(089) TESTICULAR VASAL DIAMETER: A NEW INTRA-OPERATIVE PREDICTOR OF SUCCESSFUL VASECTOMY REVERSAL

Abstract Introduction Vasovasostomy (VV), a preferred surgical technique for vasectomy reversal (VR), carries much higher reported success rates than a more complex vasoepididymostomy (VE). Although increased patient age and obstructive interval (OI) are well-established pre-operative factors predictive of need for a VE, the ultimate choice of VR technique is made at surgeon’s discretion, based on intra-operative findings. Intra-operative vasal fluid evaluation results may be affected by the level of operative staff experience and training. Objective We aimed to examine vasal lumen diameters, measured by the surgeon, as additional objective predictors of VR success. Methods Consecutive records of patients who underwent VR at our Institution between January 2008 and June 2023 were queried retrospectively. Patient demographics, medical and social history, pre-operative physical examination, and available laboratory data (Semen Analysis, Testosterone, Estradiol, and Inhibin B) were collected. Operative reports were reviewed and data including type of reversal (VV or VE), and intra-operative findings (vasal lumen diameters, presence of sperm granuloma/surgical clips, sperm quality, and vasal fluid quality) were recorded. Patient telephone calls were conducted to collect post-VR pregnancy information. Data were analyzed with use of descriptive statistics, t-tests, ANOVA, and Mann Whitney U tests when appropriate. Results 733 records were reviewed, consisting of 536 bilateral VV, 99 combination VV/VE, and 75 bilateral VE operations. Average patient age at reversal was 38 years with an average OI of 10 years. VE was associated with a significantly larger testicular vasal lumen diameter (0.94 mm vs 0.88 mm; p < 0.05), decreased odds of positive post-operative semen analysis (92.4% bilateral VV versus 64.4% VV/VE or bilateral VE), and increased OI (7.84 years bilateral VV versus 11.5 years VV/VE or bilateral VE). Conclusions This study identifies a previously unreported association between testicular vasal lumen diameter measurements and likelihood of VR success. Furthermore, the study confirms previously reported pre- and intra-operative factors predictive of VR success. Additional analysis and correlation with pregnancy outcomes are in progress. Disclosure No.