The Results of Microscopic Vasovasostomies with Different Methods in the Vasectomized Patients

Kim, Dae Hwan; Jung, Gyung Woo; Yoon, Jin Han

Abstract

PURPOSE: Vasectomy has become a popular method for male sterilization in Korea and this, in turn, has been followed by an increase in the number of patient requiring vasectomy reversal. Recently, many authors have reported high success rates of vasovasostomy using microsurgical techniques. The purpose of this study was to compare patency and pregnancy rates and operation time of a new method for vasovasostomy developed at the Department of Urology, Dong-A University Hospital with those of other methods, and to find out other factors influencing patency and pregnancy rates.
MATERIALS AND METHODS
Microscopic vasovasostomy was performed in 149 patients from June 1990 to September 1997 at our department. Among 89 patients who could be followed up post-operatively, standard two layer vasovasostomy was performed in 22 patients, modified one layer vasovasostomy with 4 full thickness sutures in 32 patients and modified one layer vasovasostomy with 5 full thickness sutures developed at our department in 35 patients. We compared mean operation times and patency and pregnancy rates between the techniques and examined patency and pregnancy rates according to age, vasal obstruction interval, presence of sperm in vas fluid and sperm granuloma.
RESULTS
Success rates were 95.5% for patency and 68.2% for pregnancy in standard two layer vasovasostomy, 87.5% for patency and 59.42% for pregnancy in modified one layer vasovasostomy with 4 full thickness sutures and 97.1% for patency and 65.7% for pregnancy in modified one layer vasovasostomy with 5 full thickness sutures and there was statistical significance in the patency rates between each method (p<0.05). Mean operation times were 136.6+/-19.2 minutes in standard two layer vasovasostomy, 86.6+/-16.8 minutes in modified one layer vasovasostomy with 4 full thickness sutures and 96.7+/-18.4 minutes in modified one layer vasovasostomy with 5 full thickness sutures (p<0.001). With regard to factors influencing operation, the pregnancy rates were slightly higher in cases of younger patients, presence of sperm in vas fluid and presence of sperm granuloma (p>0.05) and significantly lower in case of longer vasal obstruction interval (p<0.0005).
CONCLUSIONS
We found little difference in success rates between standard double layer vasovasostomy and modified one layer vasovasostomy with 5 full thikness sutures and the latter was easier and more time saving technique.