title: Microsurgical reconstruction following failed vasectomy reversal.
abstract: OBJECTIVE
  We characterized microsurgical reconstruction treatment outcomes following a failed vasectomy reversal.
  
  
  METHODS
  We evaluated 64 repeat vasectomy reversals (52 first and 12 second repeat procedures) performed on 57 men.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Urology, New York Hospital-Cornell Medical Center, New York, New York 10021, USA.
authors.forename: G J
authors.initials: GJ
authors.lastname: Matthews
authors.forename: K E
authors.initials: KE
authors.lastname: McGee
authors.forename: M
authors.initials: M
authors.lastname: Goldstein
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery; D011247:Pregnancy / Q000706:statistics & numerical data; D012086:Reoperation; D017211:Treatment Failure; D014669:Vasovasostomy