Vasovasostomy.
Vasovasostomy after sterilisation vasectomy is the most frequently performed microsurgical intervention in refertilizing surgery. Causes for obstruction other than vasectomy such as juvenile hernia repair and other kinds of surgery affecting the seminal cord appear to be rare. The pre-operative diagnostic approach follows the rules of conventional diagnostics in male infertility. The significance of the intra-operative evaluation of aspirates from the duct and its role in surgical decision-making is controversely debated in the literature. Similar controversies are evident concerning the microsurgical technique that is applied. In particular, the advantages of the two-layered technique (gold standard) of the anastomosis versus the single-layered technique are discussed. Other techniques such as laser applications and fibrin glue are not routinely used in humans. Even difficult microsurgical problems in cases with extended obstructions and cases of re-vasovasostomy can nowadays be managed and have significant success rates. Important prognostic factors appear to be the interval of obstruction, sperm granulomas, and length of the testicular end of the duct. High success rates accompanied by a lower profile in cost make the microsurgical approach (refertilization) superior versus the primary use of ART techniques such as ICSI.
Schroeder-Printzen
I
I
Department of Urology, University Hospital, Justus Liebig University Giessen, Germany. immo.schroeder-printzen@chiru.med.uni-giessen.de
Diemer
Th
T
Weidner
W
W
D000328:Adult; D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013245:Sterilization, Reproductive; D014659:Vasectomy / Q000009:adverse effects / Q000379:methods; D014669:Vasovasostomy / Q000009:adverse effects / Q000379:methods*