A incidência de trauma dos vasos deferentes durante uma herniorafia inguinal é estimada em 0.5%. Nós avaliamos as taxas de permeabilidade e o prognóstico da fertilidade a longo-prazo após o reparo microcirúrgico da obstrução dos vasos deferentes relacionados com herniorrafia inguinal prévia MÉTODOS: Vinte procedimentos foram realizados em 13 homens diagnosticados com infertilidade e trauma nos vasos deferentes secundário à herniorrafia inguinal prévia. Oito destes homens foram submetidos à herniorrafia inguinal bilateral e 5 à herniorrafia inguinal unilateral. Doze procedimentos foram vasovasostomias, 3 vasovasostomias cruzadas, 2 vasoepididimostomias e 3 vasoepididimostomias cruzadas. Oito pacientes estavam azoospérmicos, 2 com oligozosspermia grave (< 1 milhão/mL) 1 oligozoospérmico e 2 astenozoospérmicos. Dados de permeabilidade foram obtidos em 13 pacientes e dados de gravidez estavam disponíveis em 10 casais (77%) com um seguimento médio de 69,5 meses. RESULTADOS: A taxa de permeabilidade foi de 65%. No grupo de vasovasostomia, a taxa de permeabilidade foi de 60% (9/15) e no grupo de vasoepididimostomia foi de 80% (4/5). Entre os pacientes azoospérmicos, 13 procedimentos foram realizados. As taxas de permeabilidade foram de 42,9% para a vasovasostomia (3/7), e 100% para o procedimento de vasoepididimostomia (4/4). As taxas globais foram de 40%. Quatro de 5 (80%) homens que foram submetidos à vasoepididimostomia estabeleceram gravidez. CONCLUSÕES: Vasovasostomia microcirúrgica após trauma inguinal nos vasos deferentes resultam em taxas de permeabilidade razoáveis, mas uma taxa de gravidez baixa comparada à reversão de vasectomia. Quando a vasoepididimostomia microcirúrgica foi possível, ela resultou em altas taxas de permeabilidade e gravidez. A vasoepididimostomia cruzada, quando apropriada, pode ser uma alternativa útil à vasovasostomia inguinal.
The incidence of vasal injury during inguinal herniorrhaphy is estimated at 0.5%. We sought to assess the patency rates and long-term fertility outcome after microsurgical repair of vasal obstruction related to prior inguinal herniorrhaphy. METHODS: Twenty procedures were performed on 13 men diagnosed with infertility and vasal injury secondary to previous inguinal herniorrhaphy. Eight of these men had undergone bilateral and 5 unilateral inguinal herniorrhaphy. Twelve procedures were vasovasostomies, 3 were crossover vasovasostomies, 2 were vasoepididymostomies, and 3 were crossover vasoepididymostomies. Eight patients were azoospermic, 2 were severely oligospermic (<1 M/mL), 1 was oligospermic, and 2 were asthenospermic. Patency data was obtained on all 13 patients, and pregnancy data was available for 10 couples (77%), with a mean follow-up of 69.5 months. RESULTS: The overall patency rate was 65%. In the vasovasostomy group, the patency rate was 60% (9/15), and in the vasoepididymostomy group it was 80% (4/5). Among the azoospermic patients, 13 procedures were performed. The patency rate was 42.9% for the vasovasostomy (3/7), and 100% for the vasoepididymostomy procedure (4/4). The overall pregnancy rate was 40%. Of the men who underwent vasoepididymostomy, 80% (4/5) established a pregnancy. CONCLUSIONS: Microsurgical vasovasostomy after inguinal vas injury results in a reasonable patency rate but a lower pregnancy rate than that after vasectomy reversal. When microsurgical vasoepididymostomy was possible, it resulted in high patency and pregnancy rate. Crossover vasoepididymostomy, when appropriate, can be a useful alternative to inguinal vasovasostomy.
