Intraoperative Dilemmas and Challenges with Vasovasostomy and Vasoepididymostomy

Abstract

There are a number of unique dilemmas and challenges that all reversal doctors will encounter. From dealing with protuberant pouchy abdominal vasal mucosa to performing the anastomosis down to the thin-walled, deep convoluted testicular vas, these special situations often require modifications of standard techniques. How to work with absent adventitia or a large epididymal cyst or more commonly widely discrepant lumens can be challenging even for the most experienced microsurgeons. Vasoepididymostomy specific challenges include the absence of fluid or sperm in the open epididymal tubules, a very vascular or scarred overlying epididymal tunica, flat almost nonvisible epididymal tubules, as well as a lengthy vasal gap.