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Sources of Funding: Frederick J and Theresa Dow Wallace Fund of the New York Community Trust & the Agency for Healthcare Research and Quality_x000D_ This work was supported in part by the Urology Care Foundation Research Scholar Award Program and AUA New York Section Research Scholar Fund

Introduction

Vasal reconstruction is an effective method of treating obstructive azoospermia, with reported patency rates of 99% for vasovasostomy (VV) and 80% for vasoepididymostomy (VE). When deciding between sperm retrieval with in vitro fertilization or vasal reconstruction, a major consideration is often the length of time it will take for sperm to return to the ejaculate following vasal reconstruction. The objective of this study was to compare the time required for sperm to return to the ejaculate following VV or VE, and if the rate of late failures would be less common in VV compared to VE.

Methods

We performed a retrospective review of all patients undergoing VV and VE by a single surgeon. Demographic information, surgical details, and postoperative semen analysis (SA) values and dates were reviewed. Late failures were defined as those with sperm return to the ejaculate post-reconstruction who subsequently became azoospermic. Descriptive statistics, student t-test, and Fishers exact tests were used to compare the groups, with significance set at p<0.05.

Results

338 and 37 men underwent VV and VE, respectively, and had sperm return to the ejaculate postoperatively. Mean age was 43+/-6.7 years, with a mean obstructive period of 10+/-5.5 years. Mean time to return of sperm in the ejaculate was faster following VV than after VE (Table 1). Initial sperm counts were also higher following VV compared to VE (Table 1). Longitudinally, more men had late failure of vasal reconstruction after VE than after VV (Table 1). Presence of sperm granuloma did not impact time to return of sperm in the ejaculate (p=0.22) after VV. Obstructive interval was not associated with either sperm count in the ejaculate after vasal reconstruction or time to return of sperm to the ejaculate._x000D_

Conclusions

Among men undergoing vasal reconstruction, return of sperm to the ejaculate typically occurs at 3 months after VV and at 5 months after VE. A small, but significant, proportion of men undergoing vasal reconstruction will have late failures, especially after VE. Since these late failures typically occur within one year post-operatively, men undergoing vasal reconstruction should be advised to consider sperm cryopreservation as soon as motile sperm appear in the ejaculate.

Funding

Frederick J and Theresa Dow Wallace Fund of the New York Community Trust & the Agency for Healthcare Research and Quality_x000D_ This work was supported in part by the Urology Care Foundation Research Scholar Award Program and AUA New York Section Research Scholar Fund