V8-06 NOVEL BIO-WRAP ASSISTED VASECTOMY REVERSAL TECHNIQUE

You have accessJournal of UrologyMale Voiding/Infection/Infertility/Testis1 Apr 2014V8-06 NOVEL BIO-WRAP ASSISTED VASECTOMY REVERSAL TECHNIQUE Ahmet Gudeloglu, Jamin Brahmbhatt, Raj Kumar, and Sijo Parekattil Ahmet GudelogluAhmet Gudeloglu More articles by this author , Jamin BrahmbhattJamin Brahmbhatt More articles by this author , Raj KumarRaj Kumar More articles by this author , and Sijo ParekattilSijo Parekattil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2153AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical vasovasostomy (VV) is a challenging procedure requiring dedicated microsurgical training. Even though success rates are very high with contemporary techniques, there are still a few failures and a number of patients that initially succeed do have anastomotic failures after one year. Short term and long term failures could be attributed to granuloma/scar formation at the anastomosis site. A previous rodent study has shown that using a bio-wrap to cover the VV site significantly reduces granuloma/scar formation at the anastomosis site. This may also have benefits for patients who are undergoing a reversal for post-vasectomy pain. This video illustrates a bio-wrap assisted modified single layer robotic microsurgical vasovasostomy (RMV) technique. METHODS Prospective Institutional Review Board approved study on four RMV patient cases between December 2012 and March 2013. The indication for VV was post-vasectomy chronic testicular pain (failed conservative measures, pain > 1 year) in all four patients. Modified single layer vasal anastomosis utilizing five double arm 10-0 nylon sutures was performed in all cases. The bio-inert matrix material (Axogen Inc., Alachua, FL) was then placed around the anastomosis site and anchored using two 9-0 nylon sutures to the muscularis of the vas deferens on either side of the anastomosis. Preoperative and postoperative pain was assessed using an externally validated pain QOL impact score (PIQ-6), range: 78-severe impact to 40-no impact (QualityMetric Inc., Lincoln, RI). Semen analyses were obtained at the second and fifth months postop. RESULTS Three bilateral RMV and one crossover unilateral RMV procedures were performed (crossover procedure was done due to absence of the distal vas deferens on one side from prior surgery). Median duration from vasectomy was 4.5 years (1– 9). Median robotic console time was 30 minutes per side. Median follow up was 8 months. Patency (> 1 million motile sperm per ejaculate) was achieved in all three bilateral RMV patients. No sperm was found in the crossover RMV. All four patients had a significant reduction in pain (78, 78, 69, 68 to 57, 52, 44, 54, respectively at 6 month follow up). CONCLUSIONS Despite the small sample size of this study, the preliminary outcomes of the bio-wrap assisted RMV technique seem promising. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e786 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ahmet Gudeloglu More articles by this author Jamin Brahmbhatt More articles by this author Raj Kumar More articles by this author Sijo Parekattil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...