Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of intraoperative parameters observed during vasectomy reversal for predicting postoperative vas patency and fertility

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Introduction

During vasectomy reversal, it is common practice to examine the intravasal fluid both grossly and microscopically and comment on the presence or absence of a sperm granuloma, but the prognostic value of these findings is debated in the literature. Our aim is to determine the value of intraoperative semen consistency and quality as well as the presence of a sperm granuloma on predicting vas patency and fertility following vasectomy reversal.

Materials and methods

A retrospective review of 351 patients who underwent vasectomy reversal by a single surgeon was performed. Intraoperative semen consistency and the presence of a sperm granuloma were assessed macroscopically. A modified Silber score was applied after microscopic evaluation of vas fluid. Semen consistency, semen quality and the presence of a sperm granuloma were correlated with postoperative vas patency and pregnancy.

Results

In our patient collective, the vas patency rate was 93.3% resulting in a pregnancy rate of 62.4%. The data support a trend for clear and opalescent semen consistency towards higher postoperative rates of vas patency (P = 0.062) and fertility (P = 0.057). Silber score correlated with fertility (P = 0.018) but not vas patency (P = 0.148). The presence of a sperm granuloma was associated with vas patency (P = 0.029), but not with fertility (P = 0.881).

Conclusion

We demonstrate that in patients undergoing vasectomy reversal a lower Silber score predicts higher rates of postoperative fertility. At the same time, the presence of a sperm granuloma is associated with postoperative vas patency. This information can guide intraoperative decision-making in both the anastomotic technique implemented and additional interventions performed intraoperatively to allow for higher fertility following vasectomy reversal.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Aradhya KW, Best K, Sokal DC (2005) Recent developments in vasectomy. BMJ 330(7486):296–299. doi:10.1136/bmj.330.7486.296

    Article  PubMed  Google Scholar 

  2. Lohiya NK, Manivannan B, Mishra PK et al (2001) Vas deferens, a site of male contraception: an overview. Asian J Androl 3(2):87–95

    CAS  PubMed  Google Scholar 

  3. Sokal DC (2003) Recent research on vasectomy techniques. Asian J Androl 5(3):227–230

    PubMed  Google Scholar 

  4. Weiske WH (2001) Vasectomy. Andrologia 33(3):125–134. doi:10.1046/j.1439-0272.2001.00445.x

    Article  CAS  PubMed  Google Scholar 

  5. Boorjian S, Lipkin M, Goldstein M (2004) The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. J Urol 171(1):304–306. doi:10.1097/01.ju.0000098652.35575.85

    Article  PubMed  Google Scholar 

  6. Lipshultz LI (2004) Vasectomy reversal-predicting outcomes. J Urol 171(1):310. doi:10.1097/01.ju.0000102200.69922.bf

    Article  PubMed  Google Scholar 

  7. Sharlip ID (1993) What is the best pregnancy rate that may be expected from vasectomy reversal? J Urol 149(6):1469–1471

    CAS  PubMed  Google Scholar 

  8. Schwingl PJ, Guess HA (2000) Safety and effectiveness of vasectomy. Fertil Steril 73(5):923–936. doi:10.1016/S0015-0282(00)00482-9

    Article  CAS  PubMed  Google Scholar 

  9. Sigman M (2004) The relationship between intravasal sperm quality and patency rates after vasovasostomy. J Urol 171(1):307–309. doi:10.1097/01.ju.0000102322.90257.8b

    Article  PubMed  Google Scholar 

  10. Belker AM, Konnak JW, Sharlip ID et al (1983) Intraoperative observations during vasovasostomy in 334 patients. J Urol 129(3):524–527

    CAS  PubMed  Google Scholar 

  11. Weiske WH (2007) Infertilität beim Mann. Thieme, Stuttgart

    Google Scholar 

  12. Belker AM, Thomas A Jr, Fuchs EF et al (1992) Results of 1, 469 microsurgical vasectomy reversals by the vasovasostomy study group. J Urol Nurs 11(2):93–111

    CAS  PubMed  Google Scholar 

  13. Silber SJ (1989) Pregnancy after vasovasostomy for vasectomy reversal: a study of factors affecting long-term return of fertility in 282 patients followed for 10 years. Hum Reprod 4(3):318–322

    CAS  PubMed  Google Scholar 

  14. Schiff J, Chan P, Li PS et al (2005) Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men. J Urol 174(2):651–655. doi:10.1097/01.ju.0000165573.53109.92

    Article  PubMed  Google Scholar 

  15. Sharlip ID (1982) The significance of intravasal azoospermia during vasovasostomy: answer to a surgical dilemma. Fertil Steril 38(4):496–498

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest statement

The authors declare that there is no conflict of interest involved in this paper.

Author information

Authors and Affiliations

  1. Department of Urology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Stefan Hinz, Carsten Kempkensteffen, Mark Schrader, Kurt Miller & Ahmed Magheli

  2. The Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System, Long Island, NY, USA

    Soroush Rais-Bahrami

  3. The Microsurgery Centre Stuttgart, Stuttgart, Germany

    Wolf H. Weiske

Authors
  1. Stefan Hinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soroush Rais-Bahrami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wolf H. Weiske
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carsten Kempkensteffen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mark Schrader
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kurt Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ahmed Magheli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Hinz.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hinz, S., Rais-Bahrami, S., Weiske, W.H. et al. Prognostic value of intraoperative parameters observed during vasectomy reversal for predicting postoperative vas patency and fertility. World J Urol 27, 781–785 (2009). https://doi.org/10.1007/s00345-009-0397-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-009-0397-x

Keywords

Search

Navigation