V3-09 EPIDIDYMOVASOSTOMY: A TWO-SUTURE INTUSSUSCEPTION APPROACH

Abstract

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2015V3-09 EPIDIDYMOVASOSTOMY: A TWO-SUTURE INTUSSUSCEPTION APPROACH Tariq, S. Hakky, Gavin Langille, Aravind Chandrashekar, Alexander W. Pastuszak, Ranjith Ramasamy, and Larry I. Lipshultz Tariq, S. HakkyTariq, S. Hakky More articles by this author , Gavin LangilleGavin Langille More articles by this author , Aravind ChandrashekarAravind Chandrashekar More articles by this author , Alexander W. PastuszakAlexander W. Pastuszak More articles by this author , Ranjith RamasamyRanjith Ramasamy More articles by this author , and Larry I. LipshultzLarry I. Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1350AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urologists perform over 500,000 vasectomies a year in the United States. Of these men, over 6% will desire vasectomy reversal. During surgery, the decision to proceed with vaso-vasostomy (VV) or epididymovasostomy (EV) depends on the effluent fluid and the microscopic findings assessed from the testis end of the vas deferens. One should consider performing an EV when there is a lack of sperm seen microscopically, especially in the setting of poor vasal fluid quality. We demonstrate the step-by-step microsurgical approach to the epididymovasostomy utilizing a two-suture intussusception technique by an experienced urologic micro-surgeon. METHODS This surgical technique video demonstrates an EV approach utilizing an intussusception technique of the abdominal vas deferens through the tunica albuginea. The abdominal vas is then anchored to the epididymal tunic. After dilated epididymal tubules are identified two 10-0 sutures are preplaced into this tubule prior to creation of an epididymotomy. The anastomosis is then completed using a near-near far-far suture pattern. RESULTS Microsurgical vasovasostomy and epididymovasostomy by a fellowship-trained urologic micro-surgeon yields superior results than macrosurgical approaches, particularly when epididymovasostomy is indicated. The recent success rates in epididymovasostomy can be attributed to improvements in operative technique, instrumentation, and optics. The patency rate of our two-suture intussusception EV technique is 85% with a 45% pregnancy rate. CONCLUSIONS The success rate of vasectomy reversal depends on time interval from vasectomy, intra-operative findings and subsequent reversal procedure chosen. The surgical technique demonstrated here of EV using a two suture intussusception is more technically demanding than a standard VV and requires an experienced micro-surgeon. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e337 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tariq, S. Hakky More articles by this author Gavin Langille More articles by this author Aravind Chandrashekar More articles by this author Alexander W. Pastuszak More articles by this author Ranjith Ramasamy More articles by this author Larry I. Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...