Redo vasectomy reversal intraoperative findings implicate incorrect initial reversal technique in 28% of cases

Abstract

OBJECTIVE: Studies have supported redo vasectomy reversals as a viable option following initial failure; however, debate continues on factors causing vasectomy reversals (VR) to fail. The purpose of this study was to evaluate etiology of failed VR and success rate of redo vasovasostomy (VV) or vasoepididymostomy (VE) surgery at one VR clinic where 10% (222/2268) of all VR surgeries were redo cases. DESIGN: Retrospective analysis of patients undergoing redo VR at a single specialty center. MATERIALS AND METHODS: Records from 2268 patients revealed 222 subjects that received redo VR. Data from redo patients included obstructive interval, surgical method for initial and redo VR (VV or VE), vasal fluid parameters, anastomotic patency and pregnancy rate. Average patient age was 42 yr with an average obstructive interval for the initial VR of 10 yr, and average interval between initial and redo VR of 2.7 yr (range 0.5-13 yr). A follow-up semen analysis was advised every two months following surgery until pregnancy occurred. Patency was established as return of motile sperm in the post-operative semen analysis or a reported natural conception. RESULTS: Bilateral VV was performed 57% (119/208) of the time for redo patients. The remainder of the patients received a unilateral VV and a unilateral VE (VV/VE) or a bilateral VE, 25% (51/208) and 18% (38/208) respectively. A subset of 119 patient charts was reviewed to compare the type of connection made during the initial and redo VR. Data demonstrated 97% (232/238) of connections during initial VR were unilateral VV and the remaining 3% (6/238) were unilateral VE. Based on intra-op vasal fluid quality and sperm, the redo patients received 69% (165/238) unilateral VV and 31% (73/238) unilateral VE, resulting in a significant (p<0.001) shift of 28% of connections from VV to VE. Redo VR patients had a patency of 89% (161/181) with an average of 41 million motile sperm per ejaculate and a pregnancy rate of 43% (77/181). CONCLUSIONS: 1) our success of redo VR confirms prior published success rates, reaffirming redo VR as a viable option after failed VR; 2) in 28% of redo VR, a VE was indicated when an initial VV was performed. This group showed no intravasal sperm and with a short interval between initial VR and redo, new onset secondary epididymal obstruction was unlikely. We attribute the initial failure of the remaining 72% redo patients that received VV to intravasal scarring or technical reasons.