Vasovasostomy in the convoluted vas deferens: indications and outcomes

We examined the indications for vasovasostomy (VV) in the convoluted vas deferens as well as the outcome of this procedure.

We retrospectively analyzed the indications and outcomes of all vasectomy reversals performed in the convoluted vas deferens (CVV). Indications for CVV were clear fluid with or without sperm, motile or nonmotile sperm, or sperm parts. Patency was defined as motile sperm in the ejaculate postoperatively. Pregnancy data were calculated based on natural pregnancy occurring within year 1 postoperatively.

A total of 48 patients underwent bilateral CVV (42) or unilateral CVV (6) when there was an unreconstructable/atrophic contralateral side. Average patient age was 39 years. Average age of the female partner was 30 years. The average obstructive interval was 10 years. The patency rate was 88% (38 of 43 cases). The natural pregnancy rate was 48% (15 of 31 cases). There was a significant difference in the patency rate in patients with sperm or sperm parts compared to those with clear fluid alone (p = 0.015). There was no difference in the pregnancy rate.

Vasovasostomy in the CVV is a technically more difficult procedure than standard VV. Nevertheless, postoperative results are typically comparable to those obtained via VV and superior to those of epididymovasostomy in many cases. Therefore, we recommend CVV using the same indications as for standard VV in the straight portion of the vas deferens. However, consideration for epididymovasostomy should be given when no sperm are seen in the vasal fluid intraoperatively.