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Physiological System Modeling
Published in Sujoy K. Guba, Bioengineering in Reproductive Medicine, 2020
Spermatozoa as they emerge from the epididymis have already acquired a definite flagellar swimming character but the linear progression on account of this movement is too slow to contribute significantly to the rapid transport required at the time of ejaculation. Physiologists had noted the presence of peristaltic contractions in the vas deferens both in vivo and in vitro half a century ago. Although there was no direct experimental evidence available, it was believed that peristalsis was responsible for the transport of the spermatic fluid inside the vas deferens, and that the spermatozoa are passively transported along with the fluid. Ventura et al.19 went further and attributed the low pregnancy rates following vasovasostomy to inadequate manipulation. On the other hand, Mitsuya et al.20 in radiographic studies of human volunteers noted a physical movement of the vas deferens during the ejaculatory phase but definite peristalsis was not discerned. Additionally, it is known that pressing upon both the vas deferens from over the scrotal skin during the ejaculatory phase does not alter the spermatozoa count in the ejaculate. Furthermore, no distinct peristaltic contractions can be palpated. These findings led to doubts about peristalsis being the major propulsive mechanism during ejaculation.
Surgical Management Techniques for Male Infertility
Published in Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh, Male Infertility in Reproductive Medicine, 2019
Kevin C. Lewis, Scott Lundy, Sarah Vij
The first successful vasovasostomy (VV) in a human was performed by William C. Quinby in 1919, 11 years after Dr. Edward Martin at the University of Pennsylvania performed the first vasoepididymostomy (VE) for a man with epididymal obstruction due to epididymitis [24–26]. VV has evolved considerably since this early work, most notably by the introduction of the microsurgical technique in 1977 [27,28]. Vasal obstructions are most commonly the result of a previous vasectomy, and epidemiological data suggest that up to 6% of men who undergo vasectomy will seek a vasectomy reversal [29]. Traumatic vasal injury is rare, and iatrogenic injury to the vas deferens accounts for only 7% of vasal obstructions [30].
Microsurgery Techniques in Andrology *
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Owen,55 who developed a similar two-layer technique of microsurgical vasovasostomy concurrently with (but independently of) Silber,54 reported a 98% “sperm present” rate and a 72% pregnancy rate in the wives of 50 patients undergoing unilateral vasectomy reversal by this method. However, at least a few patients having no sperm in the vas fluid at the time of vasectomy reversal were excluded from his series.
Vasectomy reversal utilizing fibrin glue
Published in Baylor University Medical Center Proceedings, 2019
G. Luke Machen, Ali M. Mahmoud, Colin E. Kleinguetl, Wencong Chen, Stephanie E. Harris, Erin T. Bird
In 2005, Ho et al demonstrated that a three-suture vasovasostomy using fibrin glue may be a feasible technique, especially with vas intervals of 8 years or less.4 This update to their technique demonstrates that by using approximately six sutures with a reinforcement layer of fibrin glue, overall patency rates were 88.3%, including a 91.2% rate for obstructive intervals 10 years or less (odds ratio = 2.91; P = 0.048) (Tables 1 and 2). This compares favorably with results at other institutions. In 1991, the landmark Vasovasotomy Study Group paper was published, describing overall patency rates of 86% and patency rates of 97%, 88%, 79%, and 71% for obstructive intervals after vasectomy of <3 years, 3–8 years, 9–15 years, and >15 years, respectively.3 A more recent meta-analysis including 6633 patients found overall patency rates of 89.4%.5 Similar to our study, an odds ratio of 1.17 (95% confidence interval, 1.09–1.25) for postoperative patency when comparing obstructive intervals of <10 years and >10 years was found.5
Review of the role of robotic surgery in male infertility
Published in Arab Journal of Urology, 2018
Mohamed Etafy, Ahmet Gudeloglu, Jamin V. Brahmbhatt, Sijo J. Parekattil
Vasectomy reversal was one of the most uniquely difficult challenging procedures in urology until the introduction of the operating microscope, which improved outcomes and performance of these procedures [15]. However, these techniques require dedicated training, experience, and a skilled microsurgical assistant. Robot-assisted microsurgical approaches with the da Vinci robotic platform can provide some advantages to overcome some of these challenges. Parekattil and Gudeloglu [12] reported comparable outcomes for robot-assisted microsurgical vasectomy reversal (110 patients) compared with the pure microsurgical technique (45 patients). The median clinical follow-up was 17 months. The median (range) duration from vasectomy in the robot-assisted vasovasostomy (RAVV) group was 7 (1–21) years and 6.5 (1–19) years in the microscopic group. The median age of the patients in the RAVV group was 41 years and 39 years in the microscopic group. A significantly better patency rate of 96% was achieved in the RAVV cases vs 80% in microscopic group. Pregnancy rates (within 1 year postoperatively) did not differ significantly between the two groups: 65% for the RAVV group and 55% for the microscopic group. Operative duration (skin to skin) started at 150–180 min initially for the first 10 cases of RAVV. However, the median (range) operative duration for RAVV overall was significantly decreased at 97 (40–180) min compared with microscopic group at 120 min. The median (range) operation duration for robot-assisted microsurgical vasoepididymostomy (RAVE), at 120 (60–180) min, was also significantly faster than the microscopic group at 150 min. Kavoussi [16] also reported similar outcomes when he compared both groups.
Vasectomy reversal: a review on outcomes using a loupe-assisted vasovasostomy approach
Published in The Aging Male, 2020
Manoj Ravindraanandan, Chea Tze Ong, Mohammed Elhadi, Wasim Mahmalji, Mehmood Akhtar
In a 3-year period, 14 men underwent a reversal of vasectomy under a single surgeon. The mean age in our group was 36.9 (range 27–49), with a median ASA grade of 1 (range 1–2). All men underwent a reversal of vasectomy for purposes of conception, and the whole group had this performed via a vasovasostomy approach. The average number of years from vasectomy to reversal in our group was 7.14 (median 5.5 years, range 2–17 years).