title: Current status of vasectomy reversal.
abstract: Vasectomy reversal is the most common microsurgical intervention for the treatment of male infertility. Originally introduced in 1977, microsurgical vasectomy reversal has become highly sophisticated and is a minimally invasive, highly efficient and cost-effective treatment option for men with a desire to have children after vasectomy. It can be an effective physiological method of restoring fertility in more than 90% of vasectomized men. Although assisted reproductive technology (ART) is an alternative to vasectomy reversal, it is normally associated with higher costs without offering higher cumulative chances of a pregnancy. Recovery of physiological male fertility can take up to 2 years after vasectomy reversal, especially if reversal is performed >10 years after vasectomy, owing to impaired epididymal function. Under these circumstances, ART can be used to bridge the time until recovery of natural fertility. Although the basic principles of microsurgical vasovasostomy have been established since the late 1970s, there have since been numerous technical innovations to improve the delicate operation and promising new technical modifications, particularly for vasoepididymostomy, have been described. Robotic vasectomy reversal is an emerging field in specialized urologic centers, but whether the high quality of conventional microsurgical vasectomy reversal can be matched by robotic platforms is yet to be seen.
authors: Department of Microsurgery, Andrologie Centrum München, München, Germany. schwarzer@andromuc.de
authors: J Ullrich
authors: JU
authors: Schwarzer
authors: Heiko
authors: H
authors: Steinfatt
mesh_terms: D000818:Animals; D004822:Epididymis / Q000166:cytology / Q000502:physiology; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods* / Q000639:trends; D011247:Pregnancy; D014669:Vasovasostomy / Q000379:methods* / Q000639:trends
references: BMC Med. 2004 May 24;2:21
references: 15157272
references: Urol Clin North Am. 2004 Nov;31(4):769-72
references: 15474604
references: Fertil Steril. 2007 Jun;87(6):1340-4
references: 17258213
references: J Urol. 1997 Feb;157(2):518-20
references: 8996346
references: Urology. 1997 Sep;50(3):438-42
references: 9301713
references: Nat Clin Pract Urol. 2006 Jul;3(7):381-91
references: 16835626
references: J Urol. 2005 Feb;173(2):540-2
references: 15643242
references: BJU Int. 2005 Oct;96(6):864-6
references: 16153218
references: Fertil Steril. 2008 Nov;90(5 Suppl):S78-82
references: 19007653
references: Urology. 1995 Oct;46(4):591-602
references: 7571238
references: J Urol. 2008 Jan;179(1):256-9
references: 18001786
references: J Urol. 1998 Jan;159(1):188-90
references: 9400469
references: N Engl J Med. 2009 Jan 15;360(3):236-43
references: 19144939
references: Curr Opin Urol. 2010 Nov;20(6):503-9
references: 20852426
references: Postgrad Med J. 2006 Nov;82(973):743-7
references: 17099094
references: J Urol. 2012 Feb;187(2):385-6
references: 22177139
references: J Urol. 1998 Jan;159(1):139-41
references: 9400456
references: Fertil Steril. 1983 Nov;40(5):699-700
references: 6628717
references: J Urol. 2003 Jun;169(6):2250-2
references: 12771762
references: Fertil Steril. 1979 Sep;32(3):253-60
references: 114428
references: Urology. 1997 Nov;50(5):659-64
references: 9372871
references: J Urol. 2012 Feb;187(2):602-6
references: 22177177
references: J Androl. 2004 Nov-Dec;25(6):845-59
references: 15477352
references: Proc Natl Acad Sci U S A. 2011 May 3;108(18):7511-6
references: 21502500
references: J Urol. 2005 Aug;174(2):651-5; quiz 801
references: 16006931
references: Fertil Steril. 1998 Nov;70(5):799-810
references: 9806556
references: J Urol. 1994 Apr;151(4):892-4
references: 8126819
references: Microsc Res Tech. 1995 Jan 1;30(1):82-100
references: 7711322
references: Eur Urol. 1994;26(4):322-6
references: 7713131
references: J Reprod Immunol. 1999 Dec;45(2):159-83
references: 10674982
references: Contraception. 1986 Jun;33(6):529-32
references: 3769480
references: Ann Surg. 2005 Apr;241(4):553-8
references: 15798455
references: Urol Int. 2003;70(2):119-23
references: 12592040
references: Lancet. 1977 Sep 17;2(8038):588-9
references: 71402
references: J Urol. 2004 Jan;171(1):304-6
references: 14665900
references: J Androl. 2003 May-Jun;24(3):293-8
references: 12721203
references: Urol Clin North Am. 2009 Aug;36(3):359-73
references: 19643238
references: J Androl. 2006 Jul-Aug;27(4):565-7
references: 16582406
references: Urol Clin North Am. 2009 Aug;36(3):375-82
references: 19643239
references: J Urol. 1995 Dec;154(6):2070-3
references: 7500460
references: J Urol. 1998 Mar;159(3):827-30
references: 9474160
references: Hum Reprod. 1989 Apr;4(3):318-22
references: 2715309
references: Asian J Androl. 2010 Nov;12(6):793-4
references: 20835256
references: Hum Reprod. 2005 Feb;20(2):328-38
references: 15567881
references: Urologe A. 2012 Aug;51(8):1099-105
references: 22733399
references: J Androl. 2006 Jul-Aug;27(4):481-2
references: 16614322
references: J Urol. 2005 Nov;174(5):1935-7
references: 16217349
references: J Urol. 1991 Mar;145(3):505-11
references: 1997700
references: J Urol. 1999 Apr;161(4):1153-6
references: 10081859
references: N Engl J Med. 1985 Nov 14;313(20):1283-5
references: 4058509
references: J Urol. 2007 Jun;177(6):2272-6
references: 17509339
references: Fertil Steril. 1979 Nov;32(5):546-50
references: 499585
references: Hum Reprod. 1999 Sep;14 Suppl 1:71-81
references: 10573025
references: J Urol. 2000 Feb;163(2):483-6
references: 10647661
references: Urology. 2007 Apr;69(4):800-4
references: 17445685
references: Int J Androl. 2012 Oct;35(5):706-13
references: 22519558
references: Urol Clin North Am. 2009 Aug;36(3):391-6
references: 19643241
references: J Urol. 2006 Jul;176(1):232-6; discussion 236
references: 16753407
references: J Endourol. 2010 Apr;24(4):511-4
references: 19839783
references: Biol Reprod. 1989 Feb;40(2):353-60
references: 2720032
references: Fertil Steril. 2000 May;73(5):923-36
references: 10785217
references: J Urol. 1999 Nov;162(5):1626-8
references: 10524883
references: Int J Comput Assist Radiol Surg. 2012 Jan;7(1):27-34
references: 21573828
references: Microsurgery. 1995;16(5):325-32
references: 7565023
references: BJU Int. 2005 Sep;96(4):598-601
references: 16104917
references: Fertil Steril. 1977 Nov;28(11):1191-202
references: 923835
references: J Urol. 2012 Feb;187(2):613-7
references: 22177173
references: J Urol. 2000 Dec;164(6):1939-42
references: 11061886
references: Urology. 2005 May;65(5):968-71
references: 15882733
references: J Reconstr Microsurg. 2012 Sep;28(7):435-44
references: 22744901
references: Indian J Urol. 2010 Jul;26(3):395-403
references: 21116362
references: Fertil Steril. 1997 Jan;67(1):133-41
references: 8986698
references: Eur Urol. 2012 Jan;61(1):159-63
references: 22033172
references: Hum Reprod. 1989 Nov;4(8):947-53
references: 2613866
references: J Obstet Gynaecol Can. 2011 Nov;33(11):1165-1175
references: 22082792
references: Fertil Steril. 2004 Aug;82(2):367-73
references: 15302285
references: J Urol. 2012 Feb;187(2):607-12
references: 22177169
references: Aust N Z J Surg. 1977 Jun;47(3):305-9
references: 269700
references: Fertil Steril. 2002 Mar;77(3):516-9
references: 11872205
references: Urol Clin North Am. 2009 Aug;36(3):383-90
references: 19643240
references: J Urol. 1998 Jun;159(6):1951-3
references: 9598495
references: Fertil Steril. 2007 Jul;88(1):217-9
references: 17336963
references: J Urol. 2012 Dec;188(6 Suppl):2482-91
references: 23098786
references: J Urol. 2008 Apr;179(4):1506-9
references: 18295271