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

 

 

There were up to 6% of men who received vasectomy would later undergo 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. There were many risk factors would impact the patency rate. We aimed to analyze the risk factors of patency rate for vasectomy reversal for Taiwanese male patients.

We retrospectively reviewed patients 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, sperm motility of peri-operational cutting end fluid aspiration, diabetes mellitus, hypertension, and patency rate.

Totally 62 patients were collected with mean age of 44.6 ± 6.7 y/o. The mean vasectomy age was 35.0±5.9 y/o. Mean BMI was 24.5±2.4. The patency rate 1 month after operation was 79.1% (34/43). The patency rate after 6 months was 94.4% (34/36). The patency rate was significantly higher in shorter post vasectomy duration (p=0.049). After the reversal operation, 9 patients showed persistent azoospermia and 7 of them had vasectomy over 10 years ago. Patient numbers for bilateral VV, bilateral EV and one VV with another EV anastomosis were 47(75.8%), 4(6.5%), 11(17.7%) respectively. If vasectomy age ≥ 40 y/o, patients were significantly more likely to need EV anastomosis during vasectomy reversal (p=0.027). The patients with intra-operative finding of motile sperm from cutting end of vas deferens has significant higher patency rate 1 month after operation (p=0.026) but no statistic significant after 6 months (p=0.17). In success patients, the semen analysis in the first patent record showed morphology 38.1±28.9% and lower motility 20.2±20.9%. The motility of sperm increases gradually during follow up. There was no statistically significant in other analysis result.

In our study, the patency rate for vasectomy reversal after 6 months was 94.4%. The patency rate was significantly higher in shorter post vasectomy duration (p=0.049). If vasectomy age ≥ 40 y/o, the rate for EV anastomosis was significantly higher (p=0.027). Intra-operative finding of motile sperm from cutting end of vas deferens will not affect the patency rate in long term follow up. The motility of the sperm will recover gradually after successful vasectomy reversal.