Vasovasostomy—Microscopic Versus Macroscopic Techniques

Many different surgical techniques of vasovasostomy can be successful. Many factors, both technical and nontechnical, play a role in determining pregnancy. Theoretical considerations such as leakage of sperm, obstruction and narrowing of the anastomosis, suggest that a stentless technique with exact approximation of mucosal edges will result in a better success rate. Careful macroscopic surgery with the use of fine suture material, and experience on the part of the surgeon, will give good results and pregnancy rates of up to 50%. Microsurgery becomes quite important when the anastomosis is performed in the convoluted portion of the vas and epididymis. The microscope allows more mobility in permitting one to determine if the patient has a block proximal to the vasectomy site, and then bypass these blocks. Conventional macroscopic techniques do not allow for this freedom of choice. Factors other than technique are also important and are discussed.