Vasovasostomy (tubulovasostomy) is a surgical procedure to restore separated vas deferens in men. The operation is performed under a surgical microscope with up to 20x magnification (microsurgery). If the operation is performed after a vasectomy, it is called microsurgical refertilization (restoration of fertility).
Here you will find the most important information and qualified vasovasostomy experts.
The sperm cells mature in the testicular tissue. This process takes about 74 days. The sperm cells enter the epididymis via 12-20 efferent ducts.
In the head of the epididymis, the efferent ducts unite to form a single epididymal duct (epididymal duct = tubule). The epididymal duct has a length of 6 m and runs through the epididymis in multiple loops and windings.
At the tail of the epididymis, the epididymal duct joins the vas deferens (ductus deferens). The sperm cells can survive in the epididymis for up to 2 weeks and continue to mature there.
The vas deferens is 40-60 cm long. It initially runs in coils at the transition to the epididymis. It leads from the scrotum to the outer inguinal ring and from there through the inguinal canal to the inner inguinal ring.
The vas deferens runs to the prostate, where it meets the seminal vesicle at the seminal mound. This is where the sperm cells are produced, which enter the urethra during ejaculation.
Male reproductive system @ bilderzwerg /AdobeStock
In the case of an unfulfilled desire to have children, a semen analysis (spermiogram) is of central importance. If doctors find no sperm cells in the ejaculate, this is referred to as azoospermia (not to be confused with aspermia = lack of ejaculation).
Azoospermia can becaused by a lack of maturation of sperm cells in the testicles themselves(non-obstructive azoospermia).
Possible causes are
If sperm production is possible, the cause of azoospermia is an obstruction of the sperm ducts(obstructive azoospermia). Doctors can determine this through a testicular biopsy.
Normally , a testicle with preserved sperm cell maturation and with patency of the sperm ducts is sufficient to be fertile.
This is a diagnosis of exclusion. An obstruction is present if a testicular biopsy shows normal sperm maturation (spermatogenesis) but no sperm cells are found in the epididymis.
In rare cases , the epididymis does not develop. There is often a genetic link to cysticfibrosis.
Cystic fibrosis is an inherited disease in which the glandular secretion of all body glands is disturbed. Due to the viscous mucus formation, patients are prone to chronic respiratory infections. The life expectancy of patients is significantly lower.
The utricular cyst is a cystic dilatation of regressed (rudimentary) female genital organs (Müllerian duct derivatives). The cystic dilatation squeezes the seminal ducts at the junction with the urethra. The obstruction can be removed by opening the cyst endoscopically.
Inflammation in the area of the testicles, epididymis and vas deferens can lead to cicatricial obstruction of the seminal ducts.
In the past, tuberculosis or sexually transmitted diseases were the cause of inflammation-related spermatic duct obstructions. Today, non-specific inflammation of the epididymis is the most common cause.
Every operation in the area of the spermatic cord entails the risk of injury to the vas deferens. This is particularly possible during surgery for undescended testicles or inguinal testicular surgery.
If azoospermia is unclear, doctors must therefore clarify previous surgical procedures.
Themost common cause of post-operative azoospermia today is elective vasectomy (sterilization) as part of contraception.
If life circumstances change later and the desire to have children arises again, microsurgical refertilization is possible.
In this procedure, doctors surgically expose the vas deferens in the area of the vas deferens obstruction . This is possible after inguinal testicular surgery, inguinal hernia surgery in the area of the inguinal canal or after a vasectomy in the area of the base of the scrotum.
The doctor first identifies the scar, prepares the vas deferens below and above the scar and cuts out the scar. He then checks the patency of the vas deferens.
To do this, he takes a 2 ml saline solution and injects it into the vas deferens. He checks the patency by applying pressure to the epididymis.
If there is patency, fluid is released from the opened vas deferens . The doctor should be able to detect sperm cells or sperm cell debris in this fluid.
Once patency is established, the ends of the vas deferens are reunited by microsurgery. This can be carried out using 2 different techniques:
Single-layer vasovasostomy
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Two-layer vasovasostomy
The probability of success of a vasovasostomy is equally good for both surgical procedures.
After vasectomy, patients achieve a patency rate of 70-90%. The rate of successful pregnancies is approx. 45-70%, which is lower than the patency rate.
The time interval between vasectomy and refertilization is decisive. If there are more than 15 years between vasectomy and refertilization, the rate of successful pregnancies drops to approx. 30 %.
If there is an obstruction in the area of the epididymis, the ductus deferens can be surgically connected to the epididymal duct (tubule). The connection is technically difficult due to the small size of the epididymal duct (diameter 0.2 mm) and the thin epididymal duct wall (thickness 0.03 mm).
The rate of patency varies between 30 and 80 %. The data for successful pregnancies also vary between 10 and 55 %.
The data show that retraction of the tubule into the opened duct (intussusception) produces better results than side-to-end anastomosis.
However, scarring can also close patencies that were initially successfully achieved.
If microsurgical procedures are unsuccessful or if the seminal ducts are not present, doctors can surgically harvest sperm cells if sperm production is preserved. Preserved sperm maturation must be confirmed by a testicular biopsy.
In the case of an obstruction in the epididymal region with a blocked epididymal duct, doctors expose the epididymal duct (tubule) under the operating microscope and open it. They then use a micropipette to remove any sperm that flows out. These are then used for further artificial insemination (ICSI).
If there is a blockage in the area where the testicles meet the epididymis, doctors can extract sperm cells directly from the testicles. This requires the surgical removal of a piece of testicular tissue.
Using technical processing methods, they can extract sperm cells from the testicular tissue to use for further artificial insemination (ICSI - intracytoplasmic sperm injection). This involves doctors artificially combining the surgically obtained sperm cells and egg cells under a microscope.
Once the sperm and egg have successfully united, the embryo begins to mature in the test tube. Approximately 2-3 days after successful fertilization, doctors place the embryo back into the uterus. The probability of a successful pregnancy is around 25-30% per attempt.
In addition to microsurgical vasovasostomy, there are other microsurgical procedures in urology.
These include
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