MP68-16 ABNORMAL EPIDIDYMAL T1 SIGNAL ON PREOPERATIVE SCROTAL MRI PREDICTS SURGICAL APPROACH OF VASAL RECONSTRUCTION

Abstract

You have accessJournal of UrologyInfertility: Evaluation1 Apr 2014MP68-16 ABNORMAL EPIDIDYMAL T1 SIGNAL ON PREOPERATIVE SCROTAL MRI PREDICTS SURGICAL APPROACH OF VASAL RECONSTRUCTION David Sisul, Kevin McCammack, Hossein Mirheydar, Fiona Cassidy, Lejla Aganovic, and Tung-Chin Hsieh David SisulDavid Sisul More articles by this author , Kevin McCammackKevin McCammack More articles by this author , Hossein MirheydarHossein Mirheydar More articles by this author , Fiona CassidyFiona Cassidy More articles by this author , Lejla AganovicLejla Aganovic More articles by this author , and Tung-Chin HsiehTung-Chin Hsieh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Up to 6% of vasectomized men desire vasectomy reversal. While most urologists are capable in performing vasovasostomy (VV), epididymo-vasostomy (EV) is challenging for non-microsurgeons. We examined preoperative scrotal magnetic resonance imaging (MRI) as an objective measure to predict surgical outcome at vasal reconstruction. METHODS Prospective study was performed in 13 patients (25 testicular units [TU]) whom desired vasal reconstruction. Preoperative scrotal MRIs were obtained in all patients using a 3-Tesla magnet with surface coil and gadolinium multi-enhancement technique. Axial and coronal T1- and T2-weighted images were acquired along with axial fat-suppressed T1-weighted images. A single radiologist interpreted all radiographic images while blinded by patient history. A single fellowship-trained urologist performed vasal reconstruction in all 13 patients while blinded by MRI results. Decision to perform VV was only in TU when whole sperm were found in the vasal fluid on intraoperative phase contrast microscopy. EV was performed when no sperm or only sperm fragments were seen in the vasal fluid. RESULTS Mean age of the cohort was 39.4±5.8 years. Etiology of the vasal obstruction was prior vasectomy (12) or epididymitis (1). Mean time from vasectomy was 8.3±4.0 years. Compared to a normal control, increased epididymal T1 signal was found in 10 testicular units and normal T1 signal in the remaining 15 (Images 1 & 2, respectively). There is a significant difference in epididymal T1 signal increase between VV and EV cases(0 to 10% vs 0 to 70%, p=0.01). On logistic regression, relative epididymal T1 signal increase above 19.4% correspond to >90% probability of requiring EV. CONCLUSIONS Epididymal signal change on T1 phase of scrotal MRI can predict surgical technique required for vasal reconstruction. Further inquiry with a larger patient cohort is necessary to validate scrotal MRI as a tool in preoperative planning of patients with vasal obstruction. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e804 Advertisement Copyright & Permissions© 2014MetricsAuthor Information David Sisul More articles by this author Kevin McCammack More articles by this author Hossein Mirheydar More articles by this author Fiona Cassidy More articles by this author Lejla Aganovic More articles by this author Tung-Chin Hsieh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...