title: Prognostic value of intraoperative parameters observed during vasectomy reversal for predicting postoperative vas patency and fertility.
abstract: BACKGROUND
  During vasectomy reversal, it is common practice to examine the intravasal fluid both grossly and microscopically and comment on the presence or absence of a sperm granuloma, but the prognostic value of these findings is debated in the literature. Our aim is to determine the value of intraoperative semen consistency and quality as well as the presence of a sperm granuloma on predicting vas patency and fertility following vasectomy reversal.
  
  
  METHODS
  A retrospective review of 351 patients who underwent vasectomy reversal by a single surgeon was performed. Intraoperative semen consistency and the presence of a sperm granuloma were assessed macroscopically. A modified Silber score was applied after microscopic evaluation of vas fluid. Semen consistency, semen quality and the presence of a sperm granuloma were correlated with postoperative vas patency and pregnancy.
  
  
  RESULTS
  In our patient collective, the vas patency rate was 93.3% resulting in a pregnancy rate of 62.4%. The data support a trend for clear and opalescent semen consistency towards higher postoperative rates of vas patency (P=0.062) and fertility (P=0.057). Silber score correlated with fertility (P=0.018) but not vas patency (P=0.148). The presence of a sperm granuloma was associated with vas patency (P=0.029), but not with fertility (P=0.881).
  
  
  CONCLUSIONS
  We demonstrate that in patients undergoing vasectomy reversal a lower Silber score predicts higher rates of postoperative fertility. At the same time, the presence of a sperm granuloma is associated with postoperative vas patency. This information can guide intraoperative decision-making in both the anastomotic technique implemented and additional interventions performed intraoperatively to allow for higher fertility following vasectomy reversal.
authors.affiliation: Department of Urology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. stefan.hinz@charite.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Hinz
authors.forename: Soroush
authors.initials: S
authors.lastname: Rais-Bahrami
authors.forename: Wolf H
authors.initials: WH
authors.lastname: Weiske
authors.forename: Carsten
authors.initials: C
authors.lastname: Kempkensteffen
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.forename: Kurt
authors.initials: K
authors.lastname: Miller
authors.forename: Ahmed
authors.initials: A
authors.lastname: Magheli
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005298:Fertility / Q000502:physiology*; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012189:Retrospective Studies; D012661:Semen; D013094:Spermatozoa / Q000166:cytology; D014649:Vas Deferens / Q000502:physiology* / Q000601:surgery*; D014669:Vasovasostomy; D055815:Young Adult