Repeat vasectomy reversal after initial failure: overall results and predictors for success

Abstract

Purpose: We review the treatment outcomes for microsurgical reconstruction following failed vasectomy reversal and identify predictors for success.

Materials and methods: We performed a retrospective review of our experience with microsurgical reconstruction in 41 men who underwent 1 or more prior unsuccessful vasectomy reversal procedures. Of these patients 20 underwent bilateral (16) or unilateral (4) vasoepididymostomy, 11 underwent bilateral (7) or unilateral (4) vasovasostomy and 10 underwent unilateral vasoepididymostomy with contralateral vasovasostomy. Postoperative followup consisted of serial semen analyses and telephone interviews.

Results: Patency and pregnancy followup data were available in 33 and 31 patients, respectively. Five couples had ongoing uncorrected female factor infertility problems and were not included in pregnancy rate calculations. Mean obstructive interval was 10.6 years. Overall patency and pregnancy rates were 79 and 31%, respectively. Mean total motile sperm count for patients demonstrating patency at followup was 38.0 million. History of conception with the current partner was predictive of future conception with 4 of 5 nonremarried couples (80%) initiating a pregnancy versus 3 of 18 remarried couples (17%) (p = 0.006). Other factors, including smoking history and obstructive interval, did not correlate with postoperative success. Reconstruction with vasovasostomy on at least 1 side trended toward improved patency (p = 0.17) and pregnancy rates (p = 0.15), although they did not assume statistical significance.

Conclusions: Microsurgical reconstruction following failed vasectomy reversal is associated with high patency and moderate pregnancy rates at short-term followup. In our series previous conception with the current partner was predictive of future conception after reconstruction. Urologists performing repeat vasectomy reversal must be familiar with microsurgical techniques, since almost three-quarters of patients will require at least unilateral vasoepididymostomy.

PIP: This paper reviews treatment outcomes for microsurgical reconstruction following failed vasectomy reversal. Additionally, the report also examines a variety of factors, including smoking history, time since vasectomy, prior conception with current partner, as well as type of repair, in an attempt to identify predictors of successful surgical outcome. A total of 41 men, who underwent one or more prior unsuccessful vasectomy reversal procedure, participated in the study. Of these patients, 20 underwent bilateral (16) or unilateral (4) vasoepididymostomy; 11 underwent bilateral (7) or unilateral (4) vasovasostomy; and 10 underwent unilateral vasoepididymostomy with contralateral vasovasostomy. Patency and pregnancy follow-up data were available in 33 and 31 patients, respectively. Due to the ongoing severe female factor fertility problems, 5 couples were not included from pregnancy rate calculations. The total patency and pregnancy rates were 79% and 31%, respectively. Mean total motile sperm count for patients demonstrating patency at follow-up was 38 million. The history of conception with the current partner was predictive of future conception with 4 or 5 nonremarried couples (80%) initiating pregnancy versus 3 of 18 remarried couples (17%) (p = 0.006). Reconstruction with vasovasostomy on at least one side trended toward improved patency (p = 0.17) and pregnancy rates (p = 0.15) although they did not assume statistical significance. The study concludes that microsurgical reconstruction following failed vasectomy reversal is associated with high patency and moderate pregnancy rates at short-term follow-up.