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  • Title: [Vasovasostomy after vasectomy. The surgical results 1986-1989].
    Author: Noldus J, Otto U, Salamon J, Schulze W, Klosterhalfen H.
    Journal: Urologe A; 1992 Mar; 31(2):103-5. PubMed ID: 1561725.
    Abstract:
    The frequency of vasovasostomy has increased dramatically in recent years. A significant percentage of men who have previously undergone vasectomy are now seeking restoration of their fertility. The most common reason for requesting a reversal is remarriage. There were 90 bilateral vasovasostomies performed in 90 patients between 1986 and 1989. The procedure was done according to the technique described by Howards, in a single layer with 7 x 0 prolene and under fourfold magnification. The success rate was 87% for presence of spermatozoa in the ejaculate, 48% for pregnancy. The fertility rate decreases slowly with increasing interval between vasectomy and reanastomosis. These results are statistically significant. In cases of good anatomical and andrological conditions, the chance of restoration of fertility is good. The experience of the urologist is often more important than the details of the technique. Vasectomy was performed in 500,000 men in the US in 1974, and 33 million couples chose this method of contraception worldwide according to a 1984 study. In 1987 there were about 25,000 vasectomies performed in West Germany. Subsequent desire to have a child necessitates vasovasostomy in numerous instances. Between 1986 and 1989, in a prospective study, a total of 90 men with average age of 39 years whose vasectomy had been performed at the average age of 32.1 years underwent bilateral vasovasostomies (VVST). The Howards method of anastomosis was used with prolene thread under fourfold magnification along with a spermiogram and a test of passability of the sperm duct. 64 patients were given a follow-up examination. The passability of anastomosis or spermatozoa in the ejaculate amounted to 87%. A postoperative spermiogram showed oligospermia in 84% (54 of 64) and a normal sperm count in only 2 cases. There were 8 cases of azoospermia owing to the closing of the anastomosis. A total of 31 pregnancies (48% rate) resulted in partners. The decrease of the pregnancy rate was statistically significant as the interval between vasectomy and VVST rose. Refertilization within 5 years after vasectomy produced a 63% pregnancy rate which was significantly higher than the 30% rate within 10 years. Beyond 10 years only an 8% pregnancy rate could be expected. The intraoperative sperm motility was not a good predictor of the expected pregnancy rate, as motility of sperm was found in only 38% and lack of motility in 55%. Laser VVST has been increasingly used, but its suitability has not been evaluated yet. The possible cause of the high rate of oligospermia is the resection during vasectomy of a nerve that controls sperm transport of the vas deferens. Thorough postoperative andrological and gynecological examination is needed for accurate assessment of the success or failure of the operation.
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