Vasectomy Reversal in Men with a Long Obstructive Interval: Is There a Role for Pre-operative Testicular Biopsy?
CUA Online Library. Roberts M. 06/25/13; 31305; MP-06.04
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VASECTOMY REVERSAL IN MEN WITH A LONG OBSTRUCTIVE INTERVAL: IS THERE A ROLE FOR PRE-OPERATIVE TESTICULAR BIOPSY?
Paul Hartman, Mathew Roberts
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Purpose/Objective: To determine utility of pre-operative testicular biopsy prior to vasectomy reversal when a long obstructive interval (OI) is present.
Methods: A retrospective chart review identified patients undergoing testicular biopsy prior to considering vasectomy reversal from 2000-2010. Patients were included if the primary indication for biopsy was a long OI since vasectomy. Testicular histology was assessed and compared to the OI. Patency rates were determined for patients who underwent vasectomy reversal.
Results: 39 patients were included. Median OI was 12 years (Range 6-25 years). Testicular biopsy showed normal spermatogenesis in 37 (95%), and hypospermatogenesis in 2 (5%). 22 patients (56%) underwent vasectomy reversal; including both patients with hypospermatogenesis on biopsy. 20 of 22 patients had post-op semen analysis data. Overall patency rate was 61%, and was 43%, 71%, and 75% for OI of <9 years, 10-14 years, and > 14 years respectively. Those with hypospermatogenesis, one was lost to follow up and the other could not undergo reconstruction due to extensive vassal occlusion. When patients with a previous failed reversal were excluded, the overall patency rate was 77%.
Conclusion: In this series, testicular biopsy demonstrated normal histology in the majority of cases, and the presence of at least some sperm in all cases. Therefore, based on our findings, testicular biopsy is not predictive of success, and does not aid in the work up of men considering vasectomy reversal with long OI. However, biopsy should still be considered if other pathologies are suspected.
Paul Hartman, Mathew Roberts
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Purpose/Objective: To determine utility of pre-operative testicular biopsy prior to vasectomy reversal when a long obstructive interval (OI) is present.
Methods: A retrospective chart review identified patients undergoing testicular biopsy prior to considering vasectomy reversal from 2000-2010. Patients were included if the primary indication for biopsy was a long OI since vasectomy. Testicular histology was assessed and compared to the OI. Patency rates were determined for patients who underwent vasectomy reversal.
Results: 39 patients were included. Median OI was 12 years (Range 6-25 years). Testicular biopsy showed normal spermatogenesis in 37 (95%), and hypospermatogenesis in 2 (5%). 22 patients (56%) underwent vasectomy reversal; including both patients with hypospermatogenesis on biopsy. 20 of 22 patients had post-op semen analysis data. Overall patency rate was 61%, and was 43%, 71%, and 75% for OI of <9 years, 10-14 years, and > 14 years respectively. Those with hypospermatogenesis, one was lost to follow up and the other could not undergo reconstruction due to extensive vassal occlusion. When patients with a previous failed reversal were excluded, the overall patency rate was 77%.
Conclusion: In this series, testicular biopsy demonstrated normal histology in the majority of cases, and the presence of at least some sperm in all cases. Therefore, based on our findings, testicular biopsy is not predictive of success, and does not aid in the work up of men considering vasectomy reversal with long OI. However, biopsy should still be considered if other pathologies are suspected.
VASECTOMY REVERSAL IN MEN WITH A LONG OBSTRUCTIVE INTERVAL: IS THERE A ROLE FOR PRE-OPERATIVE TESTICULAR BIOPSY?
Paul Hartman, Mathew Roberts
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Purpose/Objective: To determine utility of pre-operative testicular biopsy prior to vasectomy reversal when a long obstructive interval (OI) is present.
Methods: A retrospective chart review identified patients undergoing testicular biopsy prior to considering vasectomy reversal from 2000-2010. Patients were included if the primary indication for biopsy was a long OI since vasectomy. Testicular histology was assessed and compared to the OI. Patency rates were determined for patients who underwent vasectomy reversal.
Results: 39 patients were included. Median OI was 12 years (Range 6-25 years). Testicular biopsy showed normal spermatogenesis in 37 (95%), and hypospermatogenesis in 2 (5%). 22 patients (56%) underwent vasectomy reversal; including both patients with hypospermatogenesis on biopsy. 20 of 22 patients had post-op semen analysis data. Overall patency rate was 61%, and was 43%, 71%, and 75% for OI of <9 years, 10-14 years, and > 14 years respectively. Those with hypospermatogenesis, one was lost to follow up and the other could not undergo reconstruction due to extensive vassal occlusion. When patients with a previous failed reversal were excluded, the overall patency rate was 77%.
Conclusion: In this series, testicular biopsy demonstrated normal histology in the majority of cases, and the presence of at least some sperm in all cases. Therefore, based on our findings, testicular biopsy is not predictive of success, and does not aid in the work up of men considering vasectomy reversal with long OI. However, biopsy should still be considered if other pathologies are suspected.
Paul Hartman, Mathew Roberts
Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Purpose/Objective: To determine utility of pre-operative testicular biopsy prior to vasectomy reversal when a long obstructive interval (OI) is present.
Methods: A retrospective chart review identified patients undergoing testicular biopsy prior to considering vasectomy reversal from 2000-2010. Patients were included if the primary indication for biopsy was a long OI since vasectomy. Testicular histology was assessed and compared to the OI. Patency rates were determined for patients who underwent vasectomy reversal.
Results: 39 patients were included. Median OI was 12 years (Range 6-25 years). Testicular biopsy showed normal spermatogenesis in 37 (95%), and hypospermatogenesis in 2 (5%). 22 patients (56%) underwent vasectomy reversal; including both patients with hypospermatogenesis on biopsy. 20 of 22 patients had post-op semen analysis data. Overall patency rate was 61%, and was 43%, 71%, and 75% for OI of <9 years, 10-14 years, and > 14 years respectively. Those with hypospermatogenesis, one was lost to follow up and the other could not undergo reconstruction due to extensive vassal occlusion. When patients with a previous failed reversal were excluded, the overall patency rate was 77%.
Conclusion: In this series, testicular biopsy demonstrated normal histology in the majority of cases, and the presence of at least some sperm in all cases. Therefore, based on our findings, testicular biopsy is not predictive of success, and does not aid in the work up of men considering vasectomy reversal with long OI. However, biopsy should still be considered if other pathologies are suspected.
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