Vasectomy reversal: is the microscope really essential?

To evaluate the outcomes of bilateral vasectomy reversal procedure in relation to the macroscopic technique, surgical time and duration of obstructive interval.

We performed a retrospective study over a twelve-year period using a macroscopic technique. All cases of vasectomy reversal were consecutive and performed by the same surgeon. The procedure was performed using a single layer, spatulate end to end anastomosis technique using 6 x 6-0 prolene. No loupe magnification was used.

The median age of the men was 42 years (range 30-56). The median obstructive interval in years was 8.5 years (range 2-23). The procedure was a day case and the median surgical time under general anaesthetic was 75 minutes (range 45-90). None of the patients required hospital admission following discharge. 63 of the 70 patients had positive patency test postoperatively (90%). The sperm count was more than twenty million/ml. The pregnancy rate was 54% and the miscarriage rate was 7.1%.

The outcomes of macroscopic vasectomy reversal performed by an experienced surgeon can have a high success rate using the macroscopic single layer spatulate end to end anastomosis technique. This technique is easy to learn compared to the learning curve involved in microsurgery and is an effective means of "re- establishing" fertility in vasectomised men.