Abstract
ABSTRACTIntroduction:When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative.Purpose:To determine the VRR effectiveness and whether specific parameters can be associated with its success.Materials and Methods:We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR).Results:The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01).Conclusions:VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.
Highlights
When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative
In the United States, it was estimated that 175.000 to 354.000 vasectomies have been performed annually between 1998 and 2002 [1], around 4 to 6% of the vasectomized patients will still desire to father children with their spermatozoa [2], that can be treated by the vasectomy reversal (VR), in vitro fertilization or intracytoplasmic sperm injection of the oocytes with spermatozoa retrieved from the patient [3, 4]
The parameters of the study were: age of the patients, the time elapsed between vasectomy and VRR (V-VRRt), the time elapsed between VR and VRR (VR-VRRt), the presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and the semen analysis after VRR (SA-VRR)
Summary
When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). The VR failure is defined as a persistent postoperative azoospermia, or a very good sperm concentration per mL with very small or even without motility and/or associated with necrozoospermia In these cases, and when the patient desires natural conception with his own sperm, the vasectomy re-reversal (VRR) is the only alternative for conceiving a child, a repeat microsurgery may be considered as a challenge for the urologist [5]. The hypotheses of this study are that VRR could be effective in a significant number of patients and at least one specific parameter could be associated with its success, helping them to decide on this repeat microsurgery
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