Vasectomy reversal outcomes in men previously on testosterone supplementation therapy - Abstract

OBJECTIVE: To report considerations for preoperative management and outcomes of vasectomy reversal (VR) in men with a history of testosterone supplementation therapy (TST).

METHODS: A retrospective review of men on TST before VR from 2010 to 2013 was performed. For inclusion, patients were required to have baseline and follow-up hormone levels as well as postoperative semen analyses. Preoperative use of medical testicular salvage therapy and testicular sperm aspiration (TESA), intraoperative findings, and pregnancies were also analyzed.

RESULTS: Six of 265 men who underwent VR had prior TST and met inclusion criteria. Median age was 39 years with a median obstructive interval of 7.5 years. Median duration of TST was 9 months before discontinuation and transition to testicular salvage therapy with clomiphene citrate with or without human chorionic gonadotropin for a median of 2.8 months. At baseline, decreased luteinizing hormone (median, 2 mIU/mL), follicle stimulating hormone (median, 5 mIU/mL), and total testosterone (median, 249 ng/dL) were observed. Two men (33%) with uncertain recovery of spermatogenesis based on physical examination and hormone response underwent preoperative testicular sperm aspiration confirming the presence of sperm. Nine vasovasostomies and 3 epididymovasostomies were performed. Patency was 83% after a median follow-up of 6.4 months and was 100% in men undergoing at least 1 vasovasostomy. Spontaneous pregnancy was achieved by 50% during the follow-up period.

CONCLUSION: Testicular salvage medical therapy may play a role in the preoperative management of VR in men with prior TST. VR after TST can have outcomes comparable to those in the general population.

Written by:
Coward RM, Mata DA, Smith RP, Kovac JR, Lipshultz LI.   Are you the author?
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC; Scott Department of Urology, Baylor College of Medicine, Houston, TX; Department of Biochemistry and Cell Biology, Wiess School of Natural Sciences, Rice University, Houston, TX; Department of Urology, School of Medicine, University of Virginia, Charlottesville, VA.  

Reference: Urology. 2014 Oct 10. pii: S0090-4295(14)00911-X.
doi: 10.1016/j.urology.2014.06.081

PubMed Abstract
PMID: 25307733 Vasectomy Section