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  • Title: Too bad for you, Humpty Dumpty.
    Author: Morton WJ.
    Journal: J Med Assoc Ga; 1980 Nov; 69(11):901-2. PubMed ID: 7452105.
    Abstract:
    The average age of men who have vasovasostomies (reversal of vasectomies) is 36, with the average interval from vasectomy to vasovasostomy being 7.6 years. The postvasovasostomy semen analysis shows uniform results in that the count is usually on the lower side (30 million), the motility is markedly reduced, and the morphology is abnormal in at least 50%. The quality of semen is usually sufficient to effect conception. A technically good result can produce a high sperm count, with good motility and morphology, but be functionally unsuccessful in that no pregnancy occurs. National statistics (U. S.) suggest a 75% successful sperm count, with a 40-60% rate of conception. The author's method of vasovasostomy is described. The operation usually takes about 2 hours. After a mid-line scrotal incision, each vas has its scar dissected out and the proximal and distal vas are isolated. Care should be taken not to strip the blood supply of the vas so as to not necrose it. Usually a creamy effluent comes from the proximal vas, which has dead and disintegrating sperm. 3.5x magnifying loupes and 8-0 opthalmic black braided silk are used. 2 sutures are taken 180 degrees apart directly through the muscularis and the lumen to exactly approximate both proximal and distal lumens. At least 6 more 8-0 sutures are taken circumferentially through the muscularis of the vas. No intralumental splints are used. The skin is then closed with 1 subcuticular suture of 4-0 dexon. It may take 5 months to a year for the patient's sperm count to enable him to impregnate his partner.
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