Vasectomy Reversal Outcomes in Men Previously on Testosterone Supplementation Therapy - 26/11/14

Doi : 10.1016/j.urology.2014.06.081

Robert M. Coward ^a,^⁎ , Douglas A. Mata ^b,^c, Ryan P. Smith ^d, Jason R. Kovac ^b, Larry I. Lipshultz ^b
^a Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
^b Scott Department of Urology, Baylor College of Medicine, Houston, TX
^c Department of Biochemistry and Cell Biology, Wiess School of Natural Sciences, Rice University, Houston, TX
^d Department of Urology, School of Medicine, University of Virginia, Charlottesville, VA

^∗Address correspondence to: Robert M. Coward, M.D., 2113 Physicians Office Building, CB#7235, 170 Manning Drive, Chapel Hill, NC 27599-7235.

Abstract

Objective

To report considerations for preoperative management and outcomes of vasectomy reversal (VR) in men with a history of testosterone supplementation therapy (TST).

Methods

A retrospective review of men on TST before VR from 2010 to 2013 was performed. For inclusion, patients were required to have baseline and follow-up hormone levels as well as postoperative semen analyses. Preoperative use of medical testicular salvage therapy and testicular sperm aspiration (TESA), intraoperative findings, and pregnancies were also analyzed.

Results

Six of 265 men who underwent VR had prior TST and met inclusion criteria. Median age was 39 years with a median obstructive interval of 7.5 years. Median duration of TST was 9 months before discontinuation and transition to testicular salvage therapy with clomiphene citrate with or without human chorionic gonadotropin for a median of 2.8 months. At baseline, decreased luteinizing hormone (median, 2 mIU/mL), follicle stimulating hormone (median, 5 mIU/mL), and total testosterone (median, 249 ng/dL) were observed. Two men (33%) with uncertain recovery of spermatogenesis based on physical examination and hormone response underwent preoperative testicular sperm aspiration confirming the presence of sperm. Nine vasovasostomies and 3 epididymovasostomies were performed. Patency was 83% after a median follow-up of 6.4 months and was 100% in men undergoing at least 1 vasovasostomy. Spontaneous pregnancy was achieved by 50% during the follow-up period.

Conclusion

Testicular salvage medical therapy may play a role in the preoperative management of VR in men with prior TST. VR after TST can have outcomes comparable to those in the general population.

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Plan

Financial Disclosure: Larry Lipshultz is a paid consultant, advisor, speaker, and clinical trial investigator to Eli Lilly and Company. He is a clinical investigator, meeting participant, and speaker to Endo Pharmaceuticals. He is also a meeting participant and speaker to Pfizer. He is a clinical trial investigator and speaker to Auxilium Pharmaceuticals. The remaining authors declare that they have no relevant financial interests.