 | This article needs additional citations for verification .(May 2022) |
| Vasovasostomy | |
|---|---|
| ICD-9-CM | 63.82 |
| MeSH | D014669 |
Vasovasostomy (literally connection of the vas to the vas) is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.[ citation needed ]
Vasovasostomy is a form of microsurgery first performed by Australian surgeon Dr. Earl Owen (1934–2014) in 1971. [1]
In most cases the vas deferens can be reattached but, in many cases, fertility is not achieved. There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal sperm activity. If blockage at the level of the epididymis is suspected, a vasoepididymostomy can be performed.
Return of sperm to the ejaculate depends greatly on the length of time from the vasectomy and the skill of the surgeon. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy can depend on female partner factors.
Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature, but there is agreement that antibodies may reduce sperm motility.
Only two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal by vasovasostomy. First, the patient must have sperm available to pass through at least one reconnection. The second condition is that each reconnection must be as watertight as possible. The surgeon's goal is to achieve a very precise circumferential reconnection of the sperm canal edges by using meticulously placed microsurgical sutures.[ citation needed ]
Vasovasostomy can be performed in the convoluted or straight portion of the vas deferens. [2]
Vasovasostomy is typically an out-patient procedure (patient goes home the same day).
The procedure is typically performed by urologists. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia.
If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient's semen only transiently after the reversal, microsurgical vasovasostomy may be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections. The failure of a competently performed microsurgical vasovasostomy following the absence of any sperm in the contents of each vas usually is due to “blowouts” in the epididymides. Under these circumstances an operation should be performed only by a micro-surgeon with proven vasoepididymostomy expertise, bypassing the blowouts.
The prognosis for each patient should be determined by a pre-operative examination of the vasectomy sites and consideration of the time interval since vasectomy.
The rate of pregnancy depends on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. The reversal procedures are frequently impermanent, with occlusion of the vas recurring two or more years after the operation.
The presence of sperm granulomas improves the likelihood of restoring sperm to the semen with a vasovasotomy. A local urologist can easily determine whether a patient has 0, 1, or 2 sperm granuloma by a painless examination of each vasectomy site. If the interval since the vasectomy is less than fifteen years, the prognosis will be 70% or better and this local examination is probably not needed.[ citation needed ] A sperm granuloma develops from post-vasectomy sperm leakage and somehow it behaves like a safety valve preventing internal pressure build up and ruptures of the delicate epididymis tubules with subsequent obstructive scarring.
Vasovasostomy can be effective regardless of how long it's been since the original vasectomy. However, if more than 15 years have passed since the original vasectomy, one may have a lower chance of having enough healthy sperm in one's own semen to father a child. Also, the longer the obstructive interval, the more likely it is that a vasoepididymostomy will be required.
Typical cost of one vasovasostomy is US$5,000–15,000 (one side).
Vasectomy, or vasoligation, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and thereby prevent fertilization of a female through sexual intercourse. Vasectomies are usually performed in a physician's office, medical clinic, or, when performed on an animal, in a veterinary clinic. Hospitalization is not normally required as the procedure is not complicated, the incisions are small, and the necessary equipment routine. The leading potential complication is post-vasectomy pain syndrome.
The epididymis is a tube that connects a testicle to a vas deferens in the male reproductive system. It is a single, narrow, tightly-coiled tube in adult humans, 6 to 7 meters in length. It serves as an interconnection between the multiple efferent ducts at the rear of a testicle (proximally), and the vas deferens (distally).
The vas deferens or ductus deferens is part of the male reproductive system of many vertebrates. The ducts transport sperm from the epididymis to the ejaculatory ducts in anticipation of ejaculation. The vas deferens is a partially coiled tube which exits the abdominal cavity through the inguinal canal.
Spermatocele is a fluid-filled cyst that develops at the top of the testicle of the epididymis. The fluid is usually a clear or milky white color and may contain sperm. Spermatoceles are typically filled with spermatozoa and they can vary in size from several millimeters to many centimeters. Small spermatoceles are relatively common, occurring in an estimated 30 percent of males. They are generally not painful. However, some people may experience discomfort such as a dull pain in the scrotum from larger spermatoceles. They are not cancerous, nor do they cause an increased risk of testicular cancer. Additionally, unlike varicoceles, they do not reduce fertility.
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Microsurgical techniques are utilized by several specialties today, such as general surgery, ophthalmology, orthopedic surgery, gynecological surgery, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery, podiatric surgery and pediatric surgery.
Vas-occlusive contraception is a form of male contraception that blocks sperm transport in the vas deferens, the tubes that carry sperm from the epididymis to the ejaculatory ducts.
Azoospermia is the medical condition of a man whose semen contains no sperm. It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations in Canada.
Congenital absence of the vas deferens (CAVD) is a condition in which the vasa deferentia reproductive organs fail to form properly prior to birth. It may either be unilateral (CUAVD) or bilateral (CBAVD).
Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilisation (IVF). TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia.
Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. When pain in the epididymides is the primary symptom, post-vasectomy pain syndrome is often described as congestive epididymitis.
A sperm granuloma is a lump of leaked sperm that appears along the vasa deferentia or epididymides in vasectomized individuals. While majority of sperm granulomas are present along the vas deferens, the rest of them form at the epididymis. Sperm granulomas range in size, from one millimeter to one centimeter. They consist of a central mass of degenerating sperm surrounded by tissue containing blood vessels and immune system cells. Sperm granulomas may also have a yellow, white, or cream colored center when cut open. While some sperm granulomas can be painful, most of them are painless and asymptomatic. Sperm granulomas can appear as a result of surgery, trauma, or an infection. They can appear as early as four days after surgery and fully formed ones can appear as late as 208 days later.
Vasectomy reversal is a term used for surgical procedures that reconnect the male reproductive tract after interruption by a vasectomy. Two procedures are possible at the time of vasectomy reversal: vasovasostomy and vasoepididymostomy. Although vasectomy is considered a permanent form of contraception, advances in microsurgery have improved the success of vasectomy reversal procedures. The procedures remain technically demanding and may not restore the pre-vasectomy condition.
Reproductive surgery is using surgery in the field of reproductive medicine. It can be used for contraception, e.g. in vasectomy, wherein the vasa deferentia of a man are severed, but is also used plentifully in assisted reproductive technology.
Sherman J. Silber is physician specializing in the field of infertility. He invented many of the infertility treatments in use today in the domain of IVF, sperm retrieval, ICSI, vasectomy reversal, tubal ligation reversal, egg and embryo freezing, ovary transplantation, and the reproductive biological clock. He performed the world's first ovary and testicle transplants, created and popularized the microsurgical vasectomy reversal, and popularized ovarian tissue freezing to preserve female fertility. He was the first to research the genetic causes of infertility in men, and developed the TESE-ICSI technique for extracting sperm from men with low or nonexistent sperm counts and direct injection of the sperm into the egg. Additionally, Silber has studied fertility in animals and performed microscopic surgery on chimpanzees, South American bush dogs, Przewalski's horse, gorillas, wolves, and other endangered species.
Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy.
Vasography is an X-ray study of the vas deferens to see if there is blockage, oftentimes in the context of male infertility. An incision is made in the scrotum, contrast is injected in the vas deferens, and X-rays are taken from different angles. Thus, it is an invasive procedure and carries risk of iatrogenic scarring and obstruction of the vas. Vasography has traditionally been considered the gold standard imaging modality for evaluating the seminal tract patency.
No-scalpel vasectomy is a type of vasectomy procedure in which a specifically designed ringed clamp and dissecting hemostat is used to puncture the scrotum to access the vas deferens. This is different from a conventional or incisional vasectomy where the scrotal opening is made with a scalpel. The NSV approach offers several benefits, including lower risk for bleeding, bruising, infection, and pain. The NSV approach also has a shorter procedure time than the conventional scalpel incision technique. Both approaches to vasectomy are equally effective. Because of the inherent simplicity of the procedure it affords itself to be used in public health programs worldwide. This method is used in over 40 countries for male sterilisation.
Raymond A. Costabile is Professor, and Chair Urology with the Department of Urology at the School of Medicine of the University of Virginia. Costabile is a retired Colonel in the US Army and the former Chief of Urology Service at Madigan Army Medical Center. Costabile is an author; his articles on men's reproductive health and infertility have been published in the Journal of Urology and Proceedings in the National Academy of Sciences, among other peer-reviewed scholarly journals. He has also been featured in television interviews in the national media.
Marc Goldstein, MD, DSc (hon), FACS is an American urologist and the Matthew P. Hardy Distinguished Professor of Reproductive Medicine, and Urology at Weill Cornell Medical College of Cornell University; Surgeon-in-Chief, Male Reproductive Medicine and Surgery; and Director of the Center of Male Reproductive Medicine and Microsurgery at the New York Presbyterian Hospital Weill Cornell Medical Center. He is Adjunct Senior Scientist with the Population Council's Center for Biomedical Research, located on the campus of Rockefeller University.
Antisperm antibodies (ASA) are antibodies produced against sperm antigens.