Pre‐operative risk factors associated with need for vasoepididymostomy at the time of vasectomy reversal

Abstract

SUMMARYThe absence of sperm in the ejaculate after vasectomy reversal is commonly caused by failure to recognize and subsequently bypass epididymal or proximal vasal obstruction at the time of vasectomy reversal. If intra-operative proximal obstruction is suspected, vasoepididymostomy (VE) is recommended rather than vasovasostomy (VV). We sought to calculate the associated risk of needing VE, rather than VV with time from original vasectomy (obstructive interval) using a large cohort of vasectomy reversal patients. We reviewed the electronic and paper vasectomy reversal database by a single surgeon from 1978 through 2012. We performed univariate analysis to identify variables that predicted the need for VE rather than VV, and then combined only significant univariates into our multi-variable analysis. 2697 total men underwent vasectomy reversal, and 239 were repeat procedures. Of the 5296 individual testes operated on, 1029 were VE. Significant variables that predicted the need for VE on univariate analysis included: age, obstructive time interval, vasectomy reversal after previous VV (repeat vasectomy reversal), and year the procedure was performed. On multi-variable analysis significant risk factors for VE were age above 50 (OR 1.36), repeat vasectomy reversal (OR 5.78), and greater obstructive time interval (OR 1.56). For every 3 years since original vasectomy, the risk of needing VE increases by 56%. There is a linear relationship between obstructive interval and need for VE. Men undergoing repeat vasectomy reversal have five times greater risk of requiring VE and men greater than 50 years of age are also at higher risk. Using these pre-operative predictors is helpful in identifying patients who will benefit from referral to an experienced surgeon who can perform VE.

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade

“…Previous studies have determined the predictors for performing a VE. Table summarizes these factors that have been reported over the last 10 years …”

“…In addition, the sperm counts were maintained with increasing time after the vasectomy, but the motile sperm counts decreased significantly. The hypothesis was that sperm production is impaired by prolonged obstruction and that protective mechanisms ameliorate epididymal “blowout.” Another study reported other factors that predict the need for a VE, including the patient's age (odds ratio: 1.11) and repeat VRs (odds ratio: 5.78) . An increased epididymal T1 signal intensity on the preoperative magnetic resonance imaging suggests vassal or epididymal tubular occlusion and the need for a VE rather than a VV …”

“…Table 1 summarizes these factors that have been reported over the last 10 years. [26][27][28][29] As the obstructive interval increases, the likelihood of needing a VE increases in several studies. 26,28,29 One study evaluated 1229 patients to define how the prevalence of an epididymal blowout and the need for a VE at reversal changes over a broad spectrum of vasectomy time intervals.…”

“…[26][27][28][29] As the obstructive interval increases, the likelihood of needing a VE increases in several studies. 26,28,29 One study evaluated 1229 patients to define how the prevalence of an epididymal blowout and the need for a VE at reversal changes over a broad spectrum of vasectomy time intervals. 28 The rate of unilateral (VV or VE) or bilateral VE increased linearly with vasectomy intervals of 1-22 years at 3% per year, but plateaued at 72% with vasectomy intervals of 24-38 years.…”

“…Another study reported other factors that predict the need for a VE, including the patient's age (odds ratio: 1.11) and repeat VRs (odds ratio: 5.78). 29 An increased epididymal T1 signal intensity on the preoperative magnetic resonance imaging suggests vassal or epididymal tubular occlusion and the need for a VE rather than a VV. 27 In 2005, Parekattil, Kuang, Agarwal, and Thomas first devised a model to predict the need for a VE by using the obstructive interval and patient's age.…”