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Unwanaobong Nseyo, Nishant Patel, Tung-Chin Hsieh
OBJECTIVE: To characterize vasectomy reversal practice patterns among American Board of Urology (ABU) certifying urologists. MATERIALS AND METHODS: We reviewed the ABU case logs for certifying urologists from 2008 to 2014. Vasectomy reversal procedures were identified by three CPT codes: 55400 (vasovasostomy), 54900 (epididymovasostomy, unilateral), 54901 (epididymovasostomy, bilateral). Demographic data was obtained and reviewed. Multivariate analysis was determined factors influencing the performance of surgical approach...
November 17, 2016: Urology
Michael T Marshall, Alexander D Doudt, Jonathan H Berger, Brian K Auge, Matthew S Christman, Chong H Choe
Of all patients who have vasectomies performed in the United States, upwards of 6% will pursue a vasectomy reversal. Currently, the gold-standard reversal procedure is a microscopic vasovasostomy utilizing either a one or two-layer vasal anastomosis. Unfortunately, most urologists do not perform these procedures as they require extensive training and experience in microsurgery. The objective of our study was to evaluate the feasibility and success rate of robot-assisted vasovasostomy performed at our institution...
November 7, 2016: Journal of Robotic Surgery
P Li, H X Chen, Y H Huang, E L Zhi, R H Tian, H Zhao, F Yang, H F Sun, Y H Gong, Z J Zhu, Y Hong, Y D Liu, S J Xia, Z Li
Objective: To evaluate the efficacy and safety of microsurgical crossover vasovasostomy in treating complicated obstructive azoospermia. Methods: The data of 14 patients with complicated obstructive azoospermia treated with microsurgical crossover vasovasostomy were reviewed from October 2012 to March 2016.Ten of them underwent microsurgical crossover vasovasostomy. Intraoperative exploration revealed that 2 patients had vas deferens injury and contralateral testicular atrophy or epididymal obstruction due to previous hernia repair; 7 patients had obstruction of intracorporeal vas deferens on one side and epididymal obstruction on the other side; the other 1 patient had unilateral vasal obstruction with contralateral epididymal obstruction...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Robert Sullivan, Roger Mieusset
BACKGROUND: Spermatozoa acquire their fertilizing ability and forward motility properties during epididymal transit. Our knowledge of gamete physiology is based on studies conducted in laboratory and domestic species; our knowledge of these processes in humans is limited. Medical indications for assisted reproductive technologies (ART) have progressed to include male infertility. Surgical procedures allow collection of spermatozoa from all along the human excurrent ducts, and the former have been used with some success in reproductive medicine...
September 2016: Human Reproduction Update
Anas Lotfi Yasin, Ahmad Lotfi Yasin, Walid Salim Basha
INTRODUCTION: Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered. AIM: This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization - intracytoplasmic sperm injection (IVF-ICSI)...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Abhishek P Patel, Ryan P Smith
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...
May 2016: Asian Journal of Andrology
M E Fuchs, R E Anderson, K A Ostrowski, W O Brant, E F Fuchs
The absence of sperm in the ejaculate after vasectomy reversal is commonly caused by failure to recognize and subsequently bypass epididymal or proximal vasal obstruction at the time of vasectomy reversal. If intra-operative proximal obstruction is suspected, vasoepididymostomy (VE) is recommended rather than vasovasostomy (VV). We sought to calculate the associated risk of needing VE, rather than VV with time from original vasectomy (obstructive interval) using a large cohort of vasectomy reversal patients...
January 2016: Andrology
Yaw A Nyame, Paurush Babbar, Nima Almassi, Alan S Polackwich, Edmund Sabanegh
PURPOSE: Approximately 2% to 6% of men undergoing vasectomy will ultimately have it reversed. Cost is a major consideration for patients and providers with regard to vasovasostomy. Opportunities for cost savings for vasectomy reversal lie in the reduction of variable costs, namely operative time and materials used. In this study we determine the cost benefits of a modified 1-layer vasovasostomy compared to a formal 2-layer vasovasostomy. MATERIALS AND METHODS: A retrospective analysis was performed of a single surgeon experience of vasectomy reversals performed from 2010 to 2015...
February 2016: Journal of Urology
A Scott Polackwich, Nicholas N Tadros, Kevin A Ostrowski, Joe Kent, Michael J Conlin, Jason C Hedges, Eugene F Fuchs
OBJECTIVE: To review our institution's experience and success with vasectomy reversal to treat postvasectomy pain syndrome (PVPS) over the last 20 years. MATERIALS AND METHODS: A single surgeon (E.F.F.) performed all the vasectomy reversals. We identified 123 procedures done for PVPS treatment and were able to contact 76 patients. We sent surveys or conducted phone interviews inquiring about satisfaction, levels of pain preoperatively and postoperatively, and the need for additional procedures for pain...
August 2015: Urology
Ryan M Dickey, Alexander W Pastuszak, Tariq S Hakky, Aravind Chandrashekar, Ranjith Ramasamy, Larry I Lipshultz
In the USA, about 500,000 vasectomies are performed each year, with up to 6% of men requesting reversal. The technique of vasectomy reversal has evolved from macrosurgical to the implementation of both microscopic and robotic technologies. The very earliest attempts at vasectomy reversal, the vasoepididymostomy and vasovasostomy, have remained central in the treatment of male infertility and will continue to be so for years to come. As seen throughout its history, urological microsurgery has consistently implemented advanced techniques and state-of-the art technology in its craft, and its continued refinement will allow for even more favorable outcomes in the lives of patients seeking restoration of fertility following vasectomy...
June 2015: Current Urology Reports
R Ramasamy, D A Mata, L Jain, A R Perkins, S H Marks, L I Lipshultz
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...
May 2015: Andrology
Feng-bin Zhang, Zhong-yan Liang, Le-jun Li, Jing-ping Li, Jing-gen Wu, Fan Jin, Yong-hong Tian
OBJECTIVE: To investigate the clinical effect of microsurgical vasoepididymostomy and/or vasovasostomy in the treatment of obstructive azoospermia. METHODS: This study included 76 patients with obstructive azoospermia, 53 treated by bilateral vasoepididymostomy (8 involving the epididymal head, 18 involving the epididymal body, 5 involving the epididymal tail, and 22 involving the epididymal head, body and tail), 14 by unilateral vasoepididymostomy, and the other 9 by unilateral vasoepididymostomy + unilateral vasovasostomy (including cross anastomosis)...
March 2015: Zhonghua Nan Ke Xue, National Journal of Andrology
Lindsey A Herrel, Michael Goodman, Marc Goldstein, Wayland Hsiao
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...
April 2015: Urology
Jason M Scovell, Douglas A Mata, Ranjith Ramasamy, Lindsey A Herrel, Wayland Hsiao, Larry I Lipshultz
OBJECTIVE: To investigate the association between the presence of sperm in the vasal fluid during vasectomy reversal (VR) and postoperative patency. METHODS: We performed a systematic review and meta-analysis of the English-language literature reporting on the association between the presence of sperm in the intraoperative vasal fluid (ie, whole or parts vs none) and patency (ie, patent or not) after microsurgical vasovasostomy for men with obstructive azoospermia due to vasectomy...
April 2015: Urology
Kevin A Ostrowski, A Scott Polackwich, Michael J Conlin, Jason C Hedges, Eugene F Fuchs
PURPOSE: We compared fertility outcomes with gross and microscopic fluid findings at vasectomy reversal at a high volume vasectomy reversal center. MATERIALS AND METHODS: A retrospective study of a prospective database was performed. All vasectomy reversals were performed by a single surgeon (EFF) between 1978 and 2011. The clinical pregnancy rate was self-reported or determined via patient mailers. Patient and operative findings were determined through database review...
July 2015: Journal of Urology
Hyun Joon Moon
INTRODUCTION: In line with the effort to evaluate feasible surgical options for vasectomy reversal and to increase patients' willingness to undergo the procedure, this study reported on a technique for ambulatory mini-incision microsurgical vasovasostomy using a double-ringed clamp (i.e. Moon's clamp). This technique does not require the use of dilators, approximators and other accessory devices. METHODS: Ambulatory mini-incision microsurgical vasovasostomy was conducted on 263 patients who satisfied the surgical eligibility requirements for vasovasostomy and the safety criteria for local anaesthesia...
April 2015: Singapore Medical Journal
Parviz K Kavoussi
Vasectomy reversal (VR) has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR (RAVR) or microsurgical VR (MVR) by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR...
March 2015: Asian Journal of Andrology
Khalid Alrabeeah, Faysal Yafi, Christine Flageole, Simon Phillips, Audrey Wachter, Francois Bissonnette, Isaac Jacques Kadoch, Armand Zini
OBJECTIVE: To evaluate testicular sperm aspiration (TESA) sperm retrieval rates and intracytoplasmic sperm injection outcomes in nonazoospermic men. MATERIALS AND METHODS: Data were collected retrospectively from 54 consecutive, nonazoospermic, infertile men who underwent TESA between March 2007 and September 2012. Sperm retrieval rates and clinical pregnancy outcomes were recorded. Patients were subgrouped based on clinical diagnosis: group 1, anejaculation (primary, situational); group 2, idiopathic severe oligoasthenozoospermia; and group 3, severe oligoasthenozoospermia after vasovasostomy...
December 2014: Urology
Robert M Coward, Douglas A Mata, Ryan P Smith, Jason R Kovac, Larry I Lipshultz
OBJECTIVE: To report considerations for preoperative management and outcomes of vasectomy reversal (VR) in men with a history of testosterone supplementation therapy (TST). METHODS: A retrospective review of men on TST before VR from 2010 to 2013 was performed. For inclusion, patients were required to have baseline and follow-up hormone levels as well as postoperative semen analyses. Preoperative use of medical testicular salvage therapy and testicular sperm aspiration (TESA), intraoperative findings, and pregnancies were also analyzed...
December 2014: Urology
Hisanori Taniguchi, Teruaki Iwamoto, Tomohiko Ichikawa, Atsushi Nagai, Hiroshi Okada, Masato Fujisawa, Akira Tsujimura, Koji Shiraishi, Hatsuki Hibi, Koichi Nagao, Akira Iwasaki, Tomomi Kamba, Hiroshi Tomomasa, Shingo Takada, Tadashi Matsuda
OBJECTIVES: To evaluate current outcomes of seminal tract re-anastomoses in Japan, and to compare them with historical data. METHODS: A total of 213 patients with obstructive azoospermia who underwent seminal tract re-anastomosis from April 2008 to March 2012 at 25 institutions were enrolled in the present study. The outcomes of the procedure were compared with those reported in a previous multi-institutional study carried out in 2000. RESULTS: The percentage of partners aged over 35 years was 37%...
February 2015: International Journal of Urology: Official Journal of the Japanese Urological Association
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