Vasovasostomy 1832433 208109245 2008-04-25T14:09:34Z Pdbs 3968402 Reverted edits by Infertilityws (talk) to last version by Pdbs (2007) {{Refimprove|date=August 2007}} {{Interventions infobox | Name = {{PAGENAME}} | Image = | Caption = | ICD10 = | ICD9 = 63.82 | MeshID = D014669 | OtherCodes = | }} '''Vasovasostomy''' (literally connection of the [[vas deferens|vas ]] to the vas) is the surgery by which [[Vasectomy| vasectomies]] are reversed in males. It can be performed in the convoluted or straight portion of the vas deferens.<ref name="pmid18001786">{{cite journal |author=Patel SR, Sigman M |title=Comparison of outcomes of vasovasostomy performed in the convoluted and straight vas deferens |journal=[[J. Urol.]] |volume=179 |issue=1 |pages=256–9 |year=2008 |pmid=18001786 |doi=10.1016/j.juro.2007.08.169 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5347(07)02349-X}}</ref> ==Limitations== In most cases the [[vas deferens]] can be reattached but, in many cases, fertility is not achieved.{{Fact|date=March 2008}} There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal [[spermatozoon|sperm]] activity. If blockage at the level of the [[epididymis]] is suspected, a vaso-epidymostomy (connecting the vas to the epididymis) can be performed. Return of sperm to the ejaculate ranges from roughly 30 to 90 percent, and may depend greatly on the length of time from the vasectomy. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy is somewhat lower (30 to 60 percent), and can depend on female partner factors. Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature but, there is agreement that antibodies reduce sperm [[motility]]. ==Process== The procedure is typically performed by [[urology| urologists]]. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional [[anesthesia]]. Vasovasostomy is typically an out-patient procedure (patient goes home the same day). ==Prognosis== Determining the prognosis for each patient may involve a pre-operative examination of the vasectomy sites and consideration of the time interval between vasectomy and reversal. If there are no granulomas at either vasectomy site, the prognosis may then be based on the time interval since the vasectomy. If the interval since the vasectomy is less than fifteen years, the prognosis will likely be 70% or better.{{Fact|date=August 2007}} The prognosis for each patient should be determined by a pre-operative examination of the vasectomy sites besides consideration of the time interval between vasectomy and reversal. A local urologist can easily determine whether you have 0, 1, or 2 sperm granulomas by a painless examination of each vasectomy site. This exam can be fairly inexpensive, if you inform his office in advance that this is the only service you wish and you obtain the cost for only this specific examination. If a patient has a sperm granuloma at one of his vasectomy sites, the time interval becomes almost unimportant. If there is no granuloma at either vasectomy site, the prognosis is then based completely on the time interval since the vasectomy. [[sperm granuloma]] A sperm granuloma as a hard knot at least the size of a BB-gun BB, often a little larger, at the tip of the lower vas end, which is usually next to the top of the testicle. A [[sperm granuloma]] develops from post-vasectomy sperm leakage and somehow it behaves like a safety valve preventing internal pressure build up and ruptures of the delicate epididymis tubules with subsequent obstructive scarring. [http://www.vasectomyreversal.com <I> Contributed by Donald R. Pohl, M.D.</I>] .{{Fact|date=August 2007}} ==References== {{reflist}} ==External links== * [http://www.vasectomyreversal.com/vastech.html <u>Vasovasostomy Techniques</u>] is a special page completely devoted to captioned illustrations of the Vasovasostomy Procedure with commentary on the different techniques. * [http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=154&x=16&y=17 Vasectomy Reversal] American Urological Association sponsored site. * [http://vasectomy.com/main.asp?siteid=R Vasectomy.com Articles on Vasectomy Reversal.] [[Category:Surgical procedures]] [[de:Vasovasostomie]] [[fr:Vasovasostomie]] [[pt:Vasovasostomia]]