Vasectomy reversal (vasovasostomy).

A survey reported in 1948 among members of the American Urological Association revealed a 30-40% rate of sperm return to the semen following vasectomy reversal. A later survey reported in 1973 found an even lower success rate (about 20%). These findings motivated some urologists to try to develop better surgical techniques or devices that could cause sterility when applied and a return to fertility when removed. Some devices tested in laboratory animals included a pull-out suture a tiny gold valve a magnetic ball valve and a polypropylene removable plug. A silicone pull-out plug in 13 men achieved 95% sterility but sperm return to the semen was very erratic when the plug was removed after being in the vas for six months. Considerable improvement in sperm return and in pregnancy rates among patients partners has come about due to the development of microsurgical techniques instruments fibrin glue laser assists and welding. A microsurgical technique developed by South Carolina physicians uses a probe needle guide non-locking needle carrier vas approximator and a combination of 7-0 8-0 and 9-0 (Polyglactin 910) Vicryl and Nylon sutures to facilitate the procedure. The technique has not changed greatly over the last 13 years. A review of the most recent 24 cases who have undergone this procedure shows an 87.5% rate of sperm return to the semen and a 65% pregnancy rate. When these cases are added to previously reported cases the sperm return rate climbs to 91.5%. The South Carolina urologists perform vasectomy reversal using the microsurgical technique in an outpatient surgical facility. The patient is discharged to home care. The physicians recommend rest and relaxation for about 10 days after the procedure. They also recommend that patients wear a very tight scrotal support all day for 30-45 days. Patients can begin sexual activities albeit passive 6-7 days postoperative.