Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal.

The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.

The Effect of Male Age Over 50 Years on Vasectomy Reversal Outcomes.

OBJECTIVE: Advancing paternal age is associated with impaired semen parameters. We sought to evaluate reproductive outcomes in men undergoing vasectomy reversal (VR) aged ≥50 vs <50 years. METHODS: Reproductive outcomes (obstructive interval, female age, anastomosis type, post-VR total motile count (TMC), and pregnancy) after VR were assessed for men aged <50 and ≥50 years. Statistical analysis was performed using Kruskal-Wallis rank sum or Chi-squared tests. Multiple logistic regression was used to identify factors associated with achieving pregnancy. RESULTS: A total of 2777 men <50 years and 353 men ≥50 years were included. The mean obstructive interval was 8.7 years less for men <50 years (8.9 vs 17.6 years, P <.001). The chances of needing a vasoepididymostomy were higher in men ≥50 years (19.5% vs 10.1%, P <.001). Post-VR total motile count was higher in men <50 years (59.3 vs 29.1 × 106/mL, P <.001). About 33.4% of men <50 years and 26.1% ≥50 years contributed to a pregnancy (P = .007). On multiple logistic regression analysis, obstructive interval <10 years (OR 1.295, P = .002) and female age <35 (OR 1.659, P <.001) were associated with achieving a pregnancy. A history of smoking was associated with decreased odds of achieving a pregnancy (OR 0.523, P <.001). Age <50 or ≥50 years at VR was not associated with achieving pregnancy (OR 0.852, P = 0.254). CONCLUSION: Compared to those ≥50 years, more men <50 years achieved a pregnancy after VR. However, on adjusted multivariable analysis, age at VR was not an independent predictor of achieving pregnancy. Shorter obstructive interval and female age were associated with achieving pregnancy, while a history of smoking was associated with decreased odds. Successful outcomes after VR can be achieved in older men, and VR should be considered in men ≥50 years, when performed by a trained microsurgeon.