Microsurgical Vasectomy Reversal Techniques to Improve Outcome

mately 500,000 procedures performed annually.1,2 Of these men, 2% to 6% will desire reversal of their vasectomy at a later time.3 Reasons include re-marriage, desire for further fertility, loss of a child, and chronic testicular pain. Vasectomy reversal can be performed in a variety of ways. Both macroand microsurgical techniques have been described and are currently being used by practicing urologists and male infertility specialists. Owen is credited with the first microsurgical method for reconstructing the vas deferens, and his technique is the predecessor of the modern day 2-layer microscopic vasovasostomy.4,5 Variability exists in the size and number of sutures used as well as in the number of layers anastomosed. Recently, attempts have been made to minimize the number of sutures used by placing surgical fibrin glue on the outer layer. While innovative, experience with this new technique is minimal. Adverse consequences include glue leakage into the vasal lumen and associated risks and the inability to adequately reapproximate disproportionately sized lumens.