Open Access

ARTICLE

Factors and practice patterns that affect the decision for vasoepididymostomy

Kevin A. Ostrowski¹, Nicholas N. Tadros¹, A. Scott Polackwich¹, R. Dale McClure², Eugene F. Fuchs¹, Jason C. Hedges¹

1 Department of Urology, Oregon Health & Science University, Portland, Oregon, USA
2 Seattle Reproductive Medicine, Seattle, Washington, USA
Address correspondence to Dr. Jason C. Hedges, Department of Urology, Oregon Health & Science University, 3303 SW Bond Ave, CH10U, Portland, OR 97223 USA

Canadian Journal of Urology 2017, 24(1), 8651-8655.

Abstract

Introduction: To determine the factors used to make the decision between vasovasostomy (VV) and vasoepididymostomy (VE) by leaders performing microsurgical vasectomy reversal using a questionnaire.
Materials and methods: An online questionnaire was sent to all members of the Society for the Study of Male Reproduction (SSMR), a male reproduction subspecialty society of the AUA, using the SurveyMonkey platform.
Results: Sixty-seven surgeons responded to the questionnaire (27% of SSMR members). Of which 72% of members performed less than 50 vasectomy reversals per year. Also, 71% of members stated that less than 20% of their vasectomy reversals are vasoepididymostomies. When evaluating epididymal fluid at the time of reversal, 87% would perform a VE for pasty fluid, 66% with creamy fluid without sperm heads and 55% with no or scant fluid. With respect to banking sperm, 36% take sperm or testicular tissue at the time of VE while 37% sometimes take sperm mostly depending on the couple's preference. The Berger end-to-side with intussusception VE technique is used by the majority of members (78%). The presence of intact sperm or sperm parts determined the location in the epididymis for anastomosis for 55% and 19% of members respectively. Postoperative semen testing after a VE is evaluated first between 6 weeks to 3 months for 64%. The procedure is considered a failure between 6 to 12 months for 34% and 12 to 18 months for another 48% if no sperm is seen on semen analysis.
Conclusions: Most members perform a VE with pasty fluid or creamy fluid without sperm heads. Three out of four members are using the Berger end-to-side intussusception technique to perform their VE. More studies are needed to determine the optimal circumstances to perform a VE as there is significant variation in responses even among members of the SSMR.

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