The post-vasectomy length of the testicular vasal remnant: a predictor of surgical outcome in microscopic vasectomy reversal

Abstract

To identify another preoperative predictor of surgical outcome in vasal reconstruction, we prospectively measured the post-vasectomy length of the testicular vas deferens from the cauda of the epididymis to the site of the vasectomy in 26 patients undergoing vasal reconstruction. Intraoperatively, the vasal fluid was microscopically inspected and classified as whole sperm present or whole sperm absent. The length of the testicular vasal remnant was correlated with the intraoperative status of the vasal fluid. A testicular vasal remnant length greater than 2.7 cm. predicted the presence of fluid with whole sperm present in 30 of 32 testicles (94%). A testicular vasal length of less than 2.7 cm. predicted the presence of fluid without whole sperm in 17 of 20 testicles (85%). The length of the testicular vasal remnant can be measured preoperatively and knowledge of this length may be used to advise patients regarding the likelihood of successful vasal reconstruction.

PIP: Urologists measured the length of the testicular vasal remnant of 26 consecutive vasectomized patients at hospitals of Emory University in Atlanta, Georgia, and of Baylor College of Medicine in Houston, Texas, to test the hypothesis that the remnant's length predicts the likelihood of successful vasal reconstruction. 32 testicles of 19 patients (13 bilateral and 6 unilateral) had whole sperm in the vasal fluid. 20 testicles in 13 patients (7 bilateral and 6 unilateral) had no whole sperm. 6 patients had ipsilateral whole sperm. The mean testicular vasal remnant length for the whole sperm group was significantly longer than that for the group with no whole sperm (4.45 cm vs. 2.27 cm; p = .003). For each centimeter increase in testicular vasal remnant length, the probability of whole sperm being present increased 4 fold. The researchers agreed on 2.7 cm being the threshold. A remnant less than 2.7 cm predicted 85% (17/20) of testicles with no whole sperm in the vasal fluid. A remnant greater than 2.7 cm predicted 94% (30/32) of testicles with whole sperm in the vasal fluid. The interval between vasectomy and vasectomy reversal did not affect the likelihood of having whole sperm present in vasal fluid (8.25 years for the whole sperm group and 8 years for the no whole sperm group). Other research shows that when whole sperm are present, the vasal patency rate is 90%, and the pregnancy rate is 54%. These figures for no whole sperm are 60% and 30%, respectively. These doubles suggest that urologists should ligate the vas deferens as high in the scrotum as possible when performing vasectomies to help preserve testicular function in men who might want to undergo vasectomy reversal later.