The Impact of Obstructive Interval and Sperm Granuloma on Outcome of Vasectomy Reversal

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Jan 2004The Impact of Obstructive Interval and Sperm Granuloma on Outcome of Vasectomy Reversal STEPHEN BOORJIAN, MICHAEL LIPKIN, and MARC GOLDSTEIN STEPHEN BOORJIANSTEPHEN BOORJIAN , MICHAEL LIPKINMICHAEL LIPKIN , and MARC GOLDSTEINMARC GOLDSTEIN View All Author Informationhttps://doi.org/10.1097/01.ju.0000098652.35575.85AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We studied the impact of the interval from vasectomy to reversal and presence of sperm granuloma on outcomes of reversal. Materials and Methods: A total of 213 microsurgical vasectomy reversals performed by a single surgeon were stratified according to obstructive intervals of less than 5 years, 5 to 10 years, 10 to 15 years and greater than 15 years. The effects of obstructive interval on patency and pregnancy rates were assessed using multivariate logistical regression. The impact of sperm granuloma on patency and pregnancy was assessed using the chi-square test. Results: Patency did not change with increasing obstructive intervals as can be seen with 91% patency at less than 5 years, 88% at 5 to 10 years, 91% at 10 to 15 and 89% at greater than 15 years. There was no difference in pregnancy rates (89%, 82% or 86%) at obstructive intervals of 0 to 5, 5 to 10 or 10 to 15 years, respectively. Pregnancy rates were significantly lower (44%, p <0.05) with obstructive intervals greater than 15 years. Men with at least unilateral sperm granuloma had patency of 95% vs 78% without granulomas, a trend which did not quite reach statistical significance (p = 0.07). There was no difference in pregnancy rates with or without granulomas. Conclusions: Vasectomy reversal patency rates are high regardless of time since vasectomy. Pregnancy rates are lower more than 15 years after vasectomy. Sperm granuloma had a favorable impact on patency. Our data indicate that for obstructive intervals less than 15 years vasectomy reversal yields much higher pregnancy rates than in vitro fertilization and intracytoplasmic sperm injection, and that even for intervals greater than 15 years reversal outcomes equal or exceed those of in vitro fertilization and intracytoplasmic sperm injection. References 1 : Surgical management of male infertility and other scrotal disorders. In: . Philadelphia: W. B. Saunders Co.2002: 1532. chapt. 44. Google Scholar 2 : Male infertility. In: . Philadelphia: W. B. Saunders Co.2002: 1475. chapt. 43. Google Scholar 3 : Microscopic vasectomy reversal. Fertil Steril1977; 28: 1191. Google Scholar 4 : Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol1991; 145: 505. Link, Google Scholar 5 : A 20-year experience with vasovasostomy. J Urol1986; 136: 413. Link, Google Scholar 6 : Intraoperative observations during vasovasostomy in 334 patients. J Urol1983; 129: 524. Link, Google Scholar 7 : Intravasal azoospermia: a surgical dilemma. BJU Int2000; 85: 1089. Google Scholar 8 : Comparison of intussusception pull-through end-to-side and conventional end-to-side microsurgical vasoepididymostomy: prospective randomized controlled study in male Wistar rats. J Urol2002; 167: 2284. Link, Google Scholar 9 : Microsurgical vasoepididymostomy: a prospective randomized study of 3 intussusception techniques in rats. J Urol2003; 169: 1924. Link, Google Scholar 10 : Triangulation with end-to-side vasoepididymostomy. J Urol1998; 159: 1951. Link, Google Scholar 11 : Reconstruction of the male reproductive tract using the microsurgical triangulation technique for vasoepididymostomy. J Urol1999; 161: 350. abstract 1355. Google Scholar 12 : Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations. J Urol1995; 154: 2070. Link, Google Scholar 13 : Microsurgical vasoepididymostomy: refinements and results. J Urol1993; 150: 1165. Link, Google Scholar 14 : Inflam