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Urol Clin North Am. 1981 Feb;8(1):53-62.

Reversal of vasectomy and the treatment of male infertility. Role of microsurgery, vasoepididymostomy, and pressure-induced changes of vasectomy.



Pressure-mediated effects of vasectomy on the epididymis and resolution of this effect via microsurgery of the epididymis are reported, and a technique of vasectomy modified to limit these pressure effects, making vasectomy more reversible, is suggested. Assuming mastery of microsurgical techniques for vas reanastomosis, the lack of which is one reason for low reversibility of vasectomy, other problems are still encountered that result in low sperm counts and demonstrable infertility. All vasectomies produce micromechanical, pressure-induced changes; 1000 vasovasectomies observed through the operating microscope always showed some degree of dilatation of the lumen of vas deferens and some congestion of the epididymis with dilatation of the epididymal tubule. Rather than augmenting infertility, the presence of a sperm granuloma seems to be a safety valve that decompresses the vas and prevents build-up of excessive pressure; this microscopic study discovered epididymal blowouts with extravasation of sperm from the epididymal tubule into the interstitium, causing secondary obstruction. Simple suture of the vas deferens is not sufficient for reanastomosis, but suturing of the inner lumen to the vas directly to the one cut epididymal tube leaking sperm must be performed. Open-ended vasectomy has a greater chance of reversibility as well as greater likelihood of spontaneous recanalization, a problem with solutions if research is started.

[PubMed - indexed for MEDLINE]
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