Vasoepididymostomy
Encyclopedia
Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies
are reversed. It involves connection of the severed vas deferens
to the epididymis
and is more technically demanding than the vasovasostomy
.
For a vasectomy reversal that involves a vasoepididymostomy, there are two microsurgical approaches. The procedure involves a similar surgical incision as vasovasostomy
; however, unlike with a vasovasostomy, the testis is usually delivered into the field for this more complex microsurgery. After the findings from the vasal fluid are reviewed showing epididymal obstruction, the epididymis is exposed by opening the outer testis covering (tunica vaginalis
). The epididymis is inspected and an individual tubule is selected to enter and connect to the vas deferens. From this point on, one of two epididymovasostomy techniques is taken. In the mucosa-to-mucosa, end to side method, an opened epididymal tubule is connected to the cut end of the vas deferens with 4 to 6 small (10-0) simple sutures placed around the circumference of each. This “inner” layer is supported with an “outer” layer of radially placed 9-0 sutures to strengthen the connection. Recently, an “invagination
” vasoepididymostomy was described as an alternative to the mucosa-to-mucosa method. With this technique, one, two or three “vest” sutures of 10-0 suture should be placed near the opening of the epididymal tubule to allow the epididymal tubule to “invaginate” into the vas deferens, theoretically creating a connection, that, based on studies in animal models, has an improved watertight seal and possibly a higher chance for success. Once the vas-deferens-epididymis connection is completed, the covering around the testis is replaced.
Vasoepididymostomy is often considered one of the most technically challenging operations in the field of urology. The procedure requires anastomosis of a single epididymal tubule (luminal diameter .15-.25 mm) to the lumen of the vas deferens (diameter .3-.4 mm), and is reserved for patients with congenital or acquired epididymal obstruction, or patients who have failed previous attempts at surgical reconstruction of the vas deferens. This surgery attaches the vas deferens directly to the epididymis, the coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is connected to the epididymis above the point of blockage.
Vasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
are reversed. It involves connection of the severed vas deferens
Vas deferens
The vas deferens , also called ductus deferens, , is part of the male anatomy of many vertebrates; they transport sperm from the epididymis in anticipation of ejaculation....
to the epididymis
Epididymis
The epididymis is part of the male reproductive system and is present in all male amniotes. It is a narrow, tightly-coiled tube connecting the efferent ducts from the rear of each testicle to its vas deferens. A similar, but probably non-homologous, structure is found in cartilaginous...
and is more technically demanding than the vasovasostomy
Vasovasostomy
Vasovasostomy is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.-Limitations:...
.
For a vasectomy reversal that involves a vasoepididymostomy, there are two microsurgical approaches. The procedure involves a similar surgical incision as vasovasostomy
Vasovasostomy
Vasovasostomy is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.-Limitations:...
; however, unlike with a vasovasostomy, the testis is usually delivered into the field for this more complex microsurgery. After the findings from the vasal fluid are reviewed showing epididymal obstruction, the epididymis is exposed by opening the outer testis covering (tunica vaginalis
Tunica vaginalis
The tunica vaginalis is the serous covering of the testis.It is a pouch of serous membrane, derived from the processus vaginalis of the peritoneum, which in the fetus preceded the descent of the testis from the abdomen into the scrotum....
). The epididymis is inspected and an individual tubule is selected to enter and connect to the vas deferens. From this point on, one of two epididymovasostomy techniques is taken. In the mucosa-to-mucosa, end to side method, an opened epididymal tubule is connected to the cut end of the vas deferens with 4 to 6 small (10-0) simple sutures placed around the circumference of each. This “inner” layer is supported with an “outer” layer of radially placed 9-0 sutures to strengthen the connection. Recently, an “invagination
Invagination
Invagination means to fold inward or to sheath. In biology, this can refer to a number of processes.* Invagination is the morphogenetic processes by which an embryo takes form, and is the initial step of gastrulation, the massive reorganization of the embryo from a simple spherical ball of cells,...
” vasoepididymostomy was described as an alternative to the mucosa-to-mucosa method. With this technique, one, two or three “vest” sutures of 10-0 suture should be placed near the opening of the epididymal tubule to allow the epididymal tubule to “invaginate” into the vas deferens, theoretically creating a connection, that, based on studies in animal models, has an improved watertight seal and possibly a higher chance for success. Once the vas-deferens-epididymis connection is completed, the covering around the testis is replaced.
Vasoepididymostomy is often considered one of the most technically challenging operations in the field of urology. The procedure requires anastomosis of a single epididymal tubule (luminal diameter .15-.25 mm) to the lumen of the vas deferens (diameter .3-.4 mm), and is reserved for patients with congenital or acquired epididymal obstruction, or patients who have failed previous attempts at surgical reconstruction of the vas deferens. This surgery attaches the vas deferens directly to the epididymis, the coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is connected to the epididymis above the point of blockage.