Archives of Urology ISSN: 2638-5228 Volume 2, Issue 2, 2019, PP: 9-23 An Updates on Techniques of Microsurgical Vasectomy Reversal- A Mini Review Dr. Kulvinder Kochar Kaur, MD1*, Dr. Gautam Allahbadia, MD (Obstt & Gynae), D. N. B2 Dr. Mandeep Singh, MD, DM. (Std) (Neurology) 1 2 Scientific3 Director, Dr Kulvinder Kaur Centre for Human Reproduction, Punjab, India. Scientific Director, Ex-Rotunda-A*kulvinder. Centre dr@gmail. for Human com reproduction, Mumbai, India. Consultant Neurologist, Swami Satyanand Hospital, Punjab, India. *Corresponding Author: Dr. Kulvinder Kochar Kaur, MD, Scientific Director, Dr Kulvinder Kaur Centre for Human Reproduction, Punjab, India. Abstract Following sterilization by vasectomy, men my need future fertility, either due to the loss of a child or a new marriage. Following vasectomy reversal there have been a lot of advances in the field to improve the patency and pregnancy rates, although in the modern era of assisted reproductive technology they are usually not counseled with the ease of sperm retrieval and IVF/ICSI. Here we carried out a systematic analysis using the MeSH terms on the search engine Pubmed, like ‘’vasectomy reversal’’, ’’vasovasostomy’(VV)’, ’’vasoepididymostomy’’(VE), ’’optimizing success’’, ’’different sutures’’ to be used, ’’most modern techniques’’ like robotic assisted VV or VE, Video microscopy, analysis of vasal fluid‘’. We found a total of 1200 articles, out of which we selected 75 articles for this review. No meta-analysis was carried out. Further emphasis has been laid on the training of new urologists to learn this complicated technique so that natural conception can be sought for. Further techniques of some complicated cases are described. Keywords: VV; VE; Vasectomy reversal; IVF/ICSI/Vasal fluid Introduction reversal in length, based on the recent evidence. The advances made recently in surgical technique and Vasectomy reversal is the recommended method how they contribute to this surgery are to be critically of reversing sterilization in men desiring fertility analyzed. Since they are technically problematic subsequently. With marked improvements in stress is put on role of microsurgical training, that techniques in the last 4 decades, high patency rates includes the current knowledge which are improving and favourable pregnancy outcomes following reconstruction can be expected. Though there are other treatment options that are available for these theEvaluation education in to this be field. done Preoperatively patients with post vasectomy obstructive azoospermia Preoperative examination of men with suspected OA starts with a proper history taking and thorough techniques, vasectomy reversal is the only method (OA) meaning different kinds of sperm retrieval which allows natural conception. Further Vasectomy the cause of azoospermia whether obstructive (OA) orexamination non obstructive physically. azoospermia Main idea (NOA). of this Specially is to find on in contrast to sperm retrieval to be used for IVF (in examination of the spermatic cord, a heating blanket reversal has also been found to be more cost effective vitro fertilization)/ICSI (Intracytoplasmic injection). or hot pack is placed with the idea of warming the Still the success of Vasectomy reversal is based on scrotum, thus relaxing the scrotal dartos muscle. Still and proper selection of subjects. The aim of this review this early examination can be further increased in case isgood to highlightclinical judgement, the treatment efficient approach microsurgical for vasectomy skills ofno borderline sign or symptom cases. is 100% sensitive or specific and Archives of Urology V2 . I2 . 2019 9 An Updates on Techniques of Microsurgical Vasectomy Reversal- A Mini Review I laboratory examination is usually not needed, like an best chances of success get obtained when the interval earlyIn case history of aof vasectomy.clear causative But in absencefactor identification, of vasectomy, n the work done by the Vaso-vasostomy Study Group, vasalof obstruction encounters was the under outcomes 3 years kept (patency on worsening, rate 97%, timeor if patient testosterone had difficulty (T) level. in Thisgetting discrimination a pregnancy, ofprior OA withpregnancy 15 plus rate years 76% of [7]. obstruction With increasing leading durationto patency of vsto sterilization,NOA was carried it is betterout by to Schoor get an et FSH al. and[1]. morningA length of testis of a minimum 4. 6cm, in combination with Once obstructive interval rises chances of secondary epididymaland pregnancy increase rates occursof 71%and and 30%thus respectively.the patient OA in 96% of the patients. With this the preoperative testicularan FSH level<7.6mIU/ml, biopsy has got identifiespractically subjects removed having for diagnosing. Though useful, the Schoor criteria will laterequires failures, both besides vasoepididymostomy reduced pregnancy (VE). rates, Technically inspite wrongly diagnose obstruction in roughly 1in 20 men. ofVE patencyis more difficult, getting withdemonstrated greater likelihood [8, 9]. Fuch’sof early etal. and Subjects with NOA, having an appropriate testicular showed a 50% increase in the probability of needing one of the biggest published series. Performance rate examinedsize, and a aFSH cohort value of <7.6mIU/ml, 600 men who usually presented have somewith a VE for every 3 year period following vasectomy in NOAform whereof maturation services arrest were on provided histology. by Hung a single et al. unit. [2] 4.3% of the subjects had a testicular length >4.6cm exposureof VE falls following once the spermatogenesislevel of obstruction [11, reaches 12]. Since the efferent ducts, secondary to inadequate epididymal be needed, many groups have chalked out extra and a normal FSH level, with maturation arrest on presenting with maturation arrest, observed both preoperativethe prognosis predictors is based largely for this on setting. if bilateral McCammack VE will biopsy. Even Tsai et al. [3] on examination of men et al. [13] tried to use magnetic resonance imaging for in 38% of the cohort they studied. Because of this laying down the prognosis of requirement of IVF in OA. testis volume and a FSH level below the threshold any reproductive urologist who asks the patient for They had a small cohort of 10 subjects with known OA, reconstructive surgery needs to know the limitations a 19. 4% increase in epididymal T1intensity predicted of the basic laboratory tests, since operative plan may change dramatically in the possible misdiagnosis. Serum antisperm antibodies assessment is useful for the need for VE in 90% of subjects. Follow up studies are required to confirm these findings which are mightconsisting prove of alarge useful cohorts. tool for Once prediction McCammack’s of epididymal finding confirming spermatogenesis; A high positive assay get confirmed, magnetic resonance imaging (MRI) confirmsMostly imaging the diagnosis studies in don’t case giveof OA much [4]. information, but for suspected ejaculatory duct obstruction, where instead of vasovasostomy (VV). Patients need to obstruction and the subsequent requirement of VE a transrectal ultrasound shows dilated seminal vesicles and/or ejaculatory ducts or midline cysts might be needed as patency and pregnancy rates are typically understand prior to the surgery that bilateral VE is additional data over physical examination in case of In terms of importance this impact of interval since diagnostic. Ultrasonography (USG) doesn’t provide any reduced in such circumstances [7]. vasal gaps, presence or absence of a sperm granuloma, obstruction has not been clear in contemporary or testicular size (if an orchid meter is utilized). Only series [14, 15]. Still most of literature implicates that the interval of obstruction remains one of the most important factor regarding preoperative counseling way USG might be helpful is in getting the diameter [16]. Other important factor in preoperative of caput epidymis, which will differentiate OA/NOA, –all these are the most important points regarding counseling is whether sperm granuloma is present. It is but not for a specific patient having maturation arrest preoperative examination [5]. Further fullness of the considered that a sperm granuloma provides a passage epidydimis might not be present in men having OA, to relieve vasal pressure, thus decreasing the risk of where obstruction is at the level of rete testis, which may be present in 15% of men with OA [6]. In contrast to obstruction interval, sperm granuloma wassecondary considered epidymal favourable obstruction in older by ‘’blowout’’ series, having [17]. should include anticipated reconstructive outcomes. more studies recently showing little or no predictive On confirming obstruction, further patient counseling 10 Archives of Urology V2 . I2 . 2019 An Updates on Techniques of Microsurgical Vasectomy Reversal- A Mini Review for these cases where IVF is unavoidable, utilization value [7, 14, 15, 18]. Boorjian et al. presented a large ofsperm vasectomy retrieval reversal is the has best decreased option. Howevermarkedly exceptin the inexperience patency ratesof a single following surgeon, a vasectomy finding more reversal chance (95% of post –ICSI era. Although many cases of increased use statistical significance (p=0.07) regarding difference family building [23]. It is clear that with increasing granuloma,vis a vis 78% since for subjectsa granuloma without might a palpable be pointing sperm maternalof ART, exist, age onethere major is an cause inverse is thatrelation women