Reversal of vasectomy and the general surgeon

Abstract

Reversal of vasectomy is a difficult procedure. Most surgeons still perform a macroscopic vasovasostomy. However, there is a little guidance in the current literature on the results that can be expected from such procedures. Patients may therefore be given unrealistic expectations preoperatively. Our study shows the results of macroscopic reversals of vasectomy performed over a 9-year period. A survey of Welsh surgeons is also presented concerning their preferred techniques and estimated success rates for reversals. The study clearly shows that a macroscopic vasovasostomy is the commonest method employed, with a wide variation in estimated success rates. Patients considering a macroscopic reversal of vasectomy should be warned of a less than 20% success rate.

PIP: 33 patients over a 9 year period had undergone macroscopic vasovasostomies (a single layer anastomosis) at a surgical unit at the University Hospital of Wales in Cardiff. 4 patients were lost to follow-up. The partners of 5 (17%) of the remaining 29 vasectomy reversal patients had become pregnant. The interval between vasectomy and reversal for these 5 men was shorter than that for those who did not have a successful vasectomy reversal (6.2 years vs. 8.9 years). After the reversal, 13 men had a normal sperm count (20,000,000/ml) and 12 had no sperm at all. 77% of the Welsh surgeons responding to a questionnaire had performed vasectomy reversals. All these surgeons had used a one-layer anastomosis. 54% used low power magnification, 43% used no magnification, and 3% used an operating microscope. 64% did not use a stent. The remaining 46% did use a stent. General surgeons and urologists generally used the same techniques. There was a wide variation in the estimates of patients who fathered children after vasectomy reversal among the 31 surgeons. Most surgeons (11) reported a pregnancy rate of 21-30%. 2 surgeons said that 60-70% of their vasectomy reversal patients fathered children. The authors recommend that surgeons tell patients undergoing a macroscopic reversal of vasectomy of a less than 20% success rate.