Failed Vasectomy Reversal: Is a Further Attempt Worthwhile Using Microsurgery?

Abstract

Following surgery for vasectomy reversal there is a substantial failure rate in achieving fertility. Obstruction at the anastomotic site is the cause in the majority of cases. Further exploration to reconstruct the anastomosis using no magnification or a magnifying loupe can be difficult and even impossible, and can result in further failure, especially if the convoluted part of the vas had been involved. The outcome of revision by a microscopic technique of vasovasostomy was thus investigated. A meticulous microsurgical technique employing a 2-layer interrupted suture, end-to-end anastomosis with 10/0 nylon, was used to establish continuity of the lumen. Sperm in the ejaculate was achieved in 64% of 22 patients operated on after previous failure. Fertility rate after a mean follow-up of 23 months (range 8 months to 6 years) demonstrated by pregnancy in their partners has occurred so far in 27%. Length of the obstructive period was related to the outcome as well as the presence or absence of sperm at operation, but neither of these indicators or the presence of antisperm antibodies comprised a bar to eventual success. Microsurgical vasovasostomy after previous failure provides the patient with further reasonable hope of success in becoming fertile, but microsurgical skills are required.