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  • Title: Is the low fertility rate after vasovasostomy caused by nerve resection during vasectomy?
    Author: Pabst R, Martin O, Lippert H.
    Journal: Fertil Steril; 1979 Mar; 31(3):316-20. PubMed ID: 437166.
    Abstract:
    Cross-sections of human spermatic cords and vasectomy specimens were prepared and the number and cross-sectional area of nerves were determined. On average, about one-half of all nerves in the near neighborhood of the vas deferens were resected during vasectomy. The total cross-sectional area of the nerves along the vasectomy specimens amounted to about one-half of the total area in the spermatic cord samples. The data support the hypothesis that removing nerves to the vas deferens during vasectomy could result in poor functional results after vasovasostomy, i.e., that powerful contraction of the proximal vas deferens and epididymis could be lacking. The possibility that an aspect inherent in the surgical technique of vasectomy is responsible for the low rate of fertility after vasovasostomy was investigated by studying the localization of nerves in the neighborhood of the vas deferens in the spermatic cord and by determining whether and to what extent nerves are resected during vasectomy. In addition, the roles of nerves in vasectomy and vasovasostomy were investigated. Spermatic cords were dissected in cross-sections from 17 cadavers; specimens from vasectomies (vas deferens) were provided by a urology dept. (n=45). In the spermatic cord material, an arbitrary radius around the vas was studied for nerve characterization, and there was no obvious prevailing localization of nerves, but they were found in the whole circumferential adventitia of the vas deferens. In the vasectomy specimens, the adventitial tissue of the vas was missing; in most cases the larger areas of the vas were bare of adventitial tissue, and the vessels and nerves found were located on 1 or 2 sides of the vas. Quantitatively, the mean number of nerves per cross-section was about 1/2 of the number in spermatic cords; the total area of nerves resected on average during vasectomy amounted to nearly 50% of all nerves found near the vas in spermatic cords. This nerve resection could result in poor functional results after reversal of sterilization because the powerful contractions of the proximal vas deferens would be lacking.
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