The objective of this study was to identify factors that predict for sperm
granuloma formation and the impact of sperm
granuloma presence and quantity on
vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of
granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019.
Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of
granulomas (p = .011).
Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However,
granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with
granuloma presence. On multivariate analysis,
granuloma quantity was not associated with TMC. Obstructive interval and
vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with
granuloma formation.
Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without
granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for
weight loss prior to
vasectomy reversal as increasing BMI was associated with lower TMC.