Vasectomy Reversal

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Vasectomy Reversal

• Andrew Adamson
• MS FRCS (Urology)

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Vasectomy

• Highly effective male contraception
• Long term failure rate 0.08-0.10
• gt 30 million couples rely on it worldwide
• Long term safety
• AUA and American Cancer Society state that at
  best associations are weak and no change in
  practice neccesary.

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Vasectomy

• Quick, no scalpel technique (Dr Li)
• Rapid return to work
• Low morbidity
• Most effective

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But !!!!!!

• Accounts for 8.5 all instances of reproductive
  disability
• Accounts for 36 of male factor infertility
• Rising divorce rates
• Large number of teen-age pregnancies
• Increased desire for progeny of middle of middle
  aged couples

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Holman et al BJU 2000

• Period 1980-1996
• Western Australia
• 28,246 vasectomies
• 1902 vasectomy reversal (vaso-vasostomies)
• Hospital registry

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Vasectomy reversal

• Increased with younger age at time of vasectomy
  (11 aged 20-23, 6.2 aged 25-29)
• Risk of seeking reversal increases with time
  period when vasectomy performed
  (94-96gt90-93gt85-89gt80-84)

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Vasectomy reversalRisk factors

• Single at time of request
• Divorced at time of request
• Separated at time of request

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Vasectomy reversalPredictive factors

• Age at operation
• Time since operation
• Short gap
• Sperm granuloma
• Long testicular stump
• Epididymitis
• Testicular size
• Same partner

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Vasectomy reversal resultsAA personal series (to
date)

• 38 consecutive patients
• 33 evaluable
• Mean age 39 years
• Mean age of partner 32
• 3 original partners
• Mean time since vasectomy 5.9 years
• Overall patency rates 79
• Patency rate for those lt 10 years 89
• 2 haematomas, 1 orchitis

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Vasectomy reversal results
Age (yrs) Mean Time since vasectomy (yrs) Patency()
Hartlepool 2005 NK NK 85
Hseieh et al 2005 (Loupe assisted) 41.3 9.2 89
Hseieh et al 2005 (Microsurgical) 40.5 8.1 91
Amerin et al 2005 44.6 12.8 62.9
Adamson (2005) 39 37.3 5.9 lt10 79 89
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Vasectomy reversalsuccess