Previous Vasectomy Research Articles

(073) A Novel Method——Identifying Anejaculation or Retrograde Ejaculation by Transrectal Dynamic Ultrasound (Report of 11 Cases)

Abstract Introduction Ejaculation is what we can see whereas orgasm is what we feel. Hence, the presence of ejaculate does not indicate the ability to experience orgasm. Having orgasm without ejaculate may be due to anejaculation (AE) or retrograde ejaculation (RE). Retrograde ejaculation is usually diagnosed by finding sperm in a urine sample after orgasm. However, it can be difficult to differentiate in cases of very low semen volume, previous vasectomy, ejaculatory duct obstruction, or azoospermia. Objective This study aims to explore the use of transrectal dynamic ultrasonographic (US) to observe the process of ejaculation, direction of seminal flow, and changes in seminal vesicles, ejaculatory ducts, and bladder neck during orgasm, providing visual differentiation between AE and RE. Methods US observations were conducted on 11 patients who experienced orgasm without ejaculate. Results Among the 11 patients (7 with diabetes, 1 with congenital megacolon surgery, 1 with urethral stricture), 3 patients had unsuccessful examinations due to discomfort or technical issues with the transrectal ultrasound probe. Successful observations were made in 8 patients, where 5 patients showed contraction of the seminal vesicles and incomplete closure of the bladder neck during orgasm, leading to RE. In 3 cases, no changes in the seminal vesicles or bladder neck were observed, and no seminal flow was seen, leading to AE. Conclusions Dynamic ultrasonographic allows for the observation of the ejaculation process and understanding of the changes in seminal vesicles and bladder neck during orgasm, enabling differentiation between AE and RE. Disclosure No.

(437) Post-Vasectomy Semen Analysis (PVSA) Compliance Rates and Associations

Abstract Introduction Vasectomy is a highly effective, permanent method of contraception. Poor compliance rates have been observed for patients in obtaining their post-vasectomy semen analyses (PVSA). Few studies have looked at associations with low compliance. Objective The objective of our study was to identify compliance rates of post-vasectomy semen analysis and to identify associations that may increase or decrease the rates of compliance. Methods We studied 111 patients between November 2018 and April 2022 who underwent vasectomy at a single institution. Only patients who underwent vasectomy for fertility-related reasons were included in our final analysis. We excluded any patients who had undergone previous vasectomy or vasectomy reversal. Variables analyzed included age, relationship status, presence of primary care provider, anxiety diagnosis, and race. Variables were obtained via chart review which included but was not limited to reviewing notes, summary diagnostic pages, problem lists, and medication lists. All analyses were performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Categorical data were described with the number and percentage of patients. Continuous data were described with the median, minimum, and maximum. Associations of race and anxiety diagnosis with PVSA were explored using Fisher’s exact test. All p-values were two-sided at the 5% significance level without adjustment for multiple testing. Results Our cohort included 111 men who underwent vasectomy with exclusion of 1 patient who underwent vasectomy for non-fertility reasons. The median age of vasectomy was 38 years (range 26-59 years). Of 110 patients, 83 (75%) returned for PVSA. There were 103 (94%) married patients. Additional cohort characteristics can be seen in Table 1. As shown in Table 2, African American patients were less likely to return for PVSA than either white patients (14% vs. 79%, p<0.001) or Hispanic patients (14% vs. 100%, p=0.015). we did not find evidence of difference between white and Hispanic patients (p=0.58). Patients with an anxiety diagnosis were more likely to undergo PVSA compared to patients without an anxiety diagnosis (p<0.001). Conclusions Patients in our cohort of African American race were significantly less likely to undergo PVSA compared to white and Hispanic patients. This suggests an opportunity for improved counseling in the African American population. We do recognize a disparity in the number of white patients studied (n=95) versus African American (n=7) and Hispanic (n=5) patients. Additionally, patients with an anxiety disorder were more likely to undergo PVSA compared to patients without an anxiety disorder. The prevalence of anxiety disorder in our cohort is somewhat high relative to the overall population in the United States. This could be due to questionnaires used at our institution and the timeliness of those questionnaires. Personality traits could also lead to confounding in anxiety diagnoses. Overall, a 75% rate of PVSA speaks to an opportunity for better counseling regarding PVSA, especially in particular populations such as the African American population. Disclosure No

P-050 Reproductive results in vasectomized patients according to the time of the surgical procedure

Abstract Study question Is there a difference in reproductive outcomes in vasectomized patients related to the time of the surgical procedure undergoing ART? Summary answer The time-interval post-vascetomy sperm recovery not affected until 19 years after procedure, although p<0,05 in the men age and AR with > 20 years procedure What is known already Assisted reproductive techniques (ART) have helped vasectomized men who want to have children again, situations that are currently seen relatively frequently. However, an adequate period of time from surgery to initiate ART has not been established. For this reason, it is intended to retrospectively analyze the reproductive results with ICSI, in couples where the man has undergone a previous vasectomy, relating them to the time elapsed since the surgical procedure. Study design, size, duration Retrospective study from 2000 to 2019 of ICSI cycles with 200 patients with their own oocytes, 38 patients with donated oocytes, carried out at IVI Alicante and Murcia. The groups were distributed according to the time elapsed since the man was vasectomized and the treatment carried out: Group A (<10 years), B (11-19 years) and C (> 20 years) discriminated as follows: Own/donated oocytes: group A: 90/26, B: 70/9 and C: 40/3. Participants/materials, setting, methods Inclusion criteria: A total of 239 patients and their partners who undergo the intracytoplasmic sperm injection technique with their own and donated oocytes, before Testicular Sperm Extraction (TESE) surgery and freezing-thamwing a biopsy of testicular tissue after. The statistical analysis was carried out with the statistical software R, version 4.0, linear and multiple regression, establishing significant differences when p < 0.05. Main results and the role of chance The age of the woman was not significant for any of the time intervals (34,5, 35,5 and 35,6 years in own oocytes cycles and 40,6, 41,8 and 43,7 years in donated oocytes cycles), while a significant increase in the age of the man is observed as the obstructive interval increases in own oocytes cycles (42,5, 46,5 and 52,9 years with p < 0,05). The results in donated eggs cycles are 47,6, 50,9, and 42,7 years. Regarding reproductive results, the fertilization rate was not significant for any type of treatment.Pregnancy and implantation rates were higher in the period between 11 and 19 years, 40% (p < 0.05) / 30.1% in own oocytes cycles and donated oocytes cycles were 55.6 / 42.9%. A live newborn rate is reported in own oocytes cycles in group A: 28.9, group B: 37.1 and group C:25%, while in donated oocytes cycles the results are: Group A: 50, group B: 66.7 and group C: 0%. The abortion rates of groups A, B and C in own oocytes cycles are: 0, 14.2 and 33.3 (p < 0.05), and donated oocytes cycles are: 7,6, 0 and 0% respectively with p = 0,78. Limitations, reasons for caution More studies are necessary to get to affirm these statements with greater scientific rigor. Wider implications of the findings According to our studies, the reproductive results of those patients who have undergone post-vasectomy ART are not affected according to the time interval up to 19 years. From the age of 20, there is a trend in increasing results based on pregnancy and abortion. Trial registration number Not applicable for non clinical-trials

Factors predicting success after microsurgical vasovasostomy.

To identify factors predicting success and analyze critically the status of microsurgical double-layer vasovasostomy using predictive models. A cohort of 263 patients treated at our institution for vasectomy reversal between 1986 and 2010 was included in our study, and the literature was reviewed. Inclusion criteria were previous bilateral vasectomy and presence of at least two postoperative semen analyses; patients reporting pregnancy without a postoperative semen analysis were excluded. A double-layer, microscope-assisted, tension-free anastomosis vasovasostomy was performed approximating mucosa to mucosa and muscle to muscle with a 10-0 non-absorbable suture. A multivariate logistic regression backward stepwise model was used to predict combined success, and a predictive model was calculated with remaining variables. Mean age was of 41.6years (SD 7.1); mean duration of obstruction 7.2years (SD 6.7). On multivariate analysis, uni- or bilateral granuloma and Silber grade of I-III were variable identified predicting higher probability to success (OR 3.105; 95% CI 1.108-8.702; p=0.031 and OR 4.795; 95% CI 2.117-10.860; p<0.001, respectively). Based on our results, some factors predicting success after vasovasostomy surgery are known but others remain unknown; our predictive model may easily predict patency and success after this surgery and offers a concrete assistance in counseling patients.

PD07-03 COMPARING VASOEPIDIDYMOSTOMY TECHNIQUE OUTCOMES: LONGITUDINAL INTUSSUSCEPTION VASOEPIDIDYMOSTOMY (LIVE) VERSUS OTHER TECHNIQUES

You have accessJournal of UrologyInfertility: Therapy II1 Apr 2016PD07-03 COMPARING VASOEPIDIDYMOSTOMY TECHNIQUE OUTCOMES: LONGITUDINAL INTUSSUSCEPTION VASOEPIDIDYMOSTOMY (LIVE) VERSUS OTHER TECHNIQUES Filipe Neto, Abimbola Ayangbesan, Bobby Najari, Phil Bach, Andrew Gottesdiener, Philip Li, and Marc Goldstein Filipe NetoFilipe Neto More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , Bobby NajariBobby Najari More articles by this author , Phil BachPhil Bach More articles by this author , Andrew GottesdienerAndrew Gottesdiener More articles by this author , Philip LiPhilip Li More articles by this author , and Marc GoldsteinMarc Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2806AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Epididymal obstruction is a common cause of obstructive azoospermia. Amongst acquired forms, those secondary to epididymal infection and prolonged vasal obstruction are the most common. Treatment is either microsurgical reconstruction and/or sperm retrieval for in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). Microsurgical reconstruction vasoepididymostomy (VE) has been shown to be more cost-effective than sperm retrieval with IVF /ICSI. Since the earliest report of VE in 1903, the technique has undergone continuous improvement, culminating more recently in the development of the longitudinal intussusception microsurgical vasoepididymostomy (LIVE) technique. We compare the patency rates in men that underwent VE using different microsurgical techniques. METHODS We reviewed a database of 754 microsurgical reconstructive procedures of the male reproductive tract done by a single surgeon (MG). We identified 87 cases with a history of bilateral VE and with post-operative semen analysis data available. Patency was defined as the presence of motile sperm in the ejaculate at six months post-operatively. Men who did not meet this criteria, but had unassisted clinical pregnancies were also considered patent. Men with a sperm concentration <100,000/mL and/or <6 month follow-up were considered not patent. We have been using the LIVE technique since 2002 and compared the outcomes of LIVE to the previous techniques. RESULTS Mean patient age was 42.1 ± 7.5 years old. 49 (57%) cases were due to infection, while 38 (43%) had a previous vasectomy as etiology. For the post-vasectomy cases, mean time since vasectomy was 12.8 ± 4.8 years. Regarding the VE technique used, 20 (23%) were LIVE cases and in 67 (77%) cases other techniques were used. The overall mean post-operative follow-up time was 18.2 ± 23 months. Overall patency rate was 81%. The patency rate for the LIVE cases was 85% and for the other techniques it was 79%, p=0.125. CONCLUSIONS Longitudinal intussusception microsurgical vasoepididymostomy (LIVE) technique is an effective way to treat patients with epididymal obstruction when compared with other techniques. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e223 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Filipe Neto More articles by this author Abimbola Ayangbesan More articles by this author Bobby Najari More articles by this author Phil Bach More articles by this author Andrew Gottesdiener More articles by this author Philip Li More articles by this author Marc Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

AB0649 Morphofunctional penile alterations with severe sperm abnormalities in antiphospholipid syndrome associated with systemic lupus erythematosus

BackgroundWe identified severe sperm abnormalities associated with intravenous cyclophosphamide (IVCYC) use and reduced penile dimensions with no deleterious effect in erectile function in systemic lupus erythematosus (SLE) patients.1 In contrast,...

Treatment of failed vasectomy reversal using a microsurgical two-layer anastomosis technique.

ObjectiveTo evaluate the application of a microsurgical two-layer anastomosis technique in the treatment of failed vasectomy reversal.MethodsA microsurgical two-layer anastomosis was used in a series of 24 patients with confirmed anastomotic obstruction after previous vasectomy reversal. The patients were followed up for 9 months to 6 years, and the efficacy of the procedure was evaluated by regular seminal analysis and pregnancy records. The results were compared with those obtained from 34 patients who had received primary microsurgical vasovasostomy in our hospital using the same microsurgical technique.ResultsIn the treatment group for failed vasectomy reversal patients, the postoperative patency rate was 87.5% (21/24), resulting in a pregnancy rate of 54.2% (13/24). In primary reversal group, the postoperative patency rate was 94.1% (32/34), resulting in a pregnancy rate of 67.6% (23/34). Both the patency and pregnancy rate were not significantly different between these two groups.ConclusionsThe microsurgical vasovasostomy and vasoepididymostomy provided satisfactory patency rate and natural pregnancy rate for patients with a previous failed vasectomy reversal, which is comparable with the results of patients who had undergone primary procedure.

1899 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: A COMPARATIVE STUDY OF PRACTICE IN THE UNITED STATES AND THE UNITED KINGDOM

You have accessJournal of UrologyInfertility: Therapy1 Apr 20131899 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: A COMPARATIVE STUDY OF PRACTICE IN THE UNITED STATES AND THE UNITED KINGDOM Ola Blach, Steve Bramwell, and Jay Sandlow Ola BlachOla Blach Aberdeen, United Kingdom More articles by this author , Steve BramwellSteve Bramwell Inverness, United Kingdom More articles by this author , and Jay SandlowJay Sandlow Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2318AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 2010 survey into “UK urologists' management of secondary azoospermia following previous vasectomy” showed that urologists with specialist andrology training and high case volumes were best equipped to successfully manage couples considering vasectomy reversal (VR). To date, no similar surveys have been conducted in the USA. The objective of this study was to review the US management of fertility options following previous vasectomy based on the exact criteria used in the UK's survey, and compare the features of practice in both countries. METHODS In October 2012, a questionnaire-based audit was undertaken of all AUA affiliated urologists regarding their individual practice in managing men requesting VR. Fisher's exact test was used to test the hypothesis that the management of fertility options following previous vasectomy, and the practice of VR, are no different when undertaken by urologists with and without andrology fellowship training, and no different in the US and the UK. RESULTS 50.4% of the US respondents (325/645) practiced VR, compared to 83.6% (178/213) in the UK. The majority in both countries performed 1-10 VR a year; just 11.9% of the US urologists and 10% of the UK urologists carried out >25 and >15 (p<0.0001) VR a year, respectively. Only 74 of the US and 61 of the UK urologists were fellowship trained in andrology; responses from those who did not provide this information were excluded from analysis. Differential performance of the urologists with and without andrological training, both in the US and the UK, is shown in figure 1 below, along with p-values for the Fisher's exact test: CONCLUSIONS A number of differences in the management of fertility options following previous vasectomy exist between the US and the UK. US urologists perform more VR each year, offer more detailed information on all fertility options and likely outcomes, and utilize microsurgical techniques more often. Unlike the UK urologists however, they less frequently counsel the infertile couples together and refer patients to specialist centres for IVF/ICSI. Importantly, in both countries, the urologists with specialist andrology training and high case volumes seem to be best equipped to appropriately manage couples considering VR. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e778-e779 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ola Blach Aberdeen, United Kingdom More articles by this author Steve Bramwell Inverness, United Kingdom More articles by this author Jay Sandlow Milwaukee, WI More articles by this author Expand All Advertisement Advertisement Loading ...

1898 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: ANALYSIS OF CURRENT PRACTICE

You have accessJournal of UrologyInfertility: Therapy1 Apr 20131898 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: ANALYSIS OF CURRENT PRACTICE Ola Blach, Anand Shridharani, Ira Sharlip, Arnold Belker, and Jay Sandlow Ola BlachOla Blach Aberdeen, United Kingdom More articles by this author , Anand ShridharaniAnand Shridharani Milwaukee, WI More articles by this author , Ira SharlipIra Sharlip San Francisco, CA More articles by this author , Arnold BelkerArnold Belker Louisville, KY More articles by this author , and Jay SandlowJay Sandlow Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2317AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The recently completed AUA Vasectomy Guidelines identified vasectomy reversal (VR) as one potential area for further research. Current practice is characterized by wide variation in preoperative counseling, surgical technique and postoperative follow-up amongst urologists. The objective of this study was to review the management of fertility options following previous vasectomy and compare the performance of urologists with and without andrology fellowship based on ten index parameters deemed to reflect best practice. METHODS In October 2012, a questionnaire-based audit was undertaken of all AUA affiliated urologists regarding their individual practice in managing men requesting VR. Fisher's exact test was used to test the hypothesis that the management of fertility options following previous vasectomy, and the practice of VR, are no different when undertaken by urologists with and without andrology fellowship training. RESULTS Of the 645 respondents, 325 (50.4%) performed VR. The majority, 54.1%, performed 1-5 VR a year with just 11.9% performing >25 per year (p<0.0001). 74 urologists were fellowship trained in andrology or male infertility, while 235 performed VR without subspecialty training; responses from the 16 who did not provide this information were excluded from analysis. Differential performance of the urologists with and without andrological training is shown in figure 1 below, along with p-values for the Fisher's exact test: CONCLUSIONS There are significant differences in the standards of practice of VR by urologists with and without andrology fellowship training. The vast majority of non-fellowship trained urologists perform <5 VR per year. These physicians are significantly less likely to counsel couples about all fertility options, be conversant in IVF/ICSI, provide individualized outcomes data, as well as utilize microsurgical techniques. Based on these differences, outcomes data should be analysed to determine if success rates differ, and if so, guidelines should be established. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e778 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ola Blach Aberdeen, United Kingdom More articles by this author Anand Shridharani Milwaukee, WI More articles by this author Ira Sharlip San Francisco, CA More articles by this author Arnold Belker Louisville, KY More articles by this author Jay Sandlow Milwaukee, WI More articles by this author Expand All Advertisement Advertisement Loading ...

UK practice regarding reversal of vasectomy 2001–2010: relevance to best contemporary patient management

Study Type - Practice trends (survey) Level of Evidence 2c What's known on the subject? and What does the study add? Approximately 6% of men who have had a vasectomy subsequently decide to have it reversed. For such men there are various options available, including vasal reconstruction, surgical sperm retrieval with assisted reproductive techniques, use of donated sperm or adoption. The decision-making process with regard to the most appropriate management is challenging and the urologist requires both an intimate knowledge of the advantages and disadvantages of each of the available options and the opportunity to counsel a couple appropriately. The study confirms that patient management after previous vasectomy is a complex process, demanding detailed knowledge about the availability and outcomes of alternatives to vasectomy reversal. It recommends that couples should not be seen by urologists with diverse interests but by those with appropriate knowledge of all of the factors influencing outcome and the available management options and their costs. Urologists should also have appropriate facilities to offer intra-operative demonstration of and, potentially, storage of sperm. To review the management of men presenting for reversal of vasectomy amongst consultant members of the British Association of Urological Surgeons (BAUS) between 2001 and 2010. • To make recommendations for contemporary practice. Three consecutive questionnaire-based surveys were undertaken by BAUS consultant members in 2001, 2005 and 2010. • Standard questionnaires were sent on each occasion asking urologists about their counselling of couples regarding options in achieving a conception, expectation of outcome from reconstructive surgery and the techniques of vaso-vasostomy used. • In 2005 additional information was obtained about the availability of fertility treatments and sub-specialization of the urologist and in 2010 about the eligibility criteria for in-vitro fertilization (IVF) treatment and synchronous sperm retrieval. Overall there was a 47% response rate with >80% of respondents still performing vaso-vasostomy. • More than 75% of respondents were doing <15 procedures a year and <50% of respondents counselled couples about other management options. • Only 41% gave their personalized outcomes from vaso-vasostomy, whilst >80% were using some form of magnification intra-operatively. • Members of the BAUS section of andrology were more likely to discuss options for becoming a parent and criteria for IVF treatment, to present their individualized outcomes from vaso-vasotomy and to carry out >15 procedures a year than urologists with no andrological affiliation. • Patient management after previous vasectomy is a complex process necessitating detailed knowledge concerning the availability and outcomes of alternatives to vaso-vasostomy. • Couples should not be seen by urologists with diverse interests but by those with appropriate knowledge of all of the factors influencing outcome. • Vaso-vasostomy should no longer be seen as a procedure within the remit of any adequately trained urologist but as one option to be considered by a sub-specialist with access to appropriate micro-surgical training and assisted reproductive technologies.

Intussusception Vasoepididymostomy With Longitudinal Suture Placement for Idiopathic Obstructive Azoospermia

Surgical reconstruction is an important treatment option for obstructive azoospermia. Vasoepididymostomy results have primarily been described in men with previous vasectomy. We evaluated vaso-epididymal anastomosis outcomes using a 2-suture microsurgical intussusception technique with longitudinal suture placement in men with idiopathic obstructive azoospermia. Between April 2007 and May 2009, 24 men with idiopathic obstructive azoospermia underwent 2-layer vaso-epididymal anastomosis using a 2-suture intussusception technique. Two double armed 10-zero polyamide sutures were placed parallel to each other longitudinally along the epididymal tubule to intussuscept the tubule into the lumen of the vas deferens for the inner layer of the anastomosis. Patency was assessed by return of sperm in the semen. A total of 23 men with a mean age of 31 years provided at least 1 postoperative semen sample. All had a mean 67-month history of primary infertility. In 11 men (48%) patency was noted a mean of 6.6 months (range 3 to 15) after surgery. One patient reported pregnancy by natural conception. Men with motile sperm in the epididymal fluid and those with bilateral surgery were more likely to have a patent anastomosis. Within 1 year after surgery approximately half of the men who underwent longitudinal vaso-epididymal anastomosis for idiopathic azoospermia had return of sperm in the ejaculate.

"4 x 4 vasovasostomy": A simplified technique for vasectomy reversal

Objectives:An ideal vasovasostomy procedure requires precise mucosal approximation with a watertight anastomosis. The standard two-layer microdot technique requires multiple sutures within each layer and is a technically difficult operation to perform. We describe a two-layered technique which adheres to the principles of tubular anastomosis, but is simpler and provides excellent results.Materials and Methods:Patients with secondary infertility following a previous vasectomy underwent the modified two-layered vasovasostomy. Two 8-0 polyamide sutures were placed at 5 and 7 o’clock positions in the sero-muscular layer to approximate the two ends of the vas. Next, four double-armed, 10-0 polyamide sutures were sequentially placed, inside out in the mucosa of the vasal ends, at 3, 6, 9, and 12 o’clock positions and tied. Two additional sero-muscular sutures were placed at 1 and 11 o’clock positions to complete the anastomosis. Patients with a suspected proximal block in the epididymis underwent a vasoepididymostomy. Semen analysis was performed at 6 weeks after surgery.Results:Between the period February 2008 and August 2009, eight men underwent vasectomy reversal using the 4 × 4 technique. The procedure was performed bilaterally in six men whereas two patients underwent a two-suture, longitudinal intussusception vasoepididymostomy on the second side. Mean operative time was 90 min per patient. All men had sperm in the ejaculate at the first semen analysis. There were no complications.Conclusions:The “4 × 4” modified two-layer vasovasostomy is a simple technique that can be performed in quick time with excellent results. It may allow a common ground between the complex microdot two-layer technique and the over-simplified single-layer procedure.

Percutaneous Sperm Retrieval in Secondary Azoospermia

Introduction: Males presenting for assisted reproduction after vasectomy have a high chance of normal spermatogenesis and of successful surgical sperm retrieval. We aimed to evaluate simple percutaneous methods of retrieving sperm for intracytoplasmic sperm injection in males with secondary azoospermia due to previous vasectomy. Patients and Methods: We analyzed a series of post-vasectomy males who presented for sperm retrieval between 1999 and 2005 and who were not being considered for vasal reconstruction as their primary method of re-establishing their fertility. Results: All 132 men had sperm retrieved successfully, 97% with percutaneous methods. In seventy-five percent of the couples intracytoplasmic sperm injection was done, with a total number of 184 cycles being performed. The clinical pregnancy and live birth rates were 25 and 24%, respectively. There were no significant scrotal haematomas, and only 2 patients had postoperative pain after percutaneous sperm retrieval that required analgesia for more than 2 days. Conclusion: We have shown that percutaneous sperm retrieval, where normal spermatogenesis is assumed, is successful in all men following vasectomy. Percutaneous methods of retrieving epididymal or testicular sperm are inexpensive, simple and could replace open techniques in men who are not considering vasal reconstruction following vasectomy.

Does Surgery Have a Role in Management of Chronic Intrascrotal Pain?

To assess the role of epididymectomy in the treatment of chronic postvasectomy and epididymal pain syndrome and to identify the factors that predict the outcome. A total of 38 patients, aged 20 to 70 years (mean 45), who had undergone epididymectomy for intractable intrascrotal pain, were identified retrospectively from the pathology records. The clinical notes were reviewed, and details on patient demographics, previous vasectomy, investigations, and histologic features were collected and analyzed. The outcome was assessed by routine outpatient clinic review and telephone interview. Overall, 32% of patients reported resolution of symptoms after epididymectomy; 17 patients had undergone previous vasectomy, and this group was significantly more likely to have ongoing pain. Abnormal examination and ultrasound findings preoperatively did not correlate with a better outcome from surgery. The results of our study have shown that epididymectomy has a limited role in the management of chronic intrascrotal pain.

MUC1 in human testis and ejaculated spermatozoa and its relationship to male fertility status

MUC1 is a cell surface glycoprotein with a previously described antiadhesive role involved in different aspects of reproductive function. We found MUC1 expressed in male germ cell line and within the ejaculated sperm, but its presence in mature sperm does not seem to be related to male fertility. This was confirmed after analysis of results from assisted reproduction techniques with oocyte donation related with MUC1, although higher MUC1 expression is related to sperm recovery after preparation.

Factors affecting successful outcome from ICSI in men following previous vasectomy

There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ICSI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner's behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension.

Vasectomy and prostate cancer characteristics of patients referred for prostate biopsy.

The prospect of an association between vasectomy and prostate cancer has gained widespread attention and has potentially influenced patterns of referral. In patients referred for prostate needle biopsies we compared the incidence and characteristics of prostate cancer in those reporting a history of vasectomy to those denying prior vasectomy. A total of 585 consecutive prostate biopsy procedures were performed on 522 veterans during a 42-month period. Upon questioning 101 patients (19.3%) reported prior vasectomy. From the remaining 421 patients 202 consecutive age matched controls were selected. Pre-procedure prostate specific antigen levels, digital examination findings, incidence of prostate cancer, cancer grade and tumor length on biopsy cores were compared between the patients with and without a history of vasectomy. Of the 101 patients who reported a history of vasectomy 46 (45.5%) had prostate cancer compared to 98 (48.5%) of the 202 age matched controls, and this difference was not statistically significant. Of the patients with prostate cancer those with prior vasectomy less frequently had an abnormal digital examination and lower prostate specific antigen levels, lower Gleason grade, lower clinical stage and shorter length of cancer on biopsies. We found no increase in prostate cancer incidence or severity in patients referred for prostate biopsy who had undergone prior vasectomy. In fact, prostate cancer was less common with fewer poor prognostic indicators in patients with previous vasectomy. These findings may be secondary to either selection bias, as patients with a vasectomy may seek more routine medical care, or a greater tendency of primary providers to refer these patients for evaluation.

Computational Models for Prediction of IVF/ICSI Outcomes With Surgically Retrieved Sperm

Various factors may be involved in determining the outcome of IVF/ICSI. Using several linear and nonlinear mathematical models, we investigated the correlation of maternal age, type of male factor infertility, sperm retrieval techniques and sperm type with IVF/ICSI outcome. A dataset of 113 exemplars containing input features maternal age, sperm retrieval technique (testicular sperm extraction, testicular sperm aspiration and microscopic epididymal sperm aspiration), type of sperm used (cryopreserved or “fresh”), type of male factor (previous vasectomy with or without subsequent reversal, congenital absence of the vas deferens, other obstructive conditions, varicocele, non-obstructive azoospermia, miscellaneous) and output intra-uterine pregnancy achieved by IVF/ICSI was randomized into a modeling (“training”) set of 83 and cross-validation (“test”) set of 30, with similar outcome frequencies preserved in each set. We used neUROn++, a set of C++ programs we developed using the Cygwin (Red Hat) GNU C++ port for Windows (Microsoft) distributed across Pentium (Intel) platforms, to model the dataset using the linear methods linear and quadratic discriminant function analysis (LDFA, QDFA) and logistic regression (LR), and the nonlinear method of neural computation (NNET) with several investigated architectures. A 4 hidden node (HN) network was found to have the highest accuracy, compared to LDFA, QDFA and logistic regression, with a ROC area for the test set of 0.783. Reverse regression of the neural network based on Wilk’s Generalized Likelihood Ratio test revealed maternal age to be most significant (p=0.025) feature in predicting pregnancy, followed by sperm type (p=0.076). Type of male factor (p=0.47) and sperm retrieval technique (p=0.88) did not predict outcome. Tabled 1 We have investigated linear and nonlinear computational models of IVF/ICSI. The demonstration that IVF/ICSI-induced intra-uterine pregnancy correlates to maternal age and to the type of sperm used supports the use of our neurocomputational model as a predictive tool when planning for the use of assisted reproductive techniques in the presence of male factor infertility.

The ratio of second to fourth digit length in azoospermic males undergoing surgical sperm retrieval: predictive value for sperm retrieval and on wubsequent fertilization and pregnancy rates in IVF/ICSI cycles.

The differentiation of the urogenital system and the appendicular skeleton in vertebrates is under the control of Homeobox (Hox) genes. It has been shown that this common control of digit and gonad differentiation has connected the pattern of digit formation to spermatogenesis and prenatal hormone concentrations in males. We wished to establish whether digit patterns, particularly the ratio between the lengths of the second and fourth digit in males (2D : 4D), was related to spermatogenesis and, more specifically, the presence of spermatozoa in testicular biopsies from azoospermic men undergoing surgical sperm retrieval. Forty-four men were recruited, of whom 16 were diagnosed with nonobstructive azoospermia and 4 with congenital bilateral absence of the vas deferens, and 24 previously fertile men were azoospermic after previous vasectomy. Our results show that men with previous fertility or of an acquired form of azoospermia had significantly lower 2D : 4D ratios than men with nonobstructive azoospermia. In nonobstructive azoospermia, there was a significantly lower 2D : 4D ratio on the left side in men who had successful retrieval than those with unsuccessful retrieval. For these men who had a successful retrieval, none had a 2D : 4D ratio more than 1 on the left side, whereas 4 of 7 men in whom sperm was not found had a 2D : 4D ratio greater than 1. On successful sperm retrieval, subsequent fertilization and clinical pregnancy rates were unaffected by 2D : 4D ratios.

Vasectomy and Prostate Cancer Characteristics of Patients Referred for Prostate Biopsy

The prospect of an association between vasectomy and prostate cancer has gained widespread attention and has potentially influenced patterns of referral. In patients referred for prostate needle biopsies we compared the incidence and characteristics of prostate cancer in those reporting a history of vasectomy to those denying prior vasectomy. A total of 585 consecutive prostate biopsy procedures were performed on 522 veterans during a 42-month period. Upon questioning 101 patients (19.3%) reported prior vasectomy. From the remaining 421 patients 202 consecutive age matched controls were selected. Pre-procedure prostate specific antigen levels, digital examination findings, incidence of prostate cancer, cancer grade and tumor length on biopsy cores were compared between the patients with and without a history of vasectomy. Of the 101 patients who reported a history of vasectomy 46 (45.5%) had prostate cancer compared to 98 (48.5%) of the 202 age matched controls, and this difference was not statistically significant. Of the patients with prostate cancer those with prior vasectomy less frequently had an abnormal digital examination and lower prostate specific antigen levels, lower Gleason grade, lower clinical stage and shorter length of cancer on biopsies. We found no increase in prostate cancer incidence or severity in patients referred for prostate biopsy who had undergone prior vasectomy. In fact, prostate cancer was less common with fewer poor prognostic indicators in patients with previous vasectomy. These findings may be secondary to either selection bias, as patients with a vasectomy may seek more routine medical care, or a greater tendency of primary providers to refer these patients for evaluation.