MICROSURGICAL REPAIR OF IATROGENIC INJURY TO THE VAS-DEFERENS

Purpose: We determined the incidence of iatrogenic injuries to the vas deferens at a tertiary care university infertility center and the res ults of surgical repair. Materials and Methods: Records of 472 patient s surgically explored for obstructive azoospermia between 1984 to 1996 were reviewed. Enrollment criteria included history of inguinal, pelv ic and scrotal (other than vasectomy) surgery. Conventional ipsilatera l and crossover vasovasostomies and vasoepididymostomies were performe d. Patency rate was defined as presence of complete sperm with tails i n a postoperative semen analysis. Followup included a minimum of 2 sem en analyses. Only naturally conceived pregnancies were included. Resul ts: Of 472 patients 34 (7.2%) had an iatrogenic injury to the vas defe rens with a mean obstruction interval of 20.5 +/- 1.9 years. Mean pati ent age was 36.7 +/- 1.8 years. Iatrogenic injury to the vas deferens was secondary to bilateral inguinal hernia repair in 19 patients, unil ateral hernia repair in 11, renal transplantation in 2, appendectomy i n 1 and spermatocelectomy in 1. Pediatric inguinal hernia repair was t he most common etiology of the vasal injury (20 patients), followed by adult inguinal hernia repair (10). A total of 36 microsurgical recons tructive procedures were performed, including 20 ipsilateral and 16 cr ossed vasovasostomies and vasoepididymostomies. There were 26 patients (29 procedures) available for followup (mean 21.0 +/- 3.7 months). To tal patency rate per procedure was 65% and pregnancy rate was 39%, Pat ency and pregnancy rates per conventional ipsilateral procedures were 62.5 and 35.7% and per crossover procedures 64.2 and 42.8%, respective ly. Conclusions: Pediatric inguinal hernia repair is the most common c ause of iatrogenic injury to the vas deferens. Results of treatment of iatrogenic injury to the vas deferens are somewhat lower than for pat ients with obstructive azoospermia due to vasectomy. Iatrogenic injuri es are associated with longer vasal defects, impaired blood supply and longer obstructive intervals frequently resulting in secondary epidid ymal obstruction. Crossover reconstruction is particularly useful when contralateral testicular atrophy is present. Intraoperatively aspirat ed sperm should be cryopreserved for later use in case the reconstruct ion fails.