This paper , comparing one- and two-layer microsurgical vasovasostomy, provides postoperative motile sperm in the seminal fluid as the only criterion of success. There is unlikely to be a significant difference between the methods, as indicated previously , particularly when the anastomosed vasal ends are in the straight part, and proximal and distal lumina are not too dissimilar, which is by no means always the case . These observations are not reported in the paper, but what is more important is that no information is given as to whether, at the time of surgery, sperm were present in the testicular ends of the vasa and if not, the consistency and volume of the vasal fluid. The latter constitute important factors in the final result [2, 4–7], and without their availability there can be no adequate comparison between the methods.
If men who sought vasectomy reversal had either no sperm or whole sperm in the vasal fluid on both sides, and if no sperm on either side predicted failure, we could predict the postoperative success of each reversal with great accuracy. Unfortunately, the intraoperative findings between sides are frequently discordant and the patency frequently better than might be predicted from fluid quality alone. For example, men with clear fluid devoid of any sperm on both sides will still have patency rates of 60%. Clearly, vasal fluid quality would be helpful in comparing surgical techniques in men who had sperm bilaterally. Unfortunately, even these men would have to be subcategorized based on whole tails or short tails on one or both sides, as each has a different prognostic value.
Our study compared the patency of two well-accepted microsurgical techniques performed during the same period by one surgeon. These groups of men had had similar obstructive intervals since their vasectomy. The obstructive interval is closely correlated with intraoperative vasal fluid quality. Men with similar obstructive intervals can expect similar outcomes after a modified one-layer or a two-layer microscopic vasectomy reversal.
J. Grantmyre and M. A. Fischer
Dalhousie University, Halifax, Nova Scotia, Canada