BERKELEY, CA (UroToday.com) - This retrospective study compared postoperative semen analysis parameters and patency rates of vasovasostomy performed in the convoluted versus straight portion of the vas deferens. This study was undertaken to assess whether or not the perceived increased technical difficulty that may be encountered resulted in a change in success rates.

Patient age, partner age, obstructive interval, gross and microscopic appearance of the intraoperative fluid aspirated from the testicular portion of the vas deferens, and postoperative semen analysis results were examined. Patency was defined as any sperm in the postoperative ejaculate and was compared for the 2 groups.

There were no significant differences in the postoperative semen analysis parameters of volume, total count, sperm density, motility or total motile count between the 2 groups. The patency rate was 98.1% and 97.3% for convoluted vasovasostomy and straight vasovasostomy, respectively, and was not statistically different.

Editorial Comment: This single surgeon series demonstrates excellent success rates in both the straight and convoluted portion vasovasostomies. These findings demonstrate the effectiveness of a well performed microsurgical anastomosis. However, readers should be aware that although excellent results may be achieved. Reconstruction in the convoluted vas is far more challenging. The vas needs to be transected so that the lumen is central rather than eccentric. This needs to be achieved without unraveling the convoluted vas. If this is not accomplished, reconstruction is more likely to fail.

Patel SR, Sigman M

Journal of Urology Vol 179:255-9. 2008
10.1016/j.juro.2007.08.169

PubMed Abstract
PMID:18001786

Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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