OBJECTIVE: To analyze the vasectomy reversal (VR) outcomes specifically among patients with vasal obstructive intervals (VOIs) of >10 years.
The VOI has been shown to be a significant predictor of outcome after VR. Although no strict cutoff exists, couples have frequently been discouraged from considering a VR strictly according to the interval from vasectomy.
MATERIALS AND METHODS: From 2006 to 2011, all consecutive VRs performed by 2 fellowship-trained microsurgeons were analyzed. The patients were stratified into 4 categories according to the duration of the VOI: < 10, 10-15, >15-20, and >20 years. The postoperative semen parameters, patency rates, and pregnancy outcomes were compared among the 4 groups.
RESULTS: Of 535 consecutive VRs, 177 patients (33%) had a VOI of >10 years. The couple characteristics, type of VR required, postoperative semen quality, and patency and pregnancy rates among the 4 groups were analyzed. The men with longer VOIs were older (P < .001) and had older female partners (P = .006). Although the VOI influenced the type of reversal performed, favorable semen concentrations (average >20 million/mL in all groups) and patency (average >90%) and pregnancy rates (range 24%-39%) were achieved in men with a VOI >10 years.
CONCLUSION: Although the interval since vasectomy has a significant effect on the type of VR required, provided a surgeon is proficient in both microsurgical vasovasostomy and vasoepididymostomy, favorable semen parameters and patency and pregnancy rates can be achieved in men with a VOI >10 years. Couples should not be discouraged from considering VR simply according to the VOI.
Grober ED, Karpman E, Fanipour M. Are you the author?
Division of Urology, Department of Surgery, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
Reference: Urology. 2013 Nov 6. pii: S0090-4295(13)01179-5.