| RE:
COMPARISON OF VASOVASOSTOMY WITH CONVENTIONAL MICROSURGICAL SUTURE AND
FIBRIN ADHESIVE IN RATS
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WILSON F. BUSATO
JUNIOR, AMANDIA M. MARQUETTI, LUIZ C. ROCHA
Section of
Urology (WFBJ), School of Medicine, UNIVALI and Catarinense Institute
of Urology (WFBJ, AMM), Itajai, Santa Catarina, Section of Urology (LCR),
School of Medicine, Federal University of Parana, Curitiba, Brazil
Int
Braz J Urol. 33: 829-36, 2007
To the Editor:
We
read with great interest the paper by Wilson F. Busato Junior and colleagues
(1). In this elegant study two techniques of vasovasostomy have been tested
in a laboratory setting. One group of rats underwent “conventional”
one-layer anastomosis on the left vas deferent, after transection on the
right side; another group was evaluated for a simplified anastomosis performed
with one anchor point plus fibrin glue, and the last group served as control
after a sham operation. The authors concluded that the two techniques
are similar (p > 0.05) and the operative time is the only relevant
difference.
As a first point to debate we would emphasize
that the results of this study cannot be considered out of an experimental
concern. This is because the anastomosis was performed using perfect stumps
of deferens and they were immediately reattached after cutting. Thus,
it does not reproduce the real clinical condition in which a scar tissue
can be found at the cut ends.
Another issue refers to the way of apposing
the divided ends of the vasa. The authors applied a direct end-to-end
anastomosis in both procedures. However, in a clinical context, it might
be helpful a modified approach based on preparing the vas ends. As reported
by Fox, the convoluted portion of the vas is always thinner and more difficult
to suture than the straight part. Therefore, in all cases in which the
stumps are of different size, it is advantageous to transect obliquely
the deferent in order to augment the diameter of its lumen (2). This technique
has shown ensuing paternity in one third of patients either after primary
or revised vasovasostomy.
Finally, the authors suggest that the fibrin-supplied
vasovasostomy since requires less operative time may became a simplified
procedure suitable also for a general urologist. Nevertheless the microsurgical
vasovasostomy performed at microscope is widely considered improved over
other methods using less magnification (3). Thus, in our opinion the vasovasostomy
should preferably address to urologists trained in microsurgery (clinical
or experimental) or practiced in dedicated centers.
In any case, we congratulate the authors
for a well drawn study dealing with appropriate number of animals according
to modern ethical rules (4).
REFERENCES
1. Busato WF Jr, Marquetti
AM, Rocha LC: Comparison of vasovasostomy with conventional microsurgical
suture and fibrin adhesive in rats. Int Braz J Urol. 2007; 33: 829-36.
2. Fox M: Easing the technical difficulty of microscopic vasectomy reversal.
Br J Urol. 1996; 78: 462-3.
3. Fox M: Failed vasectomy reversal: is a further attempt using microsurgery
worthwhile? BJU Int. 2000; 86: 474-8.
4. Hagelin J, Carlsson HE, Hau J: Increased efficiency in use of laboratory
animals. Lancet. 1999; 353: 1191-2.
Dr.
Fabio Campodonico &
Dr. Antonio Casarico
Department of Urology
EO Ospedali Galliera
Genova, Italy
E-mail: fabio.campodonico@galliera.it
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