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Predicting Reversal Success

  • Sheldon H. F. Marks
Chapter

Abstract

Predicting the success of an individual’s vasectomy reversal is difficult and cannot be done accurately preoperatively. Most experts agree that the success of a reversal is primarily dependent on the skill and expertise of the microsurgeon, even many years from vasectomy. The highest success rates with patency up to 99.5% and with the fewest complications are achieved by the most experienced. There are many surgeon and patient variables, some of which are fixed and others modifiable, that can impact on the success of the reversal. It is important to know and address many of these surgeon-related and patient factors that can have potential impact on the success of the reversal.

Keywords

Reversal success Vasovasostomy Vasoepididymostomy Microsurgery Obstructive interval Antisperm antibodies Sperm granuloma Testosterone Surgeon variables Patient variables 

References

  1. 1.
    Nagler HM, Jung H. Factors predicting successful microsurgical vasectomy reversal. Urol Clin North Am. 2009;36(3):383–90.CrossRefGoogle Scholar
  2. 2.
    Bolduc S, Fischer MA, Deceuninck G, Thabet M. Factors predicting overall success: a review of 747 microsurgical vasovasostomies. Can Urol Assoc J. 2007;1(4):388–94.CrossRefGoogle Scholar
  3. 3.
    Elzanaty S, Dohle GR. Vasovasostomy and predictors of vasal patency: a systematic review. Scand J Urol Nephrol. 2012;46(4):241–6.CrossRefGoogle Scholar
  4. 4.
    Shin YS, Kim SD, Park JK. Preoperative factors influencing postoperative results after vasovasostomy. World J Mens Health. 2012;30(3):177–82.CrossRefGoogle Scholar
  5. 5.
    Kovac JR, Lipshultz LI. Factors to consider for informed consent prior to vasectomy reversal. Asian J Androl. 2016;18(3):372.CrossRefGoogle Scholar
  6. 6.
    Crosnoe LE, Kim ED, Perkins AR, Marks MB, Burrows PJ, Marks SH. Angled vas cutter for vasovasostomy: technique and results. Fertil Steril. 2014;101(3):636–9.CrossRefGoogle Scholar
  7. 7.
    Perkins A, Marks M, Burrows P, Marks S. Sperm kinetics following vasectomy reversal. Androl. 2012;33(Suppl2):42.Google Scholar
  8. 8.
    Silber SJ, Grotjan HE. Microscopic vasectomy reversal 30 years later: a summary of 4010 cases by the same surgeon. J Androl. 2004;25(6):845–59.CrossRefGoogle Scholar
  9. 9.
    Aikoye A, Harilingam M, Khushal A. The impact of high surgical volume on outcomes from laparoscopic (totally extra peritoneal) inguinal hernia repair. J Clin Diagn Res. 2015;9(6):PC15–6.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Anderson BR, Ciarleglio AJ, Cohen DJ, Lai WW, Neidell M, Hall M, Glied SA, Bacha EA. The Norwood operation: relative effects of surgeon and institutional volume on outcomes and resource utilization. Cardiol Young. 2015;14:1–10.Google Scholar
  11. 11.
    David EA, Cooke DT, Chen Y, Perry A, Canter RJ, Cress R. Surgery in high-volume hospitals not commission on cancer accreditation leads to increased cancer-specific survival for early-stage lung cancer. Am J Surg. 2015;210(4):643–7.CrossRefGoogle Scholar
  12. 12.
    Esquivel MM, Molina G, Uribe-Leitz T, Lipsitz SR, Rose J, Bickler SW, Gawande AA, Haynes AB, Weiser TG. Proposed minimum rates of surgery to support desirable health outcomes: an observational study based on four strategies. Lancet. 2015;385(Suppl2):S12.CrossRefGoogle Scholar
  13. 13.
    Kalakoti P, Missios S, Menger R, Kukreja S, Konar S, Nanda A. Association of risk factors with unfavorable outcomes after resection of adult benign intradural spine tumors and the effect of hospital volume on outcomes: an analysis of 18,297 patients across 774 US hospitals using the National Inpatient Sample (2002-2011). Neurosurg Focus. 2015;39(2):E4.CrossRefGoogle Scholar
  14. 14.
    Shuhaiber J, Isaacs AJ, Sedrakyan A. The effect of center volume on in-hospital mortality after aortic and mitral valve surgical procedures: a population-based study. Ann Thorac Surg. 2015;100(4):1340–6.CrossRefGoogle Scholar
  15. 15.
    Mehta A, Li PS. Male infertility microsurgical training. Asian J Androl. 2013;15(1):61–6.CrossRefGoogle Scholar
  16. 16.
    Scallon SE, Fairholm DJ, Cochrane DD, Taylor DC. Evaluation of the operating room as a surgical teaching venue. Can J Surg. 1992;35(2):173–6.PubMedGoogle Scholar
  17. 17.
    Grober ED, Hamstra SJ, Wanzel KR, Reznick RK, Matsumoto ED, et al. Laboratory based training in urological microsurgery with bench model simulators: a randomized controlled trial evaluating the durability of technical skill. J Urol. 2004;172:378–81.CrossRefGoogle Scholar
  18. 18.
    Li PS, Ramasamy R, Goldstein M. Male Infertility Microsurgical Training. In: Sandlow JI, editor. Microsurgery for Fertility Specialists. New York: Springer; 2012.Google Scholar
  19. 19.
    Dickey RM, Pastuszak AW, Hakky TS, Chandrashekar A, Ramasamy R, Lipshultz LI. The evolution of vasectomy reversal. Curr Urol Rep. 2015;16(6):40.CrossRefGoogle Scholar
  20. 20.
    Baker K, Sabaneugh E Jr. Obstructive azoospermia: reconstructive techniques and results. Clinics. 2013;68(Suppl1):61–73.CrossRefGoogle Scholar
  21. 21.
    Dewire DM, Lawson RK. Experience with macroscopic vasectomy reversal at the medical college of Wisconsin. Wis Med J. 1994;93(3):107–9.PubMedGoogle Scholar
  22. 22.
    Feber KM, Ruiz HE. Vasovasostomy: macroscopic approach and retrospective review. Tech Urol. 1999;5(1):8–11.PubMedGoogle Scholar
  23. 23.
    Fox M. Vasectomy reversal—microsurgery for best results. Br J Urol. 1994;73(4):449–53.CrossRefGoogle Scholar
  24. 24.
    Gopi SS, Townell NH. Vasectomy reversal: is the microscope really essential? Scott Med J. 2007;52(2):18–20.CrossRefGoogle Scholar
  25. 25.
    Herrel LA, Goodman M, Goldstein M, Hsiao W. Outcomes of microsurgical vasovasostomy for vasectomy reversal: a meta-analysis and systematic review. Urology. 2015;85(4):819–25.CrossRefGoogle Scholar
  26. 26.
    Jee SH, Hong YK. One-layer vasovasostomy: microsurgical versus loupe-assisted. Fertil Steril. 2010;94(6):2308–11.CrossRefGoogle Scholar
  27. 27.
    Safarinejad MR, Lashkari MH, Asgari SA, Farshi A, Babaei AR. Comparison of macroscopic one-layer over number 1 nylon suture vasovasostomy with the standard two- layer microsurgical procedure. Hum Fertil (Camb). 2013;16(3):194–9.CrossRefGoogle Scholar
  28. 28.
    Schwarzer JU. Vasectomy reversal using a microsurgical three-layer technique: one surgeon’s experience over 18 years with 1300 patients. Int J Androl. 2012;35(5):706–13.CrossRefGoogle Scholar
  29. 29.
    Chawla A, O’Brien J, Lisi M, Zini A, Jarvi K. Should all urologist performing vasectomy reversal be able to perform vasoepididymostomies if required? J Urol. 2004;172(3):1048–50.CrossRefGoogle Scholar
  30. 30.
    Crain DS, Roberts JL, Amling CL. Practice patterns in vasectomy reversal surgery: results of a questionnaire study among practicing urologist. J Urol. 2004;171(1):311–5.CrossRefGoogle Scholar
  31. 31.
    Kolettis PN, Sabanegh ES, D’amico AM, Box L, Sebesta M, Burns JR. Outcomes for vasectomy reversal performed after obstructive intervals of at least 10 years. Urology. 2002;60(5):885–8.CrossRefGoogle Scholar
  32. 32.
    Matthews GJ, Schlegel PN, Goldstein M. Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations. J Urol. 1995;154(6):2070–3.CrossRefGoogle Scholar
  33. 33.
    Marks SHF, Burrows PJ, Cropp AR, Ax RL, McCauley TC. Obstructive interval should not be a deterrent in vasectomy reversal. Androl. 2008;(Suppl):21.Google Scholar
  34. 34.
    Peng J, Zhang Z, Yuan Y, Cui W, Song W. Pregnancy and live birth rates after microsurgical vasoepididymostomy for azoospermic patients with epididymal obstruction. Hum Reprod. 2017;32(2):284–9.CrossRefGoogle Scholar
  35. 35.
    Harza M, Voinea S, Ismail G, Gagiu C, Baston C, Preda A, Manea I, Priporeanu T, Sinescu I. Predictive factors for natural pregnancy after microsurgical reconstruction in patients with primary epididymal obstructive azoospermia. Int J Endocrinol. 2014;2014:873527.CrossRefGoogle Scholar
  36. 36.
    Peng J, Yuan Y, Zhang Z, Cui W, Song W, Gao B. Microsurgical vasoepididymostomy is an effective treatment for azoospermic patients with epididymal obstruction and prior failure to achieve pregnancy by sperm retrieval with intracytoplasmic sperm injection. Hum Reprod. 2014;29(1):1–7.CrossRefGoogle Scholar
  37. 37.
    Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991;145(3):505–11.CrossRefGoogle Scholar
  38. 38.
    Mui P, Perkins A, Burrows PJ, Marks SF, Turek PJ. The need for epididymostomy at vasectomy reversal plateaus in older vasectomies: a study of 1229 cases. Androl. 2014;2(1):25–9.CrossRefGoogle Scholar
  39. 39.
    Boorjian S, Lipkin M, Goldstein M. The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. J Urol. 2004;171(1):304–6.CrossRefGoogle Scholar
  40. 40.
    Maghelia A, Rais-Bahrami S, Kempkensteffen C, Weiske WH, Miller K, Hinz S. Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal. Int J Androl. 2010;33(5):730–5.CrossRefGoogle Scholar
  41. 41.
    Hsiao W, Sultan R, Lee R, Goldstein M. Increased follicle-stimulating hormone is associated with higher assisted reproduction use after vasectomy reversal. J Urol. 2011;185(6):2266–71.CrossRefGoogle Scholar
  42. 42.
    Donkol RH. Imaging in male-factor obstructive infertility. World J Radiol. 2010;2(5):172–9.CrossRefGoogle Scholar
  43. 43.
    Ammar T, Sidhu PS, Wilkins CJ. Male infertility: the role of imaging in diagnosis and management. Br J Radiol. 2012;85(Spec Iss 1):S59–68.CrossRefGoogle Scholar
  44. 44.
    World Health Organization. WHO laboratory manual for the examination and processing of human semn. 5th ed. Geneva: WHO Press; 2010.Google Scholar
  45. 45.
    Marks M, Perkins A, Russell H, Burrows P, Marks S. Antisperm antibodies: prevalence, patterns and impact on natural conception following vasectomy reversal. Fertil Steril. 2013;100(3):S375.CrossRefGoogle Scholar
  46. 46.
    Carbone DJ Jr, Shah A, Thomas AJ Jr, Agarwal A. Partial obstruction, not antisperm antibodies, causing infertility after vasovasostomy. J Urol. 1998;159(3):827–30.CrossRefGoogle Scholar
  47. 47.
    Newton RA. IgG antisperm antibodies attached to sperm do not correlate with infertility following vasovasostomy. Microsurgery. 1998;9(4):278–80.CrossRefGoogle Scholar
  48. 48.
    Sharma R, Agarwal A, Rohra VK, Assidi M, Abu-Elmagd M, Turki RF. Effects of increased paternal age on sperm quality, reproductive outcome and associated epigenetic risks to offspring. Reprod Biol Endocrinol. 2015;13:35.CrossRefGoogle Scholar
  49. 49.
    Almeida S, Rato L, Sousa M, Alves MG, Oliveira PF. Fertility and Sperm Quality in the Aging Male. Curr Pharm Des. 2017;23(30):4429–37.PubMedGoogle Scholar
  50. 50.
    Sigman M. Introduction: What to do with older prospective fathers: the risks of advanced paternal age. Fertil Steril. 2017;107(2):299–300.CrossRefGoogle Scholar
  51. 51.
    Deck AJ, Berger RE. Should vasectomy reversal be performed in men with older female partners? J Urol. 2000;163(1):105–6.CrossRefGoogle Scholar
  52. 52.
    Gerrard ER Jr, Sandlow JI, Oster RA, Burns JR, Box LC, Koettis PN. Effect of female partner age on pregnancy rates after vasectomy reversal. Fertil Steril. 2007;87(6):1340–4.CrossRefGoogle Scholar
  53. 53.
    Hinz S, Rais-Bahrami S, Kempkensteffen C, Weiske WH, Schrader M, Magheli A. Fertility rates following vasectomy reversal: importance of age of the female partner. Urol Int. 2008;81(4):416–20.CrossRefGoogle Scholar
  54. 54.
    Kolettis PN, Sebanegh ES, Nalesnik JG, D’Amico AM, Box LC, Burns JR. Pregnancy outcomes after vasectomy reversal for female partners 35 years old or older. J Urol. 2003;169(6):2250–2.CrossRefGoogle Scholar
  55. 55.
    Hsieh MH, Meng MV, Turek PJ. Markov modeling of vasectomy reversal and ART for infertility: how do obstructive interval and female partner age influence cost effectiveness? Fertil Steril. 2007;88(4):840–6.CrossRefGoogle Scholar
  56. 56.
    Chan PT, Goldstein M. Superior outcomes of microsurgical vasectomy reversal in men with the same female partners. Fertil Steril. 2004;81(5):1371–4.CrossRefGoogle Scholar
  57. 57.
    Ostrowski KA, Polackwich AS, Kent J, Conlin MJ, Hedges JC, Fuchs EF. Higher outcomes of vasectomy reversal in men with the same female partner as before vasectomy. J Urol. 2015;193(1):245–7.CrossRefGoogle Scholar
  58. 58.
    Eisenberg ML, Kim S, Chen Z, Sundaram R, Schisterman EF, Buck Louis GM. The relationship between male BMI and waist circumference on sperm quality data from the LIFE study. Hum Reprod. 2014;29(2):193–200.CrossRefGoogle Scholar
  59. 59.
    Hinz S, Rais-Bahrami S, Kempkensteffen C, Weiske WH, Miller K, Magheli A. Effect of obesity on sex hormone levels, antisperm antibodies, and fertility after vasectomy reversal. Urology. 2010;76(4):851–6.CrossRefGoogle Scholar
  60. 60.
    Jensen TK, Andersson AM, Jorgensen N, Andersen AG, Carlsen E, Petersen JH, Skakkebaek NE. Body mass index in relation to semen quality and reproductive hormones among 1558 Danish men. Fertil Steril. 2004;82(4):863–70.CrossRefGoogle Scholar
  61. 61.
    Macdonald AA, Stewart AW, Farquhar CM. Body mass index in relation to semen quality and reproductive hormones in New Zealand men: a cross sectional study in fertility clinics. Hum Reprod. 2013;28(12):3178–87.CrossRefGoogle Scholar
  62. 62.
    Marks M, Perkins A, Burrows P, Marks S. Body mass index does not predict for intraoperative findings or post-operative outcomes with vasectomy reversal. Androl. 2012;33(Suppl2):35.Google Scholar
  63. 63.
    Kato JM, Iuamoto LR, Suguita FY, Essu FF, Andraus W. Impact of Obesity and Surgical Skills in Laparoscopic Totally Extraperitoneal Hernioplasty. Arq Bras Cir Dig. 2017;30(3):169–72.CrossRefGoogle Scholar
  64. 64.
    Amri R, Bordeianou LG, Sylla P, Berger DL. Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery. Am J Surg. 2014;207(1):17–23.CrossRefGoogle Scholar
  65. 65.
    Srinivasan D, La Marca F, Than KD, Patel RD, Park P. Perioperative characteristics and complications in obese patients undergoing anterior cervical fusion surgery. J Clin Neurosci. 2014;21(7):1159–62.CrossRefGoogle Scholar
  66. 66.
    McPherson NO, Lane M. Male obesity and subfertility, is it really about increased adiposity? Asian J Androl. 2015;17(3):450–8.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Rossi BV, Abusief M, Missmer SA. Modifiable risk factors and infertility: what are the connections? Am J Lifestyle Med. 2014;10(4):220–31.CrossRefGoogle Scholar
  68. 68.
    Sharma R, Biedenharn KR, Fedor JM, Argawal A. Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol. 2013;11:66.CrossRefGoogle Scholar
  69. 69.
    Pacey AA, Povey AC, Clyma JA, McNamee R, Moore HD, Baillie H, Cherry NM. Participating Centres of Chaps-UK. Modifiable and non-modifiable risk factors for poor sperm morphology. Hum Reprod. 2014;29(8):1629–36.CrossRefGoogle Scholar
  70. 70.
    Jensen TK, Gottscchau M, Madsen JO, Andersson AM, Lassen TH, Skakkebaek NE, Swan SH, Priskorn L, Juul A, Jorgensen N. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men. BMJ Open. 2014;4(9):e005462.CrossRefGoogle Scholar
  71. 71.
    Gundersen TD, Jorgensen N, Andersson AM, Bang AK, Nordkap L, Skakkebaek NE, Priskorn L, Juul A, Jensen TK. Association between use of marijuana and male reproductive hormones and semen quality: a study among 1215 healthy young men. Am J Epidemiol. 2015;182(6):473–81.CrossRefGoogle Scholar
  72. 72.
    Eisenberg ML. Invited Commentary: The Association between Marijuana Use and Male Reproductive Health 2015. Am J Epidemiol. 2015;182(6):482–4.CrossRefGoogle Scholar
  73. 73.
    van Dongen J, Tekle FB, van Roijen JH. Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post-surgical use of assisted reproductive techniques. BJU Int. 2012;110(4):562–7.CrossRefGoogle Scholar
  74. 74.
    Perkins, AR, Burrows PJ, McCauley TC, Ax RL and Marks SF. Smoking decreases pregnancy rates of vasectomy reversal patients. 64th Ann. Mtng Amer Soc Reprod Med. 2008. Abstract.Google Scholar
  75. 75.
    Agarwal A, Said TM. Implications of systemic malignancies on human fertility. Reprod Biomed Online. 2004;9(6):673–9.CrossRefGoogle Scholar
  76. 76.
    Kovac JR, Scovell J, Ramasamy R, Rajanahally S, Coward RM, Smith RP, Lipshultz LI. Men regret anabolic steroid use due to lack of comprehension regarding the consequences on future fertility. Andrologia. 2015;47(8):872–8.PubMedGoogle Scholar
  77. 77.
    Kovac JR, Lipshultz LI. Basic concepts and recent advancements in the study of male fertility. Asian J Androl. 2016;18(3):331.CrossRefGoogle Scholar
  78. 78.
    Coward RM, Mata DA, Smith RP, Kovac JR, Lipshultz LI. Vasectomy reversal outcomes in men previously on testosterone supplementation therapy. Urology. 2014;84(6):1335–40.CrossRefGoogle Scholar
  79. 79.
    Johnson D, Sandlow JI. Vasectomy: tips and tricks. Transl Androl Urol. 2017;6(4):704–9.CrossRefGoogle Scholar
  80. 80.
    Leslie TA, Illing RO, Cranston DW, et al. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int. 2007;100:1330–3.CrossRefGoogle Scholar
  81. 81.
    Tandon S, Sabanegh E Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int. 2008;102:166–9.CrossRefGoogle Scholar
  82. 82.
    Myers SA, Mershon CE, Fuchs EF. Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol. 1997;157:518–20.CrossRefGoogle Scholar
  83. 83.
    Lee JY, Cho KS, Lee SH, Cho HJ, Cho JM, Oh CY, Han JH, Lee KS, Kim TH, Lee SW. A comparison of epididymectomy with vasectomy reversal for the surgical treatment of postvasectomy pain syndrome. Int Urol Nephrol. 2014;46(3):531–7.CrossRefGoogle Scholar
  84. 84.
    Lee JY, Chang JS, Lee SH, Ham WS, Cho HJ, Yoo TK, Lee KS, Kim TH, Moon HS, Choi HY, Lee SW. Efficacy of vasectomy reversal according to patency for the surgical treatment of postvasectomy pain syndrome. Int J Impot Res. 2012;24(5):202–5.CrossRefGoogle Scholar
  85. 85.
    Sinha V, Ramasamy R. Post-vasectomy pain syndrome: diagnosis, management and treatment options. Transl Androl Urol. 2017;6(Suppl 1):S44–7.CrossRefGoogle Scholar
  86. 86.
    Smith-Harrison LI, Smith RP. Vasectomy reversal for post-vasectomy pain syndrome. Transl Androl Urol. 2017;6(Suppl 1):S10–3.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sheldon H. F. Marks
    • 1
  1. 1.University of Arizona College of MedicineInternational Center Vasectomy ReversalTucsonUSA

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