Microsurgical vasectomy reversal: experience of a single center

Reversión microquirúrgica de vasectomía: experiencia de un centro

Background: Vasectomy reversal (VR) is the only technique that allows men previously submitted to a vasectomy to conceive by natural pregnancy. We report our experience with microsurgical VR and identify predictive factors of natural pregnancy. Methods: We retrospectively reviewed all patients submitted to VR by a single surgeon from 2008 to 2021 at our single center. Patency and pregnancy rates were evaluated. The main outcomes after surgery were the patency and natural pregnancy rates. Secondary outcomes were the identification of predictive factors of success and patient satisfaction with the natural pregnancy. Results: Forty VRs were performed with a patency rate of 97.1% and, among those who became patent, pregnancy occurred in 13 of 31 couples by natural conception (41.9%). Two-layer anastomosis was significantly associated with a successful procedure (Odds Ratio of 12.428; p = 0.045). We did not identify a significant association between any of the other variables and a successful outcome. Even without a successful surgery, most of the patients were very satisfied with the results and would do the procedure again. Conclusions: VR is a useful technique for men previously submitted to a vasectomy and who pretend to have children by natural conception. Two-layer anastomosis is significantly associated with a successful surgery.

Resumen

Antecedentes: La reversión de la vasectomía (RV) es la única manera de permitir a los hombres, después de la vasectomía, concebir por embarazo natural. Presentamos nuestra experiencia en la RV microquirúrgica y buscamos identificar los factores predictores del éxito. Métodos: Revisión retrospectiva de todos los pacientes sometidos a RV por un cirujano entre 2008 y 2021 en el nuestro centro. Se analizaron las tasas de permeabilidad y embarazo. El objetivo principal fue la tasa de permeabilidad y embarazo natural. El objetivo secundario fue identificar factores predictivos del éxito y la satisfacción del paciente con la tasa de embarazo natural. Resultados: Se realizaron 40 RV con una tasa de permeabilidad del 97.1%. De las que se quedaron patentes, el embarazo ocurrió en 12 de 31 parejas por concepción natural (41.9%). La anastomosis de doble capas se asoció significativamente al éxito del procedimiento (Odds ratio 12.428; p = 0.045). No identificamos una asociación significativa de ninguna de las otras variables al éxito del resultado. Incluso sin una cirugía exitosa, la mayoría de los pacientes volverían a realizar el procedimiento y se quedaran muy satisfechos con el resultado. Conclusiones: La RV es una técnica útil después de la vasectomía en los casos de hombres que desean tener hijos por concepción natural. La anastomosis de doble capas se asocia significativamente al éxito de la cirugía.

Vasoepididymostomy; Vasovasostomy; Vasectomy reversal; Patency rate; Pregnancy rate

Palabras Clave

Vasoepididimostomía; Vasovasostomía; Reversión de vasectomía; Tasa de permeabilidad; Tasa de embarazo

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