Impact of prednisone on vasectomy reversal outcomes (iPRED study): results from a randomized, controlled clinical trial.

Objective: To evaluate the safety and efficacy of prednisone on pregnancy rates and semen concentrations at 1 year after vasectomy reversal.

Design: Randomized, controlled trial (NCT04788823).

Setting: Single medical center specializing in vasectomy reversals.

Factors affecting patency time and semen quality in a single-armed microsurgical vasoepididymostomy.

Although microsurgical vasoepididymostomy (MVE) is an effective treatment for epididymal obstructive azoospermia, some patients may experience delayed patency or suboptimal semen parameters after patency. However, research into patency time, semen quality postpatency, and associated influencing factors remains limited. This study aimed to address these issues by evaluating 181 patients who underwent at least one-sided MVE employing asingle-armed longitudinal intussusception vasoepididymostomy technique, with a follow-up period of over 12 months for 150 patients.

Simplifying vasectomy reversal without compromising outcomes: a single-surgeon series.

Background: In vasovasostomy (VV) surgery, the micro-surgical technique has consistently been shown to provide superior outcomes to both macroscopic and loupe-assisted techniques, with large studies showing overall patency rates of ~86% and pregnancy rates of ~52%. However, the question of whether a single- or double-layer anastomosis offers the best outcomes remains contentious, and despite the popularity of the two-layer technique, a meta-analysis suggests little difference in outcomes. This study records the outcomes of a single-surgeon series of a simplified single-layer technique, along with the comparative outcomes and predictive factors.

Testosterone therapy at the time of vasectomy reversal Impact on intraoperative decision-making and interpretation of postoperative outcomes.

Introduction: During vasectomy reversal (VR), accurate intraoperative microscopic assessment of the vasal fluid for sperm presence and quality is essential in determining the indication for a vasovasostomy (VV) or vasoepididymostomy (VE). The use of testosterone therapy (TT), known to supress spermatogenesis, can potentially interfere with this determination. This initiative evaluated the impact of TT on vasal and epididymal fluid sperm characteristics and intraoperative decision-making among men on TT at the time of VR.

Can we improve time to patency with vasoepididymostomy with an innovative epididymal occlusion stitch?

Introduction: Obstructive azoospermia occurs when there is a blockage in the male reproductive tract, leading to a complete absence of sperm in the ejaculate. It constitutes around 40% of all cases of azoospermia (1, 2). Blockages in the male reproductive tract can arise from either congenital or acquired factors, affecting various segments such as the epididymis, vas deferens, and ejaculatory ducts (3).

Comparative evaluation of double- and single-armed two-suture longitudinal intussusception techniques in microsurgical vasoepididymostomy: An updated systematic review and meta-analysis.

Background: This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates.

Methods: Data from patients with EOA who underwent two-suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science.

[Surgery to improve male fertility].

Background: At a time when increasing attention is being paid to the limitations and risks of in vitro fertilisation techniques, surgeries to improve male fertility are attracting growing interest.

Methods: Systematic review based on a Pubmed search of surgeries to improve male fertility.

Results: Vasovasostomy (VV) gives patency rates of 70-97% and pregnancy rates of 30-76%.

The Diversity of Vasectomy Reversal Providers and Their Web-based Advertising Habits in the United States.

Objective: To better understand the internet advertising material published on clinician websites for the 30,000 men who undergo evaluation for vasectomy reversal (VR), which is a technically demanding procedure requiring microsurgical expertise.

Methods: Internet search trends for "vasectomy" and "vasectomy reversal" from 2004 to 2022 were assessed using Google Trends. Search engines were then queried on a state-by-state basis for physicians performing VR and the available information aggregated and analyzed using standard statistical approaches.

Robotic Surgery for Male Infertility and Chronic Scrotal Content Pain.

Robot-assisted microsurgery is a trending approach for the treatment of male infertility and chronic scrotal pain. The advantages seem to include increased optical magnification, improved surgical efficiency, absent tremor, and similar outcomes with standard methods. This chapter covers robotic microsurgical application and techniques for: robot-assisted vasectomy reversal with vasovasostomy and vasoepididymostomy, varicocelectomy, microsurgical testicular sperm extraction, and targeted denervation of the spermatic cord.

Vasectomy Regret or Lack Thereof.

Background: Vasectomy is a procedure that results in permanent yet reversible sterility and remains a great contraceptive option for many. Previous research studies have highlighted frequency of vasectomy utilization, defining characteristics of individuals who opt for this method, various surgical techniques, and the risks and benefits associated with the procedure. What remains to be defined is why or why not individuals may experience post-vasectomy regret and whether the previous characteristics correlate.

Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal.

The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined.

Practice patterns of vasal reconstruction in a large United States cohort.

We aimed to characterise diverse practice patterns for vasal reconstruction and to determine whether surgeon volume is associated with vasoepididymostomy performance at the time of reconstruction. We identified adult men who underwent vasal reconstruction from 2000 to 2020 in Premier Healthcare Database and determined patient, surgeon, cost and hospital characteristics for each procedure. We identified 3,494 men who underwent either vasovasostomy-alone (N = 2,595, 74.

Vasectomy Reversal Online Marketing Practices: What Are We Putting Out There?

Objective: To determine characteristics of providers marketing vasectomy reversal (VR) online, degree of information available online, the ease with which patients can compare providers, and the differences in VR practice patterns between academic and private practices.

Materials And Methods: We identified VR practices operating within the top 50 most populous metropolitan areas in the US. Practice websites were reviewed to obtain information such as provider educational background, level of magnification, ability to perform vasoepididymostomy, surgical volume, and cost.

Impact of surgical volume and resident involvement on patency rates after vasectomy reversal-A 14-year experience in an open access system.

Objective: Evaluate the influence of fellowship training, resident participation, reconstruction type, and patient factors on outcomes after vasectomy reversals in a high volume, open access system.

Methods: Retrospective review of all vasectomy reversals performed at a single institution from January 1, 2002 to December 31, 2016 was conducted. Patient and spouse demographics, patient tobacco use and comorbidities, surgeon training and case volume, resident participation, reconstruction type, and postoperative patency were collected and analyzed.

Challenges in completing a successful vasectomy reversal.

Although a wide array of interventions exist for men seeking fertility after vasectomy, up to 6% of them will elect for a vasectomy reversal. While the widespread adoption of telemedicine promises convenience and improved access, lack of ability to do a physical examination may hinder appropriate counselling. Although vasectomy reversal is successfully completed in most of the men either with a vasovasostomy or a vasoepididymostomy, there could be various reasons for the inability to successfully complete the operation.

3D digital image microscope system-assisted vasovasostomy and vasoepididymostomy in rats.

Optimal vision and ergonomics are essential factors contributing to the achievement of good results during microsurgery. The three-dimensional (3D) digital image microscope system with a better 3D depth of field can release strain on the surgeon's neck and back, which can improve outcomes in microsurgery. We report a randomized prospective study of vasoepididymostomy and vasovasostomy using a 3D digital image microscope system (3D-DIM) in rats.

Microsurgical seminal reconstruction; our experiences in a single institute.

We assessed the contribution of microsurgical seminal reconstruction to achieving natural conception in conjunction with advanced assisted reproductive technologies. Ninety obstructive azoospermic subjects who underwent microsurgical seminal reconstruction were evaluated. Vasovasostomy (VV) was undertaken in 45 subjects whereas vasoepididymostomy (VE) in 45, respectively.

The Effect of Male Age Over 50 Years on Vasectomy Reversal Outcomes.

Objective: Advancing paternal age is associated with impaired semen parameters. We sought to evaluate reproductive outcomes in men undergoing vasectomy reversal (VR) aged ≥50 vs <50 years.

Methods: Reproductive outcomes (obstructive interval, female age, anastomosis type, post-VR total motile count (TMC), and pregnancy) after VR were assessed for men aged <50 and ≥50 years.

[45 years of microsurgery in urology : Contemporary witnesses report with special reference to vasectomy reversal].

On the occasion of the 45th anniversary of the introduction of microsurgery in urology, the author describes the historical development of urologic microsurgery in Germany, with special reference to vasectomy reversal. Together with contemporary witnesses, a critical historical review is drawn and the current status is analyzed as well as an outlook is given.