The Need for Epididymovasostomy at Vasectomy Reversal Plateaus in Older Vasectomies
Paulani Mui and Paul J Turek, The Turek Clinic, San Francisco, CA
Most vasectomy reversals require vasovasostomy (VV) for successful repair. However, as the obstructive interval after vasectomy lengthens, so does the rate of epididymal obstruction and the need for epididymovasostomy (EV). Since spermatid counts are lower in testes with chronic obstruction due to vasectomy (Jarow et al, NEJM, 1985), we hypothesized that decreased sperm production associated with older vasectomy age could protect the system from epididymal blowout. With this in mind, we sought to better define how the need for EV changes with obstructive interval after vasectomy.
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 EV was performed in the presence of occasional sperm fragments with creamy fluid (Silber score 4 fluid) or complete vasospermia (Silber score 5).
Among 165 patients who underwent reversal and who had adequate followup, 65 men had either unilateral (n=39) or bilateral EV’s (n=29) for an overall rate of 40% (65/165) of reversals. Among all cases, the mean patient age was 44 +/-7 years. Median vasectomy age was 10 years (range 1 to 37). The rate of needing either unilateral (EV/VV) or bilateral EV increased linearly over vasectomy ages 1-21 years, but plateaus off (combined rate between 56%-75% of cases) from vasectomy ages 22-37 years (Figure).
Although the rate of needing either unilateral or bilateral EV at vasectomy reversal increases with vasectomy age, this relationship does not remain linear throughout all vasectomy ages. The rate of EV actually plateaus after 22 years of vasectomy, suggesting that down regulated sperm production or sufficient storage capacity exists to protect some older vasectomies from “blowout.”