Login to Access Video or Poster Abstract: MP89-17
Sources of Funding: None

Introduction

During vasectomy reversal (VR), intra-operative microscopic evaluation of the vasal fluid for sperm presence and quality can inform of the possibility of epididymal obstruction and need for a vasoepididymostomy (VE). Despite its potential utility, the practice of intra-operative microscopic vas fluid evaluation is not universal. Some centers may not have bench microscopy available. Some surgeons may only perform vasovasostomy (VV) and therefore are not influenced by vasal fluid characteristics or alternatively feel that the vasal fluid quality alone can predict the need for a VE. Objective: In an effort to validate the utility of microscopic vasal fluid evaluation, the current initiative correlates vasal fluid characteristics with sperm presence and quality in a large series of VRs.

Methods

1108 bilateral vasectomy reversals performed by a single surgeon (EG) yielded a total of 2216 vasal units (right & left sides) for analysis. During VR, vasal fluid was expressed and sampled from the transected testicular end vas and the fluid was characterized (thick-paste/opaque/translucent/clear). The volume of vasal fluid was documented (copious/minimal). Each aspirated sample underwent microscopic evaluation for sperm quality and categorized as: motile sperm/intact non-motile sperm/sperm parts/no sperm. The predictive utility of the gross vasal fluid characteristics with respect to sperm presence and quality was analyzed.

Results

Table 1 summarizes the relationship between the gross vasal fluid characteristics and the microscopic presence and quality of sperm within the fluid among 2216 vasal units. When thick-pasty fluid was observed, no sperm were seen in the samples in 50% of cases and if present, only non-motile sperm were observed. Importantly, even in the setting of more favorable vasal fluid characteristics (clear, translucent & opaque fluid), no sperm were seen in 7-11% of cases, suggesting the possibility of epididymal obstruction and the need for a VE.

Conclusions

Intra-operative microscopic evaluation of the vasal fluid for sperm is a necessary practice during vasectomy reversal to optimize surgical outcomes. The gross characteristics of the vasal fluid alone does not universally predict sperm presence and quality. Reliance on vasal fluid characteristics in isolation, without microscopic sperm analysis, may lead to unrecognized epididymal obstruction and the possible need for a VE in approximately 10% of cases of VR.

Funding

None