One-layer vasovasostomy: microsurgical versus loupe-assisted.

OBJECTIVE

To compare the outcomes of microsurgical versus loupe-assisted technique for vasectomy reversal.

DESIGN

Retrospective comparative study with randomization.

SETTING

University hospital male infertility clinic.

PATIENT(S): Fifty men with obstructive azoospermia after vasectomy.

INTERVENTION(S): One-layer vasovasostomy with microscope (group I) or optical loupe (group II).

MAIN OUTCOME MEASURE(S): Patency, pregnancy, operation time, postoperative stricture.

RESULT(S): Mean operation time was 106.4±10.3 minutes in group I and 78.3±5.7 minutes in group II, showing a statistically significant difference. Analysis of semen sampled from men, who succeeded in getting vasal patency, was performed finally at the sixth month after surgery and showed sperm concentrations of 21.5 million/mL and 20.7 million/mL and sperm motilities of 32.5% and 30.8% in groups I and II, respectively, without a statistical significance. Patency rates were 96% (24 out of 25) in group I and 72% (18 out of 25) in group II, showing a statistically significant difference. Pregnancy rates were 40% (10 out of 25) in group I and 28% (7 out of 25) in group II. There was no statistically significant difference in pregnancy rate between the two groups. Postoperative vasal stricture occurred in four patients, all of them from group II. There was no operation-related complication, such as hematoma or wound infection.

CONCLUSION(S): Microscopic technique yielded a higher patency rate than loupe-assisted technique, possibly by reducing the chance of postoperative vasal stricture.