Before initial consultation for VR, 3 patients had used

injectable testosterone, 1 used topical testosterone and 2

had used either a topical or injectable preparations at

different times. All 6 men were current users of TST for a

median duration of 9 months (IQR, 6-22 months).

Baseline hormone levels were recorded for all patients

(

Table 2

). At baseline, hypogonadotropic hypogonadism

was observed in all patients, with decreased median LH

level (2 mIU/mL; IQR, 1-4 mIU/mL), FSH level (5 mIU/

mL; IQR 2-6 mIU/mL), and total testosterone level

(249 ng/dL; IQR 203-375 ng/dL). All patients underwent

medical testicular salvage therapy for a median of

2.8 months (IQR, 2.5-3.0 months). Two patients un-

derwent testicular salvage therapy with CC only and 4

with CC and hCG (

Table 1

). Two patients (33%) with

clinical uncertainty regarding the response to medical

testicular salvage therapy underwent preoperative TESA,

con

rming the presence of active spermatogenesis before

VR.

Nine VVs (75%) and 3 EVs (25%) were performed in

the 6 patients. Four patients underwent bilateral VV

(66.7%), 1 underwent VV and EV (16.7%), and 1 un-

derwent bilateral EV (16.7%). The

ﬂ

uid consistency and

the presence or absence of sperms in the vasal and

epididymal

ﬂ

uid were noted intraoperatively (

Table 1

Follow-up hormone levels were available in all patients

(

Table 2

). The follow-up LH, FSH, and total testosterone

levels all increased to within normal limits and trended

toward

statistical

signi

cance.

Median

levels

increased from 2 mIU/mL (IQR, 1-4 mIU/mL) to 4 mIU/

mL (IQR, 3-5 mIU/mL;

.08), FSH level increased

from 5 mIU/mL (IQR, 2-6 mIU/mL) to 7 mIU/mL (IQR,

6-8 mIU/mL;

.07), and total testosterone level

increased from 249 ng/dL (IQR, 203-375 ng/dL) to

563 ng/dL (IQR, 337-655 ng/dL;

.17).

Postoperative semen analyses were available in all pa-

tients studied (

Table 3

). Five of 6 patients (83.3%)

demonstrated patency after a median follow-up of

6.4 months (IQR, 5.5-7.0 months), and patency was

100% in men undergoing at least 1 VV. One patient who

underwent a bilateral EV remained azoospermic at the

end of the study follow-up period. Pregnancy was ach-

ieved by 3 men (50%) during the follow-up period. Of

the 5 men who were patent, the mean seminal volume

was 2.3 mL, sperm density was 27 million/mL, motility

was 25%, forward progression was 2.0, total sperm count

was 59 million, and total motile sperm count was 17

million (

Table 3

COMMENT

A contemporary study (2006-2010) by the National

Survey for Family Growth reported that 15.9% of

American men aged 36-45 years have undergone a va-

sectomy, whereas 19.6% of vasectomized men expressed a

desire for future children.

Coupled with the latest TST

prevalence statistics, indicating that younger men have

the highest rate of increased utilization,

these emerging

Table 1.

Preoperative and intraoperative factors with postoperative patency

Patient

Prior Testosterone

Supplementation

Obstructive

Interval (y)

Salvage

Therapy Used

Preoperative

TESA

Reversal

Procedure

Fluid, Left

Fluid, Right

Postoperative

Patency (at Median

6.4 mo)

Topical

N/A

Bilateral VV

Clear; Motile sperm

Patent

Topical, Injectable

CC, hCG

N/A

EV/VV

Creamy; Vasal

ﬂ

uid: no sperm;

Epididymal

ﬂ

uid: Nonmotile

sperm

Creamy; Nonmotile sperm

Patent with pregnancy

Injectable

CC, hCG

Positive

Bilateral VV

Clear; Motile sperm

Clear; Nonmotile sperm

Patent with pregnancy

Injectable

N/A

Bilateral EV

Creamy; Vasal

ﬂ

uid: no sperm;

Epididymal

ﬂ

uid: Nonmotile

sperm

Creamy; Vasal

ﬂ

uid: no sperm;

Epididymal

ﬂ

uid: Nonmotile

sperm

Not patent

Topical, Injectable

4.5

CC, hCG

N/A

Bilateral VV

Copious, clear; Motile sperm

Patent with pregnancy

Injectable

CC, hCG

Positive

Bilateral VV

Clear; Nonmotile sperm

Patent

CC, clomiphene citrate; EV, epididymovasostomy; hCG, human chorionic gonadotropin; N/A, not applicable; VV, vasovasostomy.

UROLOGY 84 (6), 2014

1337