Vasectomy reversal by microsurgery.

Approximately 90,000 vasectomies are carried out in the United Kingdom every year, and in 1982 it was reported that 3% of vasectomized men were asking for reversal. Vasectomy reversal (vasovasostomy) can be achieved in some cases by approximating the 2 divided ends of the vasa deferens with 3 or 4 stitches. Using this technique, up to 60% of vasectomized men can obtain sperm in their ejaculate, and about half of these can father children. In 103 cases of microsurgical vasectomy reversal over a period of 6 years prior to 1993, the median age of the patients was 36 years, and an average of 7 years had elapsed since vasectomy. 66% of the patients were 30 or younger, and 24% had barely reached 25 years. Only 89 patients attended for seminal analysis after reversal. The operation was performed on one side only in 24 patients for anatomical reasons, or to obtain less discomfort or lower cost. In the first 42 cases, 8/0 Vicryl suture material was used and 58% of unilaterally operated anastomoses were patent for 6 months or longer. However, a much better anastomosis could be constructed using 10/0 Ethilon suture material, thus the patency rate in later cases was 69%. The results were much better with bilateral surgery, even in the early cases, when 85% patency rate was achieved. 31 pregnancies occurred in 48% of the possible cases. The rate was 64% if vasectomy had been performed less than 10 years previously, falling to 39% if 10 years or more had elapsed since vasectomy. 1 patient operated on 19 years after his vasectomy became fertile. 10 patients had undergone a 2nd vasectomy reversal because of a previous failure without the use of microsurgery. 4 of them had sperm in their ejaculate, and 2 of their wives conceived.