Patency, Pregnancy, and Live Birth Outcomes of Microsurgical Vasovasostomy Com-pared with Vasoepididymostomy for Vasectomy Reversal: A Systematic Review and Me-ta-Analysis.
Azza Fithra Alhanifa, Putu Thio Mahapradana, Putu Krisna Agastya Artawan et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared microsurgical vasovasostomy (VV), vasoepididymostomy (VE), and mixed bilateral reversal in men undergoing surgery for post-vasectomy obstructive azoospermia. Thirteen observational studies included 6,867 patients. Compared with VE, VV was associated with higher odds of patency (OR 6.98, 95% CI 4.23 to 11.50), as well as higher natural pregnancy and overall live-birth odds. Mixed procedures had intermediate patency outcomes. The authors note that the techniques are complementary and should be selected according to intraoperative vasal fluid findings.
Key findings
- VV was associated with higher patency than VE (OR 6.98, 95% CI 4.23 to 11.50; I2=52.6%).
- Natural pregnancy odds were higher after VV than VE (OR 2.01, 95% CI 1.38 to 2.91).
- Overall live-birth odds were higher after VV than VE (OR 2.79, 95% CI 1.67 to 4.67).
- VV was associated with earlier sperm return than VE (MD -1.95 months); mixed procedures had intermediate patency.
Why it matters
The findings compare outcomes across the principal microsurgical approaches to vasectomy reversal and show that reported success differs by procedure. They also underscore that anatomy influences which reconstruction is appropriate: the authors describe VV and VE as complementary rather than interchangeable techniques. Pregnancy and live-birth outcomes provide clinically relevant endpoints alongside patency.
What to keep in mind
The evidence came from observational cohorts, and small-study effects could not be fully excluded because few studies contributed to some outcomes.