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Microsurgical reconstruction following failed vasectomy reversal
G J Matthews1, K E McGee, M Goldstein
1Department of Urology, New York Hospital-Cornell Medical Center, New York, New York 10021, USA.
The Journal of Urology
|March 1, 1997
Summary
Repeat vasectomy reversals can achieve good outcomes, but success rates are lower than initial procedures. Unrecognized epididymal obstruction is a common cause of complete failure, and sperm cryopreservation is recommended due to higher stenosis rates.
Area of Science:
- Urology
- Reproductive Medicine
- Microsurgery
Background:
- Vasectomy reversal procedures can fail, necessitating repeat interventions.
- Understanding outcomes of repeat vasectomy reversals is crucial for patient counseling and surgical planning.
Purpose of the Study:
- To characterize the treatment outcomes of microsurgical reconstruction following failed vasectomy reversals.
- To analyze factors contributing to failure and success in repeat vasectomy reversal surgeries.
Main Methods:
- Retrospective evaluation of 64 repeat vasectomy reversals (vasovasostomy and vasoepididymostomy) in 57 men.
- Analysis of patency, pregnancy, and stenosis rates based on initial failure type (complete vs. late).
Main Results:
- Men with complete vasectomy reversal failure (azoospermia) had a 74% need for vasoepididymostomy, versus 24% for late failures (p < 0.001).
- Overall crude patency and pregnancy rates were 67% and 30%, respectively.
- Patency and pregnancy rates were higher for vasovasostomy (93% and 43%) compared to vasoepididymostomy (47% and 15%).
- Stenosis rates were 27% for repeat vasovasostomy and 18% for vasoepididymostomy.
Conclusions:
- Complete vasectomy reversal failure often indicates underlying epididymal obstruction.
- Late failures suggest issues with the initial anastomosis.
- Repeat reversals yield lower patency and pregnancy rates than primary procedures, with increased stenosis risk.
- Intraoperative and postoperative sperm cryopreservation is advised for repeat vasectomy reversals.