title: The significance of sperm heads and tails within the vasal fluid during vasectomy reversal.
abstract: BACKGROUND
  The finding of only sperm heads and/or short tails (SHST) during vasectomy reversal (VR) creates a difficult decision for the best method of vasal reconstruction, i.e. vasovasostomy (VV) or epididymovasostomy (EV). Using outcome analyses, we report the impact of SHST alone and combined with qualitative analysis of gross fluid quality in predicting successful VR.
  
  
  METHODS
  The records of 356 men who underwent VR by a single surgeon from 2005 to 2012 were retrospectively reviewed. Intravasal fluid was assessed for gross quality (i.e., clear, opaque, pasty or creamy) as well as microscopic composition (i.e., motile or non-motile whole sperm, SHST or no sperm). The post-operative patency rates and semen analysis parameters were assessed.
  
  
  RESULTS
  Fourteen men (3.9%) demonstrated SHST bilaterally in the vasal fluid. The median duration from vasectomy was 6.0 years (interquartile range 4.0-9.8). Bilateral VVs were performed on 12 men (86%), while two men (14%) had a unilateral VV and a contralateral EV. Of the 26 vasa undergoing VR, the majority of the fluid quality was classified as creamy (n = 20 vasa, 76.9%). The remaining fluid was classified as pasty (n = 3 vasa, 11.5%), opaque (n = 2 vasa, 7.7%) and clear (n = 1 vasa, 3.8%). In cases undergoing bilateral VV with only SHST, patency rates were 90.9%, and both cases of unilateral EV were patent (100%).
  
  
  CONCLUSIONS
  VV was successful in 90.9% of patients undergoing VR in the setting of SHST alone. Even when creamy or pasty fluid was present, the results surpassed the expected patency rate for an EV. Therefore, the presence of only SHST, regardless of fluid quality, should not dissuade the surgeon from performing a VV.
  
  
  CONCLUSIONS
  VV was successful in 90.9% of patients undergoing VR in the setting of SHST alone. Even when creamy or pasty fluid was present, the results surpassed the expected patency rate for an EV. Therefore, the presence of only SHST, regardless of fluid quality, should not dissuade the surgeon from performing a VV.
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Khanna
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kovac
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Niraj
authors.initials: N
authors.lastname: Badhiwala
authors.affiliation: Department of Urology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Coward
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
keywords: Infertility; male; spermatozoa; vasectomy reversal; vasovasostomy
references.citation: J Urol. 2005 Feb;173(2):540-2
references.pmid: 15643242
references.citation: J Am Med Assoc. 1948 Jan 17;136(3):162
references.pmid: 18920081
references.citation: Urology. 2002 Nov;60(5):885-8
references.pmid: 12429321
references.citation: Urology. 2003 Jun;61(6):1221-3
references.pmid: 12809901
references.citation: J Urol. 2003 Jun;169(6):2250-2
references.pmid: 12771762
references.citation: J Urol. 1983 Mar;129(3):524-7
references.pmid: 6834537
references.citation: J Urol. 1991 Mar;145(3):505-11
references.pmid: 1997700
references.citation: J Urol. 2012 Jan;187(1):215-8
references.pmid: 22099990
references.citation: J Urol. 2004 Jan;171(1):307-9
references.pmid: 14665901
references.citation: Andrologia. 2001 May;33(3):125-34
references.pmid: 11380327
references.citation: J Urol. 1998 Jan;159(1):188-90
references.pmid: 9400469
references.citation: Fertil Steril. 2008 Nov;90(5 Suppl):S78-82
references.pmid: 19007653
references.citation: J Urol. 2004 Sep;172(3):1048-50
references.pmid: 15311035
references.citation: J Urol. 2004 Jan;171(1):311-5
references.pmid: 14665903
references.citation: J Urol. 1999 Jun;161(6):1835-9
references.pmid: 10332448
references.citation: J Androl. 2003 Jan-Feb;24(1):22-4
references.pmid: 12514075
references.citation: J Androl. 2006 Jul-Aug;27(4):565-7
references.pmid: 16582406
references.citation: Hum Reprod. 1989 Apr;4(3):318-22
references.pmid: 2715309
references.citation: Urol Clin North Am. 2009 Aug;36(3):375-82
references.pmid: 19643239