Maloney Trevor J, Armstrong Daniel B, Grant Loran J, Bowling Gartrell C, Zamani Michael, Watson Nora, Dean Robert C, Hawksworth Dorota J
Division of Urology, Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
Department of Surgery, Portsmouth Naval Medical Center, Portsmouth, Virginia, USA.
Andrology. 2025 Jul 11. doi: 10.1111/andr.70098.
Vasectomy reversal (VR) can be a challenging surgery and numerous factors have been identified to guide surgical decision-making to optimize success.
The objective of this study was to identify pre-operative and intra-operative factors associated with VR surgical method and success. Additionally, we aimed to investigate the role of testicular vas deferens diameter in surgical decision-making and success.
This study was a retrospective cohort of men >18 years of age who underwent a VR at our Institution from January 2008 to June 2023. Qualified patients underwent chart review and details recorded included age, obstructive interval, surgical technique, vasal lumen diameters, presence of sperm granuloma or surgical clips, sperm quality, and vasal fluid quality. Semen analysis (SA) parameters were also recorded. Pregnancy outcomes were ascertained via telephone interview. Descriptive statistics and correlations were analyzed with two-sample t-tests for continuous and chi-square or Fisher's exact tests for categorical characteristics. Logistic regression using generalized estimating equation (GEE) methods was used to estimate associations of diameter with surgery types unadjusted and adjusted for patient and intra-operative fluid characteristics.
A total of 710 patients underwent VR during the study period and 326 post-operative semen analyses were available for review. Average patient was 38 years old, with an obstructive interval of 10 years. Vasoepididymostomy (VE) had modestly larger observed mean testicular vasal lumen diameter (0.94 mm) versus vasovasostomy (VV; 0.88 mm; p = 0.10). However, diameter ≥1 mm was associated with >2 times higher odds of VE versus VV (odds ratio [OR] 2.12; p < 0.01) adjusted for several patient characteristics. VE was associated with lower frequency of positive post-operative semen analyses (64.4% VV/VE or bilateral VE vs. 92.4% bilateral VV), and longer obstructive interval (11.5 years VV/VE or bilateral VE vs. 7.84 years bilateral VV). There were higher rates of spermatozoa on post-operative SAs when bilateral VV was performed (VV/VV 92.3%; VV/VE 73.3%; VE/VE 51.5%; p < 0.001). Of the 207 patients with pregnancy data, 103 (49.8%) experienced pregnancy following VR.
Intra-operative measurements of testicular vasal lumen diameter can be an adjunctive factor that may influence choice of VR technique. This finding can help guide pre-operative surgical counseling and VR success rates.
输精管复通术（VR）可能是一项具有挑战性的手术，已确定了许多因素来指导手术决策以优化成功率。
本研究的目的是确定与VR手术方法和成功率相关的术前和术中因素。此外，我们旨在研究睾丸输精管直径在手术决策和成功率中的作用。
本研究是一项回顾性队列研究，研究对象为2008年1月至2023年6月在我们机构接受VR的18岁以上男性。符合条件的患者接受病历审查，记录的详细信息包括年龄、梗阻时间、手术技术、输精管腔直径、精子肉芽肿或手术夹的存在、精子质量和输精管液质量。还记录了精液分析（SA）参数。通过电话访谈确定妊娠结局。采用两样本t检验对连续变量进行描述性统计和相关性分析，对分类特征采用卡方检验或Fisher精确检验。使用广义估计方程（GEE）方法进行逻辑回归，以估计直径与手术类型之间的关联，未调整以及调整患者和术中液体特征。
在研究期间，共有710例患者接受了VR，其中326例术后精液分析可供审查。患者平均年龄为38岁，梗阻时间为10年。附睾输精管吻合术（VE）观察到的平均睾丸输精管腔直径（0.94mm）略大于输精管端端吻合术（VV；0.88mm；p = 0.10）。然而，在调整了几个患者特征后，直径≥1mm与接受VE而非VV的几率高出2倍以上相关（优势比[OR]2.12；p < 0.01）。VE与术后精液分析阳性频率较低相关（VV/VE或双侧VE为64.4%，双侧VV为92.4%），且梗阻时间较长（VV/VE或双侧VE为11.5年，双侧VV为7.84年）。进行双侧VV时，术后SA中精子发生率较高（VV/VV为92.3%；VV/VE为73.3%；VE/VE为51.5%；p < 0.001）。在207例有妊娠数据的患者中，103例（49.8%）在VR后怀孕。
术中测量睾丸输精管腔直径可能是影响VR技术选择的一个辅助因素。这一发现有助于指导术前手术咨询和VR成功率。
