Toward a sutureless vasovasostomy: use of biomaterials and surgical sealants in a rodent vasovasostomy model.
OBJECTIVE
With 500,000 to 800,000 vasectomies performed annually and a reversal rate of 3% to 8% vasectomy reversal has become a commonly performed procedure. Two-layer microsurgical vasovasostomy remains the gold standard for surgical reconstruction of the vas. However, this procedure is technically demanding and time-consuming. We determined the ability of biomaterials and surgical sealants to decrease the number of sutures used, enhance anastomosis watertightness and decrease operative time.


METHODS
Adult male Wistar rats underwent vasectomy 2 weeks prior to vasovasostomy. Standard 2-layer microsurgical repair was performed in control animals. Experimental groups underwent 3-suture mucosal approximation and then completion of the anastomosis with a biomaterial membrane and/or synthetic sealant. The rats were sacrificed 9 weeks after vasovasostomy. Anastomotic patency was assessed functionally by the presence of motile sperm in the vas distal to the testes and anastomosis, and mechanically by methylene blue vasogram. The presence and size of sperm granulomas were also recorded.


RESULTS
Microsurgical vasovasostomy required significantly less time when biomaterial (42.7 minutes) or sealant (40 minutes) was used compared to the standard sutured group (102.5 minutes, each p < 0.001). There was no difference in patency between the standard sutured and biomaterial groups (90% vs 92%). Patency was significantly lower in the sealant groups, that is 70% in the suture, biomaterial and sealant group, and 75% in the suture and sealant group. The biomaterial group had only 1 sperm granuloma in 12 procedures, which was significantly better than the 7 in the control group (p <0.001).


CONCLUSIONS
Using a biomaterial wrap during vasovasostomy resulted in significantly decreased operative time and fewer sperm granulomas than in the control group. Sealants were not effective. Biomaterial wrap may support vasovasostomy and by decreasing leakage improve the outcome.
Schiff
Jonathan
J
Department of Urology and Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine, New York Presbyterian Hospital-Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
Li
Philip S
PS
Goldstein
Marc
M
D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D006859:Hydrogen; D008297:Male; D008866:Microsurgery / Q000379:methods; D011108:Polymers; D051381:Rats; D017208:Rats, Wistar; D013537:Sutures; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014669:Vasovasostomy / Q000379:methods*
D001672:Biocompatible Materials; D011108:Polymers; D014014:Tissue Adhesives; D006859:Hydrogen