Microsurgical Vasovasostomy Following Failed Vasovasostomy

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Abstract

PURPOSE: We reviewed the surgical outcomes (Patency and pregnancy rates) for microsurgical vasovasostomy following failed vasovasostomy and elucidate possible predictors for success.
MATERIALS AND METHODS
We evaluated 62 repeat vasectomy reversal patients who were available for patency of pregnancy follow-up data. We performed bilateral microsurgical 2-layer vasovasostomy as possible, regardless of the presence of sperm in the intraoperative vas fluid. Of these patients 60 (96.8%) underwent bilateral (58) or unilateral (2) vasovasostomy and 2 (3.2%) underwent unilateral vasovasostomy with contralateral epididymovasostomy.
RESULTS
Patency and pregnancy follow-up data were available in 62 and 42 patients, respectively. In our study of 62 cases, which underwent microsurgical vasovasostomy on minimal one side, the overall patency and pregnancy rate proved to be 91.9% and 57.1% respectively, and natural birth rate reached 52.4%, Increase of wife's age was proven to be a negative prognostic factor for pregnancy (p=0.018). Other factors, including obstructive interval, intraoperative detection of sperm, type of reconstruction, site of anastomosis, age of patient and postoperative semen parameters, did not influence the surgical outcome.
CONCLUSIONS
Microsurgical vasectomy reversal after previous failure results in high patency and pregnancy rates. Microsurgical vasovasostomy regardless of the presence of sperm in the intravasal fluid during operation is more successful than other studies that epididymovasostomy was performed in the absence of sperm from vas fluid. This study suggests that a compromised anastomosis after previous surgery is most common cause of failed vasectomy reversal. We recommend that microsurgical vasovasistomy should be performed preferentially in failed vasectomy reversal cases.