Performing vasectomy reversal? Use a microscope

In the retrospective study from Bundang CHA Hospital in Sungnam, researchers found a 24% higher patency rate in patients who underwent microsurgical vasovasostomy using 9-0 nylon compared with those who underwent a loupe-assisted technique using 8-0 nylon. However, the improved patency rate of the microsurgical technique did come at the expense of a significantly longer operation time than that of the loupe-assisted approach.

"We conclude that the additional time and effort required for a microsurgical vasovasostomy are worthwhile to obtain a superior patency rate," said first author Young Kwon Hong, MD, assistant professor of urology at Bundang CHA Hospital, who presented the group's findings at the AUA annual meeting.

Dr. Hong and colleagues decided to take a scientific approach to determine which of the two techniques provided better outcomes. The researchers retrospectively reviewed the charts and records of all surgical procedures performed on a series of 50 patients who had one-layer vasovasostomy between 2003 and 2005. Twenty-five patients underwent microsurgical vasovasostomy, and 25 underwent loupe-assisted vasovasostomy. The loupe-assisted procedures were performed during a time when the microscope was not available.

The two patient groups were similar in terms of age (mean of 39.1 and 38.7 years in the microsurgical and loupe-assisted groups, respectively) and time to reversal (mean of 7.1 and 6.9 years, respectively). Patients underwent semen analysis at the first, third, and sixth months after surgery. Success was defined as the presence of motile sperm after 6 months. Postoperative stricture was defined as a loss of motile sperm found at the first or third postoperative month.

Longer, but better operation

Results showed that the microsurgical technique took significantly longer to perform than the loupe-assisted technique (mean operative times: 106.4 and 78.3 minutes, respectively, p=.026). However, microsurgical vasovasostomy proved to be the better technique in terms of patency, providing a 96% patency rate (24 of 25 patients), compared with a 72% rate (18 of 25) for the loupe-assisted technique (p=.021). No significant differences were observed between the two groups in terms of postoperative sperm concentration and motility.

Postoperative stricture occurred in four patients in the loupe-assisted group and none in the microsurgical group. No other surgery-related complications (eg, hematoma, wound infection) occurred in either group. The cost of microscopic surgery is about $800, compared with about $670 for macroscopic surgery under medical insurance in Korea, Dr. Hong said.

"Time, cost, and efforts required for microsurgical vasovasostomy are worthwhile to obtain a higher patency rate and a lower probability of postoperative vasal stricture," he concluded.