Benefit of Microsurgical vasectomy reversal
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Microsurgical Vasectomy Reversal
Benefits of microsurgical vasectomy reversalThe driving force of these innovations was to improve reversal results. The ideal study to evaluate microscopic vas reversal in comparison with traditional non-microsurgical reversal (conventional instruments and sutures, without the use of a microscope) has never been done and likely will never be done. The only prospective study of the two methods is a small study done in India with significant design problems when viewed to compare the two techniques. A multi-center, double-blinded, randomized trial would be needed to evaluate the two techniques in a rigorous, scientific manner. Simply put, this study would treat two different groups of patients whose overall characteristics (years since vasectomy, patient age, etc.) were the same. One group would receive the conventional repair, and the other group would receive the microscopic procedure, depending on a decision made by chance (not at all acceptable to the usual patient). The other nearly impossible part of this study would be neither the patients nor the investigators evaluating the results would know the type of operation received.
Without the completion of this type of study, there will likely continue to be some controversy regarding the merits of each type of surgery. There are certainly good surgeons and urologists who are performing the traditional reversal and obtaining good results. However, without going into a detailed description of the surgical literature, the consensus opinion evaluating the available evidence regards microscopic microsurgical vasectomy reversal to be superior in patency (patients with motile sperm in fluid) and pregnancy rates. Pregnancy rates are 30-40% below the 85-95% patency rates in most microsurgical series.
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