title: Microsurgical vasovasostomy after failed vasovasostomy.
abstract: OBJECTIVE
  We analyzed our experience with repeat microsurgical vasovasostomy after failed vasovasostomy and elucidate the possible predictors of surgical outcome.
  
  
  METHODS
  We evaluated 62 repeat vasectomy reversal cases with followup data available. Regardless of the intraoperative observation of sperm in the vasal fluid bilateral microsurgical 2-layer vasovasostomy was performed when surgically possible. Of these 62 patients 60 (97%) underwent bilateral (58) or unilateral (2) vasovasostomy and 2 (3%) underwent unilateral vasovasostomy with contralateral epididymovasostomy.
  
  
  RESULTS
  Patency and pregnancy followup data were available on 62 and 42 patients, respectively. The overall patency and pregnancy rates achieved were 92% and 57%, respectively, and the natural birth rate was 52%. Increased age of the wife proved a negative prognostic factor for pregnancy (p = 0.018). The intraoperative detection of sperm and other factors, including obstructive interval, reconstruction type, anastomotic site, patient age and postoperative semen parameters, did not influence the surgical outcome.
  
  
  CONCLUSIONS
  Regardless of the detection of sperm in the intravasal fluid during the operation repeat microsurgical vasovasostomy resulted in a better outcome than in other studies, in which adopted epididymovasostomy was done when sperm was absent from the vas fluid. Our study suggests that compromised anastomosis after previous surgery is the most common cause of failed vasovasostomy. We recommend that microsurgical vasovasostomy should be performed preferentially in failed vasovasostomy cases.
authors.affiliation: Department of Urology, Seoul National University College of Medicine and Seoul Boramae Hospital, Korea.
authors.forename: Jae-Seung
authors.initials: JS
authors.lastname: Paick
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Park
authors.forename: Dal Woo
authors.initials: DW
authors.lastname: Park
authors.forename: Kwanjin
authors.initials: K
authors.lastname: Park
authors.forename: Hwancheol
authors.initials: H
authors.lastname: Son
authors.forename: Soo Woong
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011247:Pregnancy; D012086:Reoperation; D013076:Sperm Count; D013081:Sperm Motility; D017211:Treatment Failure; D014669:Vasovasostomy