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Selected Research Papers

Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male wistar rats.

McCallum S, Li PS, Sheynkin Y, Su LM, Chan P, Goldstein M.

J Urol. 2003 Jan;169(1):294.

Center for Male Reproduction Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, Department of Urology, New York Weill Cornell Medical Center, New York, New York 10021, USA.

PURPOSE: Vasoepididymostomy is a technically challenging and complex microsurgical procedure. Recently a new triangulation end-to-side microsurgical technique was reported that allows intussusception of the epididymal tubule into the vasal lumen, resulting in a higher clinical patency rate of 92% with shorter operative time in preliminary clinical studies. We performed a prospective controlled randomized study comparing the patency rate, postoperative sperm granuloma rate and operating time of conventional and intussusception end-to-side vasoepididymostomy in previously vasectomized rats. MATERIALS AND METHODS: We randomized 42, 6-week-old male Wistar rats into 4 groups, including 6 into the sham operation, and 12 each into the control, conventional end-to-side and intussusception end-to-side vasoepididymostomy groups. Bilateral 2-clip vasectomy was performed in all animals except those in the sham operation group. Bilateral intussusception or conventional end-to-side vasoepididymostomy was performed in the assigned animals 2 weeks after vasectomy. Animals in the control group underwent vasectomy only. In the sham operation group the testes were mobilized out of the scrotum and then returned. Rats were sacrificed at 8, 12, 16 and 24 weeks, respectively. The anastomosis and vasectomy sites were inspected for sperm granuloma. To assess patency the abdominal end of the vas was transected and intraluminal fluid was examined microscopically at 400x magnification for the presence of motile sperm. Patency was further confirmed by performing retrograde indigo carmine vasography through the anastomoses. RESULTS: In the intussusception and conventional groups the patency rate was 91.7% and 54.2% (p = 0.004), the sperm granuloma rate was 20.8% and 58.4% (p = 0.035), and average operative time was 65.8 and 67.7 minutes (p = 0.197), respectively. CONCLUSIONS: Intussusception end-to-side vasoepididymostomy is superior to conventional end-to-side vasoepididymostomy with respect to the patency and postoperative sperm granuloma rates. Further investigations are required to confirm such findings clinically inhumans.


Innovative single-armed suture technique for microsurgical vasoepididymostomy.

Monoski MA, Schiff J, Li PS, Chan PT, Goldstein M.

Urology. 2007 Apr;69(4):800-4.

Department of Urology, Cornell Institute for Reproductive Medicine, Weill Medical College of Cornell University, New York, NY 10021-4873, USA.

OBJECTIVES: Vasoepididymostomy outcomes are heavily dependent on the surgeon's microsurgical experience and skill. To avoid back-walling the tubular lumen, the needles are generally placed inside-out through the vasal lumen using double-armed microsutures. These double-armed sutures for infertility microsurgery are very expensive and may be difficult to obtain. We describe a randomized trial that used a novel single-armed suture placement pattern for vasoepididymostomy. METHODS: Male adult Wistar rats underwent vasectomy. Two weeks later, vasoepididymostomies were performed using either a single-armed longitudinal intussusception vasoepididymostomy (n = 6) or a standard double-armed longitudinal intussusception vasoepididymostomy (n = 6) technique. After 9 weeks, patency was assessed functionally by evaluating for motile sperm distal to the anastomosis. If no motile sperm were visible, the mechanical patency of the anastomoses was tested by the ability of methylene blue to pass through the surgical anastomosis. RESULTS: The patency rate for the double-armed vasoepididymostomy group was 100% (6 of 6) compared with 83.3% (5 of 6) for the single-armed vasoepididymostomy group. This difference was not significant (P = 0.50). Sperm granulomas were found in three (50%) of six anastomoses in the double-armed group and five (83%) of six anastomoses in the single-armed vasoepididymostomy group (P = 0.27). The mean operative times for the double and single-armed longitudinal intussusception vasoepididymostomy techniques were similar (35 minutes versus 43 minutes; P = 0.39). CONCLUSIONS: The results of our study have shown that the single-armed suture technique to perform vasoepididymostomy is almost as effective as the double-armed technique. Although we still prefer to use double-armed sutures, we believe that this is a practical and effective alternative when specialized double-armed microsurgical sutures are not available.


Effect of female partner age on pregnancy rates after vasectomy reversal.

Gerrard ER Jr, Sandlow JI, Oster RA, Burns JR, Box LC, Kolettis PN.

Fertil Steril. 2007 Jun;87(6):1340-4. Epub 2007 Jan 25

Division of Urology, University of Alabama at Birmingham, Birmingham, Alabama 35294-3411, USA.

OBJECTIVE: To determine the effect of female partner age on pregnancy rates after vasectomy reversal. DESIGN: Retrospective review. SETTING: Two academic infertility practices. PATIENT(S): Men undergoing vasectomy reversal and their partners. INTERVENTION(S): Microsurgical vasectomy reversal. MAIN OUTCOME MEASURE(S): Patency and pregnancy rates. RESULT(S): Two hundred ninety-four patients met the inclusion criteria. Groups were similar with regard to types of procedure performed (vasovasostomy or vasoepididymostomy), obstructive interval, female factors, number of repeat procedures, and quality of vasal fluid. Patency rates were 90%, 89%, 90%, 86%, and 83% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. Pregnancy rates were 67%, 52%, 57%, 54%, and 14% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. The pregnancy rate for couples with female partner aged 40 or older was lower than for those with the female partner aged 39 or younger (14% vs. 56%). CONCLUSION(S): Pregnancy rates for vasectomy reversal were good regardless of female age as long as the partner was 39 years old or younger. Pregnancy rates were lower if the female partner was 40 or more years old.


The relationship between intravasal sperm quality and patency rates after vasovasostomy.

Sigman M.

J Urol. 2004 Jan;171(1):310.

Brown Medical School, Providence, Rhode Island, USA.

PURPOSE: Most surgeons examine the intravasal fluid at vasectomy reversal. Vasovasostomy is performed when sperm are identified in the intravasal fluid or when sperm are absent but the fluid is copious and clear. When sperm are absent and the intravasal fluid is not copious and clear, vasoepididymostomy is often performed. Frequently the intravasal fluid contains only fragments of sperm. This study examines patency rates after microsurgical vasovasostomy as a function of the quality of sperm in the intravasal fluid. MATERIALS AND METHODS: The records of patients who had undergone microsurgical vasovasostomy were reviewed. The intravasal fluid was examined and sperm quality was recorded as no sperm, sperm heads, sperm with short tails or whole sperm. Results of postoperative semen analyses were recorded. Patency rates and postoperative semen parameters were compared. RESULTS: A total of 53 patients satisfied the entrance criteria. Ages ranged from 25 to 53 (mean age 39). Mean obstructive interval was 9.9 years (range 1 to 20). Overall patency was 98% (52 of 53 cases). Patency rates were 95% for the group with sperm heads and 100% for whole sperm, sperm with short tails and absent sperm groups. Patency rates did not vary significantly as a function of intravasal sperm quality. CONCLUSIONS: Modern microsurgical techniques yield excellent patency rates. The presence of sperm parts compared to whole sperm does not adversely affect patency rates after vasovasostomy. Vasovasostomy should be performed if any sperm parts are identified in the intravasal fluid.





This is just a small selection of papers that I use to inform the management of my patients.

I use the longitudinal intussuscepted vaso-epididymostomy technique if a vas to vas join is unfavourable.

Rather than use simple single armed sutures (which has a lower success rate) I use the much more expensive double armed 10.0 sutures for this delicate procedure.