PD07-04 MEN UNDERGOING VASOEPIDIDYMOSTOMY FOR VASECTOMY REVERSAL HAVE WORSE OUTCOMES THAN MEN WITH PRIMARY EPIDIDYMAL OBSTRUCTION

Abstract

You have accessJournal of UrologyInfertility: Therapy II1 Apr 2016PD07-04 MEN UNDERGOING VASOEPIDIDYMOSTOMY FOR VASECTOMY REVERSAL HAVE WORSE OUTCOMES THAN MEN WITH PRIMARY EPIDIDYMAL OBSTRUCTION Bobby Najari, Abimbola Ayangbesan, Andrew Gottesdiener, Phil Bach, Filipe Tenorio Lira Neto, Philip Li, and Marc Goldstein Bobby NajariBobby Najari More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , Andrew GottesdienerAndrew Gottesdiener More articles by this author , Phil BachPhil Bach More articles by this author , Filipe Tenorio Lira NetoFilipe Tenorio Lira Neto More articles by this author , Philip LiPhilip Li More articles by this author , and Marc GoldsteinMarc Goldstein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2807AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical vasoepididymostomy (VE) for obstructive azoospermia is amongst the most challenging procedures in all of microsurgery. Epididymal obstruction can be secondary to vasal obstruction, most commonly vasectomy, or primary, usually after epididymitis. We hypothesized that men undergoing VE for vasectomy reversal (VR) would have better outcomes than men with primary epididymal obstruction (PEO). METHODS We retrospectively reviewed a database of 756 reconstructive cases performed for obstructive azoospermia by a single surgeon. Inclusion criteria was having a unilateral or bilateral VE and at least one semen analysis post-surgery. Exclusion criteria included a vasovasostomy on either side. Patency was defined as a sperm concentration of >100,000/mL by 6 months post-surgery. Men who did not meet this criteria, but had unassisted clinical pregnancies were also considered patent. Men with a sperm concentration <100,000/mL and/or <6 month follow-up were considered not patent. Late failure was considered to be azoospermia after initial patency. RESULTS Of the 126 men who met inclusion criteria, 68 (54%) underwent VE for PEO (Table). Compared to the 58 men who underwent VE for VR, men with PEO were younger, had fewer children, and were less likely to undergo bilateral reconstruction. At a median follow up of 10 months, the patency rate was significantly lower in the men with PEO vs VR (85.3% vs 69%, p=0.033). This significant difference was driven by the men with bilateral reconstruction (Figure). Men with PEO vs VR had similar late failure rates (12.5% vs 25%, p=0.237) and natural pregnancy rates (27.9% vs. 20.7%, p=0.409), however men with PEO and bilateral VE had higher overall pregnancy rates compared to men with VR (52.9% vs. 37.9%, p=0.030). CONCLUSIONS Contrary to our hypothesis, men with PEO have better outcomes after VE compared to men undergoing the procedure for VR. The absence of short vasal length often encountered in post-vasectomy VE may explain better outcomes and lower late failures in PEO cases. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e223-e224 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Bobby Najari More articles by this author Abimbola Ayangbesan More articles by this author Andrew Gottesdiener More articles by this author Phil Bach More articles by this author Filipe Tenorio Lira Neto More articles by this author Philip Li More articles by this author Marc Goldstein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...