Experience wiht vasovasostomy: operative technique and results

Abstract

Between 1972 and 1977 vasovasostomy to reverse a previous vasectomy for contraception has been attempted in 27 cases. The procedure was abandoned as a technical impossiblity in only 1 case. The first 17 have been studied and in these there have been 11 pregnancies, 10 of which have already come to term with the birth of normal children, including one set of twins. Of the remainder, 2 are known to have oligozoospermia and 4 have been lost to follow-up although 2 of these were euspermic when last heard of. In spite of the encouraging results it is considered that there are no grounds for altering the present basis of vasectomy counselling in which the operation is described as likely to be irreversible.

PIP: In an attempt to determine both technical and functional success of vasovasostomy 27 operations for reversal of vasectomy between 1972 and 1977 were studied. 17 were considered a review group because 18 months or more had elapsed since the vasovasostomy was performed. The mean age of men at the time of vasectomy was 32.3 years ranging between 28 and 45 years of age. At the time of the vasovsaostomy the range was 30 to 49 years with mean age 36.1 years. Intervals between vasectomy and vasovasostomy averaged 46.4 months. Important elements in the operation appeared to be the monofilament nylon splint left in situ for 5 postoperative days plus strict bedrest for 7 days after the operation to minimize strain on the anastomosis and the risk of sperm leakage into surrounding tissue. Seminal analysis occurred 2 months after the operation and at various times thereafter. Sperm counts were initially low in density with some motility impairment. Later specimens showed increased density, viability and motility. Of the review group there was a 64.7% (11 pregnancies) functional success. The remaining men are currently under observation. The mean interval between vasectomy and vasovasotomy among the 11 pregnancies was 39.8 months. An average of 10.4 months elapsed between the vasectomy reversal operation and conception. The authors contend that although functional success rates appear encouraging prospective vasectomy clients should consider the operation a permanent means of birth control.