呂謹亨¹  黃志賢^{1, 2, 3} 黃奕燊^{1, 2, 3} 林登龍^1,2,3  陳光國^1,2,3

¹臺北榮民總醫院 泌尿部

²國立陽明大學 醫學院 泌尿學科 ³書田泌尿科學研究中心

Chin-Heng Lu¹, William J.S. Huang^1,2,3, I-Shen Huang^1,2,3, Alex T.L. Lin^1,2,3, Kuang-Kuo Chen^1,2,3

¹Department of Urology, Taipei Veterans General Hospital

²Department of Urology, School of Medicine and ³Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan

 

Purpose: Up to 6% of men who received vasectomy would later seek vasectomy reversal. Vasectomy reversal involves either vasovasostomy (VV) or epididymovasostomy (EV) anastomosis. Patency rates have been reported ranging from 71% to 99% for VV anastomosis and from 43% to 80% for EV anastomosis. We aimed to analyze the risk factors affecting operation outcome for vasectomy reversal for Taiwanese male patients in our hospital.

 

Materials and Methods: We retrospectively reviewed patients’ log who had undergone vasectomy reversal at Taipei Veterans General Hospital from 1999 to 2016. Patients with incomplete surgical records were excluded. We analyzed the age at vasectomy, duration between vasectomy and vasectomy reversal, BMI, semen analysis parameters, operation method, histories of DM, hypertension, patency and pregnancy rate in these patients.

 

Results: Totally 62 patients were collected with mean age of 44.6 ± 6.7 y/o. The mean age at vasectomy was 35.0±5.9 y/o. Mean BMI was 24.5±2.4. The patency rate after 6 months was 97.6% (41/42). The patency rate was significantly lower for the duration of vasectomy over 10 years (P= 0.049). Patient numbers for bilateral VV, bilateral EV and one VV with another EV anastomosis were 47 (75.8%), 4 (6.5%), and 11 (17.7%) respectively. If vasectomy age < 40 y/o, the rate for EV anastomosis was significantly higher (P= 0.027). Patients with intra-operative findings of motile sperm from cutting end of proximal vas had significantly higher patency rates 1 month after operation (P= 0.026), but they were no difference after 6 months (P= 0.17). In patients with successful patency, the first patent record of semen analysis showed 20.2±20.9% in  morphology and 38.1±28.9 in motility. The motility of sperm increases significantly during follow up (P= 0.012). There was no statistical significance in other analysis results. The natural pregnancy rate was 52.2% (12/23) in patients who were followed.

 

Conclusions: In our study, the patency and natural pregnancy rate for vasectomy reversal after 6 months was 97.6% and 52.2%. The patency rate was significantly higher in shorter post vasectomy interval. The motility of the sperm will recover gradually after successful vasectomy reversal.