VASECTOMY REVERSAL - MICROSURGERY FOR BEST RESULTS

Objective To determine whether microsurgery achieves a better result in vasectomy reversal than other macroscopic techniques. Patients and methods A series of 103 consecutive patients with a median age of 36 years (range 26-58) who underwent microsurgical vasovasostomy was studied. The method employed was a modification of a two-layer anastomotic technique. In the first 49 patients 8/0 Vicryl was used to create a two-layer anastomosis whereas in 54 patients 10/0 Ethilon was used. Results Sperm were present in the ejaculate in 85% of patients who underwent bilateral vasovasostomy. The rate increased to 94% in those in whom 10/0 Ethilon had been used as the suture material but the difference was not statistically significant. In half of the patients sperm concentration, quality and motility improved over the 12 months following reversal. The fertility rate, measured between 8 months and 5 years after vasovasostomy, was 64% if the vasectomy had been performed within 10 years and fell to 39% if 10 years or more had elapsed. In the 10 patients who had undergone a failed reversal attempt elsewhere four had sperm in the ejaculate and two of these patients became fertile. Conclusion The additional time and effort required for a microsurgical approach to vasovasostomy were worthwhile to obtain patency and fertility rates which were superior to those of other techniques.