Abstract
BackgroundOur understanding of early post-vasectomy recanalization is limited to histopathological studies. The objective of this study was to estimate the frequency and to describe semen analysis patterns of early recanalization after vasectomy.MethodsCharts displaying serial post-vasectomy semen analyses were created using the semen analysis results from 826 and 389 men participating in a randomized trial of fascial interposition (FI) and an observational study of cautery, respectively. In the FI trial, participants were randomly allocated to vas occlusion by ligation and excision with or without FI. In the cautery study, sites used their usual cautery occlusion technique, two with and two without FI. Presumed early recanalization was based on the assessment of individual semen analysis charts by three independent reviewers. Discrepancies were resolved by consensus.ResultsPresumed early recanalization was characterized by a very low sperm concentration within two weeks after vasectomy followed by return to large numbers of sperm over the next few weeks. The overall proportion of men with presumed early recanalization was 13% (95% CI 12%–15%). The risk was highest with ligation and excision without FI (25%) and lowest for thermal cautery with FI (0%). The highest proportion of presumed early recanalization was observed among men classified as vasectomy failures.ConclusionEarly recanalization, occurring within the first weeks after vasectomy, is more common than generally recognized. Its frequency depends on the occlusion technique performed.
Highlights
Our understanding of early post-vasectomy recanalization is limited to histopathological studies
The objectives of this secondary analysis were to estimate the frequency of post-vasectomy early recanalization and to describe semen analysis patterns associated with presumed early recanalization
Their agreement was moderate to substantial in the fascial interposition (FI) trial, where they had to classify the charts as either recanalization or not, and was fair to moderate in the cautery study, where in addition they could classify a chart as indeterminate[11]
Summary
Our understanding of early post-vasectomy recanalization is limited to histopathological studies. Data from two studies – a randomized clinical trial of the effectiveness of fascial interposition (FI)[8] and an observational study of vasectomy using cautery[9] – in which sequential semen analyses were performed early after vasectomy, provided an opportunity to enhance our clinical understanding of post-vasectomy recanalization. The objectives of this secondary analysis were to estimate the frequency of post-vasectomy early recanalization and to describe semen analysis patterns associated with presumed early recanalization
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