Matthews G J, McGee K E, Goldstein M
Department of Urology, New York Hospital-Cornell Medical Center, New York, New York 10021, USA.
J Urol. 1997 Mar;157(3):844-6.
We characterized microsurgical reconstruction treatment outcomes following a failed vasectomy reversal.
We evaluated 64 repeat vasectomy reversals (52 first and 12 second repeat procedures) performed on 57 men.
Of men with absolute azoospermia (initial or complete procedure failures) following vasovasostomy 74% required 1 or more vasoepididymostomies, compared to 24% of men with initially patent vasovasostomies (late failures) (p < 0.001). Crude patency and pregnancy rates were 67 and 30%, respectively, for the entire cohort, 93 and 43%, respectively, for men undergoing vasovasostomy on at least 1 side, and 47 and 15%, respectively, for those undergoing vasoepididymostomy only. Stenosis rates for repeat vasovasostomy and vasoepididymostomy were 27 and 18%, respectively.
Complete failure of vasectomy reversal usually is due to unrecognized epididymal obstruction. Late failure following initial patency suggests a compromised anastomosis. Repeat vasectomy reversals result in patency and pregnancy rates somewhat lower than previously reported for unselected vasovasostomy and vasoepididymostomy. Because stenosis rates are greater following reoperation, intraoperative and postoperative sperm cryopreservation is recommended.
我们对输精管复通失败后的显微外科重建治疗结果进行了特征分析。
我们评估了对57名男性进行的64例重复输精管复通术（52例首次和12例第二次重复手术）。
输精管吻合术后出现绝对无精子症（初次或完全手术失败）的男性中，74%需要进行1次或更多次附睾输精管吻合术，而初次输精管吻合术通畅的男性（后期失败）中这一比例为24%（p<0.001）。整个队列的粗略通畅率和妊娠率分别为67%和30%，至少一侧进行输精管吻合术的男性分别为93%和43%，仅进行附睾输精管吻合术的男性分别为47%和15%。重复输精管吻合术和附睾输精管吻合术的狭窄率分别为27%和18%。
输精管复通完全失败通常是由于未识别的附睾梗阻。初次通畅后的后期失败提示吻合口受损。重复输精管复通术导致的通畅率和妊娠率略低于先前报道的未选择的输精管吻合术和附睾输精管吻合术。由于再次手术后狭窄率更高，建议术中及术后进行精子冷冻保存。
