IMPACT OF SPERM GRANULOMA ON PATENCY IN MEN UNDERGOING VASECTOMY REVERSAL

Abstract

This study aims to identify the relationship between sperm granulomas and patency of vasectomy reversals. This information will provide physicians with important knowledge about pre-operative findings that could impact the success of vasectomy reversals. This information could help counsel patients on the best options to restore fertility following a vasectomy. A retrospective medical chart review was performed at a single clinic, designed to look at the various factors contributing to patency of vasectomy reversals. All patients had a bilateral vasectomy reversal at the International Center for Vasectomy Reversal (ICVR) by one of two highly trained urologists. Overall, patients with one or two granulomas had a higher patency rate (97.6%) than those without (94.0%) (p = 0.0003). Interestingly, the presence of a granuloma did not impact the patency of the vasectomy reversal when the obstructive interval (OI) was less than 10 years. However, when the obstructive interval was greater than 10 years, the patency was higher in patients with one or two granulomas (p < 0.002 for OI between 11-15 years; p < 0.020 for OI greater than 16 years). Additionally, the presence of a granuloma was associated with the type of surgical connection. Patients with a granuloma were more likely to undergo a bilateral vasovasostomy (VV) and less likely to require a vasoepididymostomy (VE) on the granuloma side (p < 0.00001). A VV surgical connection had a patency rate of 98.2% while the VE connection has a patency rate of 73.2% (p < 0.00001). This data demonstrates that sperm granulomas impact the patency of vasectomy reversals, especially when the interval exceeds 10 years. Thus, this preoperative factor should be considered in seeking a vasectomy reversal. More research is still necessary to determine the clinical significance of these results.