Refertilization surgery. A surgeon's experience of over 27 years with nearly 2000 patients

The aim of this paper was to present the experiences of microsurgical refertilization in a single-centre study during a period of 27 years.

Nearly 2000 patients were operated by a single surgeon (JUS). A total of 1708 patients were evaluated in a data base, 1164 were available for a follow-up. Both vasovasostomy (VV) and epididymovasostomy (EV) were carried out in a three-layer technique. Vasectomy reversal (VR) end-to-end VV was performed only if spermatozoa had been demonstrated at the epididymal stump of the vas. In all other cases of VR, EV was done in a preocclusive region of the epididymal tubule. In the cases of postinfectious obstruction (PIO) of seminal pathways, an EV was always carried out.

The outpatient procedure of refertilization was associated with a very low complication rate, which underlines its minimal-invasive character. The follow-up rate was 68%, the overall patency rate was 88% for VR and 67% for PIO and the pregnancy rate was 59% for VR and 38% for PIO. Secondary azoospermia was observed in 1% of the patients.

In relation to the intervals of obstruction, the patency and pregnancy rates were higher after short-term obstruction than after long-term obstruction. There is a significant discrepancy between patency and pregnancy rates that is likely to be caused by a relevant number of patients with postoperative asthenozoospermia.