Outcomes for vasovasostomy performed when only sperm parts are present in the vasal fluid

This article reviews the outcomes for vasovasostomy (VV) when only sperm parts were present in the vasal fluid. Thirtyfour patients who underwent bilateral (31) or unilateral (3) VV had either sperm parts bilaterally or sperm parts on 1 side and intravasal azoospermia on the contralateral side. Two of the procedures (1 unilateral, 1 bilateral) were repeat procedures. Patient and partner age were 42 +/- 1.2 (range: 34-54 and 33 +/- 0.9 (range: 23-42) years, respectively. Follow-up was 10 +/- 1.8 months. The obstructive interval was 10 +/- 0.9 (range: 4-27) years. The patency rate was 76% (26/34). The obstructive interval ranges for patent cases versus not-patent cases were 3 to 21 and 3 to 27 years, respectively. The obstructive interval did not differ between the patent and not-patent groups (9 years vs 11 years, P = 0.3978). The pregnancy rate for those with sufficient follow-up was 35% (7/20). Of the 8 failed cases, 2 had only an occasional sperm head bilaterally and 1 other had an occasional sperm head on 1 side and contralateral intravasal azoospermia. If these 3 cases were excluded, then the patency rate was 84% (26/31). The patency rate for VV performed when only sperm parts were present in the vas fluid was lower than previously reported patency rates with complete sperm but at least as good as most surgeons' experience with vasoepididymostomy. The pregnancy rate was also less than previously reported pregnancy rates with complete sperm. These data suggest that VV is indicated only when sperm parts are noted in the vasal fluid. There does not appear to be a threshold obstructive interval above which VE would be indicated in this setting. If only an occasional sperm head is noted in the vasal fluid, then the surgeon should consider vasoepididymostomy.