Techniques - Tension-relieving microdot vasovasostomies and longitudinal intussuscepted vasoepididymostomy vasectomy reversals: A first report.

Introduction: Tension and malalignment of vasectomy reversal (VR) anastomoses are hypothesized to contribute to failure. We report VR outcomes using a novel technique introducing a tension-reliving hitch in the multi-layer microdot vasovasostomy (VV) and longitudinal intussuscepted vasoepididymostomy (LIVE; VE).

Methods: All vasectomy reversal patients between May 2019 and September 2023 from a single surgeon were reviewed. Patients were included if they underwent a VR, with at least one semen analysis within six months of surgery and a minimum of six months of followup after the surgery to deem a failure. The primary outcome was patency, which was defined as 1) any sperm in the ejaculate; and B) functionally as at least two million motile sperm. Late failure was defined as an azoospermic semen analysis result after previously documented presence of sperm.

Results: A total of 159 patients were evaluated, of which 136 patients met the inclusion criteria. The patency rate among all VRs was 97.7 %, with an overall functional patency rate of 93.1%. One hundred and one patients underwent bilateral VVs, with a 99% patency rate and 95.5% functional patency rate. Twenty-three patients underwent a mixed VV/VE with a patency rate of 100% and a functional patency rate of 88.8%. Finally, 12 patients underwent bilateral VE, with a patency rate of 83.3% and a functional patency rate of 77.7%. Among these patients, four VV patients were identified to have a late failure.

Conclusions: The combination of tension-relieving stitches for VVs and VEs, along with attention to symmetrical and precise stitch placement, results in high patency rates.