Grafting Techniques for Vasectomy Reversal

  • Henry M. RosevearEmail author
  • Moshe Wald


Grafting of the male reproductive tract is an exciting new area of tissue engineering which may allow natural conception for patients with significant lengths of obstructed vas deferens. While stents had a significant and important role in increasing patency and pregnancy rates in the pre-microsurgical era, their role in the modern era of microsurgical two-layered anastomosis remains to be defined. To date, if the vasal obstruction is amenable to a primary watertight, tension-free anastomosis, microsurgical non-stented techniques remain the gold standard. Cases where a tension-free anastomosis is not possible because of the physical length of the obstruction remain problematic, but further research into tissue engineering in the form of implantable conduits holds much promise.


Partial vasal agenesis Congenital prostatic cysts Obstruction of the vas deferens Two-layered vasovasostomy Microsurgical two-layered anastomosis Spontaneous recanalization Tuberculous epididymitis Gonorrheal urethritis Obstructive epididymitis Chlamydial epididymitis 



We would like to thank Kris Greiner for her editorial assistance in preparing this chapter.


  1. 1.
    Barone MA, Hutchinson PL, Johnson CH, et al. Vasectomy in the United States, 2002. J Urol. 2006;176:232–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Magnani RJ, Haws JM, Morgan GT, et al. Vasectomy in the United States, 1991 and 1995. Am J Public Health. 1999;89:92–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Holman CD, Wisniewski ZS, Semmens JB, et al. Population-based outcomes after 28,246 in-hospital vasectomies and 1,902 vasovasostomies in Western Australia. BJU Int. 2000;86:1043–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Schiff J, Li PS, Goldstein M. Toward a sutureless vasovasostomy: use of biomaterials and surgical sealants in a rodent vasovasostomy model. J Urol. 2004;172:1192–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Castaldo G, Tomaiuolo R, Vanacore B, et al. Phenotypic discordance in three siblings affected by atypical cystic fibrosis with the F508del/D614G genotype. J Cyst Fibros. 2006;5:193–5.PubMedCrossRefGoogle Scholar
  6. 6.
    Stricker H, Kunin J, Faerber G. Congenital prostatic cyst causing ejaculatory duct obstruction: management by transrectal cyst aspiration. J Urol. 1993;149:1141–3.PubMedGoogle Scholar
  7. 7.
    Engin G, Kadioglu A, Orhan I, et al. Transrectal US and endorectal MR imaging in partial and complete obstruction of the seminal duct system. A comparative study. Acta Radiol. 2000;41:288–95.PubMedCrossRefGoogle Scholar
  8. 8.
    Handelsman DJ, Conway AJ, Boylan LM, et al. Young’s syndrome. Obstructive azoospermia and chronic sinopulmonary infections. N Engl J Med. 1984;310(1):3–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Thomas AH, Sabanegh Jr ES. Microsurgical treatment of male infertility. In: Lipshultz LI, Howards SS, Niederberger CS, editors. Infertility in the Male. 4th ed. New York: Cambridge University; 2009. p. 392–406. A very well written summary of current microsurgical surgical techniques.Google Scholar
  10. 10.
    Kolettis PN, Woo L, Sandlow JI. Outcomes of vasectomy reversal performed for men with the same female partners. Urology. 2003;61:1221–3.PubMedCrossRefGoogle Scholar
  11. 11.
    Silber SJ. Microscopic vasectomy reversal. Fertil Steril. 1977;28:1191–202.PubMedGoogle Scholar
  12. 12.
    Vrijhof HJ, Delaere KP. Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres. Urol Int. 1994;53:143–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Belker AM, Thomas Jr AJ, Fuchs EF, et al. “Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145:505–11.PubMedGoogle Scholar
  14. 14.
    Vrijhof EJ, de Bruine A, Zwinderman A, et al. New nonabsorbable stent versus a microsurgical procedure for vasectomy reversal: evaluating tissue reactions at the anastomosis in rabbits. Fertil Steril. 2005;84:743–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Carbone Jr DJ, Shah A, Thomas Jr AJ, et al. Partial obstruction, not antisperm antibodies, causing infertility after vasovasostomy. J Urol. 1998;159:827–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Practice Committee of the American Society for Reproductive Medicine. Vasectomy reversal. Fertil Steril. 2008;90:S78–82.Google Scholar
  17. 17.
    Lipshultz LI, Rumohr JA, Bennett RC. Techniques for vasectomy reversal. Urol Clin North Am. 2009;36:375–82. The most recent definitive treatise on surgical techniques.PubMedCrossRefGoogle Scholar
  18. 18.
    Kolettis PN. Restructuring reconstructive techniques—advances in reconstructive techniques. Urol Clin North Am. 2008;35:229–34.PubMedCrossRefGoogle Scholar
  19. 19.
    Derrick Jr FC, Yarbrough W, D’Agostino J. Vasovasostomy: results of questionnaire of members of the American Urological Association. J Urol. 1973;110:556–7.PubMedGoogle Scholar
  20. 20.
    Kim HH, Goldstein M. History of vasectomy reversal. Urol Clin North Am. 2009;36:359–73. A concise and fascinating summary of the history of the vasectomy reversal.PubMedCrossRefGoogle Scholar
  21. 21.
    Amelar RD, Dubin L. Vasectomy reversal. J Urol. 1979;121:547–50.PubMedGoogle Scholar
  22. 22.
    Dorsey JW. Surgical correction of post-vasectomy sterility. J Urol. 1973;110:554–5.PubMedGoogle Scholar
  23. 23.
    Montie JE, Stewart BH, Levin HS. Intravasal stents for vasovasostomy in canine subjects. Fertil Steril. 1973;24:877–83.PubMedGoogle Scholar
  24. 24.
    Fernandes M, Shah KN, Draper JW. Vasovasostomy: improved microsurgical technique. J Urol. 1968;100:763–6.PubMedGoogle Scholar
  25. 25.
    Rowland R, Nanninga JB, O’Connor VJ. Improved results in vasovasostomies using internal plain catgut stents. Urology. 1977;10:260–2.CrossRefGoogle Scholar
  26. 26.
    Silber SJ. Microsurgery in clinical urology. Urology. 1975;6:150–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. Aust N Z J Surg. 1977;47:305–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Silber SJ, Galle J, Friend D. Microscopic vasovasostomy and spermatogenesis. J Urol. 1977;117:299–302.PubMedGoogle Scholar
  29. 29.
    Silber SJ. Vasectomy and vasectomy reversal. Fertil Steril. 1978;29:125–40.PubMedGoogle Scholar
  30. 30.
    Flam TA, Roth RA, Silverman ML, et al. Experimental study of hollow, absorbable polyglycolic acid tube as stent for vasovasostomy. Urology. 1989;33:490–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Rothman I, Berger RE, Cummings P, et al. Randomized clinical trial of an absorbable stent for vasectomy reversal. J Urol. 1997;157:1697–700.PubMedCrossRefGoogle Scholar
  32. 32.
    Nudell DM, Conaghan J, Pedersen RA, et al. The mini-micro-epididymal sperm aspiration for sperm retrieval: a study of urological outcomes. Hum Reprod. 1998;13:1260–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Miller C, Shanks H, Witt A, et al. Oriented Schwann cell growth on micropatterned biodegradable polymer substrates. Biomaterials. 2001;22:1263–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Kamischke A, Nieschlag E. Analysis of medical treatment of male infertility. Hum Reprod. 1999;14 Suppl 1:1–23.PubMedCrossRefGoogle Scholar
  35. 35.
    Romero-Maroto J, Escribano G, Egea L, et al. Transplant of a pediculate segment of vas deferens. Experimental study. Eur Urol. 1989;16:133–7.PubMedGoogle Scholar
  36. 36.
    Gilis J, Borovikov AM. Treatment of vas deferens large defects. Int Urol Nephrol. 1989;21:627–34.PubMedCrossRefGoogle Scholar
  37. 37.
    Carringer M, Pedersen J, Schnurer LB. Experimental vas replacement by either vas or a vascular graft. Scan J Urol Neprhol. 1995;29:97–102.CrossRefGoogle Scholar
  38. 38.
    Rutkowski GE, Miller CA, Jeftinija S, et al. Synergistic effects of micropatterned biodegradable conduits and Schwann cells on sciatic nerve regeneration. J Neural Eng. 2004;1:151–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Miller C, Jeftinija S, Mallapragada S. Synergistic effects of physical and chemical guidance cues on neurite alignment and outgrowth on biodegradable polymer substrates. Tissue Eng. 2002;8:367–78.PubMedCrossRefGoogle Scholar
  40. 40.
    Labrecque M, Hays M, Chen-Mok M, et al. Frequency and patterns of early recanalization after vasectomy. BMC Urol. 2006;6:25.PubMedCrossRefGoogle Scholar
  41. 41.
    Stahl BC, Ratliff TL, De Young BR, et al. Involvement of growth factors in the process of post-vasectomy micro-recanalization. J Urol. 2008;179:376–80.PubMedCrossRefGoogle Scholar
  42. 42.
    Simons CM, De Young BR, Griffith TS, et al. Early microrecanalization of vas deferens following biodegradable graft implantation in bilaterally vasectomized rats. Asian J Urol. 2009;11:373–8.Google Scholar
  43. 43.
    Koneru S, Varma Penumathsa S, Thirunavukkarasu M, et al. Sildenafil-mediated neovascularization and protection against myocardial ischaemia reperfusion injury in rats: role of VEGF/angiopoietin-1. J Cell Mol Med. 2008;12:2651–64.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of UrologyUniversity of IowaIowa CityUSA

Personalised recommendations