University of Toronto
Vasectomy reversal following Percutaneous Epididymal Sperm Aspiration (PESA): Operative implications and post-operative outcomes
Udi Blankstein1, Joseph Moryousef2, Ethan D. Grober1.
1Division of Urology, University of Toronto, Toronto, ON, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada
Introduction: Options for fertility following vasectomy include vasectomy reversal (VR) or sperm retrieval with IVF/ICSI. PESA poses a theoretical risk of epididymal scarring/obstruction and may have implications on the operative approach and success following VR. In an effort to better inform couples, the current study investigated the intra- and post-operative outcomes of VR following PESA.
Methods: A prospective database of 2023 VRs was reviewed to identify men who had undergone PESA prior to VR. Intra-operative findings including vasal fluid, sperm quality and anastomotic technique (vasovasostomy-VV/vasoepididymostomy-VE) were correlated with PESA details. Post-operative semen parameters and patency rates were compared among men presenting with a pre-VR PESA to patients with no history of PESA prior to VR.
Results: 28 men were identified who underwent unilateral or bilateral PESA prior to VR. Mean age and vasal occlusive interval was 43 and 11.7 years, respectively. 44% and 66% of men reported having a bilateral and unilateral PESA performed, respectively. Bilateral VV was performed in 82% of men, with VE required in 18%. Among men requiring VE, 80% had a PESA performed on the same side. Among all testicular units where a PESA was performed, favourable vasal fluid characteristics (non-pasty) were identified in 81% of men and intra-operative microscopic vasal fluid analysis confirmed the presence of sperm in 82% of men. Compared to an aged-matched sample of patients with no history of PESA prior to VR, post-operative patency rates (motile sperm in ejaculate) were equivalent (94% PESA+VR, 94% VR). Mean total motile sperm counts (TMC) were 18.4 among PESA+VR patients compared to 23.4 among men who underwent VR without PESA.
Conclusions: VR remains an option for couples post PESA. Favourable vasal fluid characteristics and sperm quality allow for VV >80% of men. Post-operative patency rates and semen parameters compared favourably to patients without PESA prior to VR.
||Unmoderated Posters||Vasectomy Reversal Following Percutaneous Epididymal Sperm Aspiration (PESA): Operative Implications and Post-Operative Outcomes.||TBD|