to determine factors and characteristics associated with the success rate of reversal in a population in Southern Brazil. PATIENTS AND METHODS: We reviewed 29 cases of vasectomy reversal performed over a 7-year period using the single-layer technique under microscopic magnification. RESULTS: Mean patency, pregnancy, and birth rates were 75, 41.7 and 29%, respectively. The patency and pregnancy rates were 92.3 and 38.5%, respectively, for time intervals since vasectomy <10 years and 63.6 and 45.4%, respectively, for intervals >10 years. Patency and pregnancy rates were 87.5 and 50%, respectively, for patients who had their vasectomy performed by a urologist, and 50 and 25%, respectively, for those who had their vasectomy performed by a generalist surgeon (p < 0.05). CONCLUSIONS: High patency and pregnancy rates are associated with time intervals since vasectomy of <10 years and vasectomies performed by urologists. There was no significant difference in the anastomosis time between the first 12 procedures and the next 12 procedures.