INTRODUCTION

Vasectomy is a simple and reliable method of permanent contraception in men causing obstructive azoospermia. As many as 50 million men worldwide have relied on vasectomy for family planning. However, it is estimated that around 6% of these men who underwent vasectomy will ultimately seek vasectomy reversal for various reasons. Vasectomy reversal is the most cost effective option for couples desiring children after vasectomy and is the most challenging microsurgical procedures. This study presents local experience, outcomes and complications of microsurgical reconstruction of the male ductal system in the Philippines setting.

METHODS

This is a retrospective study of 157 post-vasectomy patients who underwent microsurgical vasectomy reversal by a single surgeon from January 2001 to March 2024. Outcomes such as patency and pregnancy rates were documented and analyzed.

RESULTS

One hundred and fifty seven (157) underwent microsurgical vasectomy reversal. One hundred five (105) patients underwent bilateral microsurgical vasovasostomy. Forty eight (48) patients underwent combined microsurgical vasovasostomy and vasoepididymostomy. Three patients underwent bilateral vasoepididymostomy and one crossed microsurgical vasoepididymostomy (left to right). Four patients had no child, 87 patients had 1 child, 34 patients had 2 children, 29 had 3 children and 3 patients had 4 children prior to vasectomy. Age of wife was between 20 to 32 years old. Mean interval from vasectomy was 9 years. Vas deferens was patent in 120 (76%) of patients. Clinical pregnancy with successful delivery was achieved in 99 (63%) patients. There were only three who had postoperative hematoma (0.02%) and one developed surgical site infection (0.001%).

CONCLUSION

Microsurgical vasectomy reversal is an excellent option in men post vasectomy to achieve natural clinical pregnancy with minimal complications. The study confirms the effectiveness of male infertility microsurgery for vasectomized men who wish to father children.

Human ; Male ; Vasectomy

INTRODUCTION: Urethroplasty is the gold standard treatment for urethral stricture disease, regardless of the reconstructive technique utilized, because of its high success rate as compared with endoscopic urethrotomy or simple dilation. Among the different urethroplasty techniques, the Kulkarni Procedure has gained wide acceptance worldwide for strictures of varying etiologies. This is the first ever local experience study to review this one-sided dissection technique aimed at preserving the lateral blood and nervous supply to the urethra thereby increasing the chances of graft survival. METHODS: A retrospective review from October 2017 – October 2021 was done. Twenty male patients were included. Their ages ranged from 24 to 75 years old (mean age 43). The patient underwent one-sided urethral dissection followed by dorsal onlay mucosal graft urethroplasty. All the surgeries were performed by a single surgeon. On follow up, outcomes were measured using a variety of tools. Incidence of postoperative complications and stricture recurrence were likewise noted. RESULTS: In this study, 20 patients underwent one-sided dorsal onlay BMG (buccal mucosal graft) urethroplasty (Kulkarni technique), from October 2017 to October 2021.The outcome was deemed successful if the patient no longer needed additional procedures after the initial surgery. Of the 20 patients, 18 had successful outcomes. The other 2 patients had to undergo a redo urethroplasty. CONCLUSION This technique was shown to have an overall success rate of 92% in 24 patients, with a follow-up period of 12-55 months based on Kulkarni’s initial report in 2009. The results of the present study are similar wherein the overall success rate was 90% in 20 patients, but on a shorter follow up period. Despite the small sample size and short follow-up period, the results of the initial experience are very promising. As urologists gain more experience, they can achieve higher success rates in the future.