WHAT IS REVAS?
The Reinforcing Vasal Suture Technique was developed by Dr. Landon Trost at the Mayo Clinic in 2018 while he was serving as the chief of male infertility. At the time, Dr. Trost recognized that the leading cause of failures following reversal (both his and other surgeon's) was because the area that had been sewn together had pulled apart (dehisced). This meant that the surgery itself was often successful but that the two tubes eventually pulled apart.
HOW IS REVAS PERFORMED?
The ReVas technique is performed by sewing the sides of the vas deferens together. The technique is akin to what is commonly done with electrical or phone cords, where the cord is looped back on itself to take much of the pressure off of the ends of the connection. By doing this, the vas is able to withstand much more stress before any strain is placed on the microscopic surgical area. This additional strength leads to higher success rates, and more importantly, higher total numbers of sperm post-operatively.
The following video demonstrates the ReVas technique, including published outcomes showing a roughly 8-fold higher rate of pregnancy within the first year after reversal among men who received the technique. Based on our experience and those findings, we routinely perform the ReVas technique in all vasectomy reversals.
What Does the Evidence Show?
SCIENTIFIC PUBLICATION RESULTS
Beginning in January of 2018, Dr. Landon Trost and Joshua Savage began performing the ReVas technique in all men who sought a vasectomy reversal at the Mayo Clinic. In 2019, the results of these men were compared against those who had undergone the traditional technique.
HIGHER RATES OF SPERM POST-OP
Results above show that regardless of the definition for sperm concentration used, men who underwent the ReVas technique were more likely to have a successful outcome. In contrast, prior to ReVas, success rates declined with stricter definitions for success. Please note that in the figure above, this includes all men undergoing a vasectomy reversal (vasovasostomy or epididymovasostomy). Most success rates that are reported online by reversal surgeons ONLY include those that underwent a vasovasostomy on both sides and had at least 1 sperm present at any point post reversal (patency).
HIGHER SPERM CONCENTRATIONS
The figure above shows that following introduction of ReVas, men had higher peak sperm concentrations and higher concentrations at the most recent follow-up. This meant that not only were a higher percentage of men achieving a successful outcome, but the total sperm counts were also higher. Additionally, the successful outcomes remained successful over time. In contrast, men who underwent the traditional technique were more likely to have initial success but then go on to have failures later on. Although not shown in the figure above, pregnancy rates were also higher in the men who underwent ReVas.
Compared to those who underwent a traditional surgery, men who underwent the ReVas technique were:
- 7.0x more likely to have >0 sperm
- 9.9x more likely to have >100,000 sperm
- 11.1x more likely to have >1 million sperm
- 12.3x more likely to have >5 million sperm
- 5.8x more likely to have >15 million sperm
The key takehome message though was that ReVas men were:
8.1x more likely to achieve a pregnancy
The higher pregnancy rate was likely because not only were a higher percentage of men successful at getting sperm back post-op, but the total number of sperm were also higher.
So, Why Does This All Matter?
Higher success rates = more likely to achieve a pregnancy post reversal
More likely to maintain a successful result long term
Defined as >5 million sperm (maintained long-term) compared to others who define it as >1 sperm or >1 million sperm at any time point post-op.
Allows us to set a very high definition for success
5 million was specifically selected as this number has been shown to be the threshold where optimal pregnancy rates are achieved.