Does the Need for Epididymovasostomy Relate to the
Patient Age at the Time of Vasectomy?

Introduction

Most vasectomy reversals require only vasovasostomy for successful repair. However, as the obstructive interval after vasectomy lengthens, the rate of epididymal obstruction rises, and the need for epididymovasostomy increases. There is also evidence in the literature that the need for epididymovasostomy correlates with patient age. We hypothesized that younger men, having better sperm production, might be more prone to epididymal blowout over the same obstructive interval than older men. We sought to determine how the rate of epididymovasostomy varies with both obstructive interval and patient age after vasectomy.

Methods

In a retrospective review of consecutive vasectomy reversals performed by a single surgeon, the relationship between the type of reversal procedure was correlated with age of vasectomy and the age of the patient. An epididymovasostomy was performed in the presence of sperm fragments with creamy fluid (Silber score 4 fluid) or complete vasospermia (Silber score 5). Included in the analysis were cases in which both units, or one of two units, underwent epididymovasostomy.

Results

Among 174 patients who underwent reversal and who had adequate follow-up, n=74 had epididymovasostomy’s for an overall rate of 21% of patients. Among all cases, the mean age was 44 +/-7 years. Median vasectomy age was 10 years (range 1 to 30). The rate of epididymovasostomy increased as the age of vasectomy lengthened; the calculated epididymovasostomy rate was approximately 3%/year beyond 5 years of vasectomy obstruction(see figure). However, when controlling for obstructive interval, men >45 years of age showed an increased need for epididymovasostomy compared to younger patients.

Conclusions

The need for epididymovasostomy after vasectomy increases with patient age. However, the need for epididymovasostomy after vasectomy is not greater for younger men with the same vasectomy obstructive interval as older men. (See chart on downloadable PDF.)

Patient Vasectomy Age Relationship To Epididymovasostomy