title: Vasectomy reversal outcomes among patients with vasal obstructive intervals greater than 10 years.
abstract: OBJECTIVE
  To analyze the vasectomy reversal (VR) outcomes specifically among patients with vasal obstructive intervals (VOIs) of >10 years. The VOI has been shown to be a significant predictor of outcome after VR. Although no strict cutoff exists, couples have frequently been discouraged from considering a VR strictly according to the interval from vasectomy.
  
  
  METHODS
  From 2006 to 2011, all consecutive VRs performed by 2 fellowship-trained microsurgeons were analyzed. The patients were stratified into 4 categories according to the duration of the VOI: <10, 10-15, >15-20, and >20 years. The postoperative semen parameters, patency rates, and pregnancy outcomes were compared among the 4 groups.
  
  
  RESULTS
  Of 535 consecutive VRs, 177 patients (33%) had a VOI of >10 years. The couple characteristics, type of VR required, postoperative semen quality, and patency and pregnancy rates among the 4 groups were analyzed. The men with longer VOIs were older (P <.001) and had older female partners (P = .006). Although the VOI influenced the type of reversal performed, favorable semen concentrations (average >20 million/mL in all groups) and patency (average >90%) and pregnancy rates (range 24%-39%) were achieved in men with a VOI >10 years.
  
  
  CONCLUSIONS
  Although the interval since vasectomy has a significant effect on the type of VR required, provided a surgeon is proficient in both microsurgical vasovasostomy and vasoepididymostomy, favorable semen parameters and patency and pregnancy rates can be achieved in men with a VOI >10 years. Couples should not be discouraged from considering VR simply according to the VOI.
authors.affiliation: Division of Urology, Department of Surgery, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada. Electronic address: egrober@mtsinai.on.ca.
authors.forename: Ethan D
authors.initials: ED
authors.lastname: Grober
authors.affiliation: El Camino Urology, Mountain View, CA.
authors.forename: Edward
authors.initials: E
authors.lastname: Karpman
authors.affiliation: Division of Urology, Department of Surgery, Mount Sinai and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Majid
authors.initials: M
authors.lastname: Fanipour
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy / Q000706:statistics & numerical data; D018873:Pregnancy Rate; D013997:Time Factors; D016896:Treatment Outcome; D014669:Vasovasostomy