VASOEPIDIDYMOSTOMY FOR A CASE OF VASECTOMY REVERSAL: RAMAYYA PRAMILA HOSPITAL GET REGULAR MEDICAL TOURISM PATIENTS FOR INFERTILITY ISSUES

A 50 year old gentleman came for vasectomy reversal to us.He was a foreign national and was vasectomised in 2001.He had remarried and wanted to get vasectomy reversal done. He was a diabetic and had a predisposition.

He was evaluated for antisperm antibodies ; which were negative and his wife was evaluted for ovarian reserve.Her ovarian reserve was reasonably good.

He had underdone right orchiopexy in childhood; the right sided testis was atrophied.The left testis was good in size and the vas defect was reasonably long.His reproductive hormone assay was normal. 

High hemiscrotal vertical incision given extending into the external inguinal ring.The testis was delivered out and the vas was isolated.The scarred vasal tissue was excised and the both vasal ends were freshened till healthy margins.The proximal vasal patency was confirmed with saline flush test and the distal vas was flushed and flush effluent was checked by the Embryologist for sperms.But sperms could not be seen till the tail of epididymis.

Finally head of the epididymis was chosen for VEA. On microscopy the tubules were looking healthy , turgid and yellowish.

The vas was brought till the head region and approximated to the tunic with 8-0 prolene. A longitudinal 2-suture intussusception VEA approach was done. A two parallel double-arm sutures were placed in the distended epididymal tubule with 10- Nylon suture (Ethicon 3313); however, the needles are not pulled through. A nick was made on the distended tubule and the epididymal fluid was tested for sperm.The fluid was tested positive for the sperms and given for cryopreservation. The 2 needles within the epididymal tubule are pulled through, and all 4 needles are placed through the vas lumen at the allowing the epididymal tubule to be intussuscepted into the vasal lumen, completing the anastomosis . The vasal adventitia is then approximated to the epididymal tunic with 8-0 nylon.

CONVOLUTED VAS BEING STRAIGHTENED BUT NO SPERMS FOUND AT THE CUT END

OUR EMBRYOLOGIST LOOKING FOR SPERM IN EOPIDIDYMAL ASPIRATE AND TAKING IT FOR CRYOPRESERVATION

COMPLETED VEA AND 8-0 PROLENE BEING PLACED OVER EPIDIDYMAL TUNIC AND VASAL ADVENTITIA

The prognosis for success after microsurgical vasectomy reversal declines progressively as the interval between vasectomy and its reversal increases. The Vasovasostomy Study Group observed that both patency and pregnancy rates after vasovasostomy decrease as the time since vasectomy increases. Pregnancy rates drop to lower than 50% after 9 years as secondary obstruction of the epididymis becomes increasingly more common(because of blow out phenomenon). 

VEA is the microsurgical procedure for treatment of epididymal obstruction. It is the most difficult microsurgical procedures for the treatment of male infertility and requires excellent microsurgical skills. 

We are one of the few centres in Andhra Pradesh who regularly perform VEA,vasectomy reversal and mcirosurgical varicocelectomy as part of andrologfical reconstructive surgeries.