Abstract
Abstract Introduction Due to a myriad of reasons, vasectomy reversal (VR) is requested by up to 6% of men who have previously had a vasectomy. Current surgical and technical advances in VR have led to high patency and pregnancy rates. However, there remains a subset of patients who desire natural conception but fail VR. Redo-VR is a feasible option to achieve paternity for this specific subset of patients. Objective This study aims to evaluate our own experience with redo-VR patients and factors contributing to a successful outcome in the form of patency rates. Methods This is a retrospective review of a prospectively updated patient database. Patients who had a redo vasectomy reversal with either a vasovasotomy (VV) or a vaso-epididymostomy (VE) were included in the review. Outcomes of interest included patient age, partner age, obstructive interval (OI), intra-operative vasal fluid microscopy findings and post-operative patency rates. The Silber 1977 grading system was used to describe vasal fluid microscopic findings. Data was extracted and organised using Microsoft Excel, and further analysis was done using SPSS v29. A p-value of <0.05 was considered significant. Results Seventy two (72) patients were eligible for review and had complete records. The average age was 48.8 +/- 7.6 years, with an average partner age of 32.9 +/-4.2 years. The average number of years since the initial vasectomy or OI was 10 years. The majority (63.8%) had bilateral vasovasostomy. Vasal microscopic fluid appearances are described in the figure with less than half having Silber Scale 1. The overall patency rate of the redo-reversal procedures was 82%. A Cochrane-Armitage test demonstrated that Silber classification of vasal fluid on microscopy did not predict successful outcomes (p = 0.66). Patients with redo-VE had lower patency rates. Conclusions Redo-VR is a feasible option for patients seeking natural conception after a vasectomy and an unsuccessful reversal procedure. Our findings demonstrate post-operative patency rates similar to primary VR patency rates described in the literature. Silber scale does not reliably predict outcomes. Disclosure No.
Published Version
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