Does the need for epididymovasostomy relate to the patient age at the time of vasectomy?

Abstract

OBJECTIVE: Most vasectomy reversals require vasovasostomy for successful repair. However, as the obstructive interval after vasectomy increases, the rate of epididymal obstruction rises, and the need for epididymovasostomy (EV) increases. There is also controversy in the literature whether patient age correlates with the need for EV. Given that younger men may have better sperm production, we hypothesized that they might be more prone to epididymal blowout over the same obstructive interval than older men. We sought to determine how the rate of EV varies with both obstructive interval and patient age after vasectomy. DESIGN: Retrospective chart review. MATERIALS AND METHODS: In an analysis of consecutive vasectomy reversals performed by a single surgeon, the relationship between the type of reversal procedure was correlated with duration of vasectomy and patient age. An EV was performed in the presence of sperm fragments with creamy fluid (Silber score 4 fluid) or complete vasospermia (Silber score 5). Cases of unilateral and bilateral EV were included in the analysis. RESULTS: A total of 174 patients who underwent reversal with a mean patient age of 44±7. Among the 101 patients <45 years of age, 29.7% had EVs. Of the 73 patients ≥45 years of age, 43.8% had EVs. Overall median vasectomy age was 10 years (range 1 to 30) For men <45 years of age, the median age of vasectomy was 8 years compared to 13 years for men ≥45. The rate of EV increased as the age of vasectomy lengthened; the calculated EV rate was approximately 3%/year beyond 5 years of vasectomy obstruction. However, when controlling for obstructive interval, men >45 years of age showed an increased need for EV compared to younger patients.Table 1Percentage of Epididymovasostomies by Vasectomy AgeVasectomy Age (years)Patient Age (years)p-value∗<45≥451-40%0%1.05-814.3%11.1%0.799-1220%22.5%0.1913+30%42.3%0.37∗Chi-squared analysis. Open table in a new tab ∗Chi-squared analysis. CONCLUSIONS: The need for EV after vasectomy increases with age of vasectomy. Patient age does not predict the need for EV.