Vasovasostomy: kinetics and predictors of patency

Vasovasostomy patency and late failure, typically occur within 3 months and 1–2 years after surgery, respectively. Younger patients, shorter obstructive intervals, and intraoperatively identified sperm correlate with superior outcomes.

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Volume 113, Issue 4, Pages 774–780.e3

Authors:

Nicholas J. Farber, M.D., Ryan Flannigan, M.D., Arnav Srivastava, M.D., M.P.H., Hanhan Wang, M.P.S., Marc Goldstein, M.D., D.Sc. 

Abstract:

Objective

To assess the timing of patency and late failure (secondary azoospermia) after vasovasostomy (VV) using standardized kinetics definitions.

Design

Retrospective cohort study.

Setting

University-affiliated hospital.

Patient(s)

Patients with obstructive azoospermia.

Intervention(s)

Vasovasostomy.

Main Outcome Measure(s)

Univariate and multivariate logistic regression assessed predictors of patency and late failure. Patency was defined as any sperm return to the ejaculate; and >2 million total motile sperm (TMS) in ejaculate. Late failure after VV was defined as azoospermia; or <2 million TMS in ejaculate.

Result(s)

429 men underwent VV, with median follow up of 242 days. Mean time to patency was 3.25 months versus 5.29 months in the “any sperm” versus “>2 million TMS” groups. Finding sperm intraoperatively during VV significantly improved patency rates in multivariable analysis (odds ratio [OR] 4.22). This association was further boosted when sperm was found bilaterally (OR 6.70). Late failure rate (azoospermia) was 10.6% at mean time of 14.1 months and 23% for <2 million, at mean time of 15.7 months. When assessing predictors of late failure, intraoperative motile sperm bilaterally was a statistically significant protective factor on multivariate analysis (hazard ratio 0.22).

Conclusion(s)

Vasovasostomy remains highly efficacious in treating obstructive azoospermia. Young patients, shorter obstructive intervals, and sperm identified intraoperatively predict improved outcomes. Clinicians can expect VV patency in 3 months and late failure within the first 2 years after surgery. However, patency rates, late failure rates, and kinetics vary by definition.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

1 Comments

Go to the profile of Mary Samplaski
Mary Samplaski 6 months ago

The authors are to be commended on a large series of men looking at VV outcomes. I would be curious to know how many of these men underwent at least a unilateral VE, and how that impacted outcomes. Also, were any of these men being treated with EMTs? Lastly, were they able to separate out sperm parts versus intact sperm?