With advances in surgical technique and the development of microsurgical techniques, modern vasoepididymostomy allows us to accurately approximate the mucosa of a single epididymal tubule to the mucosa of the vasal lumen. With this increased precision, we have been able to achieve even higher patency and pregnancy rates. Microsurgical vasoepididymostomy, however, is the most technically demanding procedure in all of microsurgery. In virtually no other operation are results so dependent upon technical perfection. Thus, microsurgical vasoepididymostomy should only be attempted by an experienced microsurgeon who performs a sufficient volume of microsurgery. Modern IVF–ICSI has opened up reproductive options for those couples desiring fertility. This has caused some to question the need for advanced reconstructive reproductive tract surgery. However, in the hands of experienced microsurgeons, vasoepididymostomy is a safe, effective method of reconstruction for patients who do not want to undergo IVF or desire multiple children.
This is a preview of subscription content, log in to check access.
Dr. Hsiao is supported by a grant from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.
Jequier AM. Edward Martin (1859–1938). The founding father of modern clinical andrology. Int J Androl. 1991;14(1):1–10.PubMedCrossRefGoogle Scholar
Martin E, Carnett JB, Levi JV, et al. The surgical treatment of sterility due to obstruction at the epididymis; together with a study of the morphology of human spermatozoa. Univ Pa Med Bull. 1902;15:2.PubMedGoogle Scholar
Martin E. The operation of epididymo-vasostomy for the relief of sterility. Therapeutic Gazette. 1909;1–19.Google Scholar
Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978;30(5):565–71.PubMedGoogle Scholar
Schlegel PN, Goldstein M. Microsurgical vasoepididymostomy: refinements and results. J Urol. 1993;150(4):1165–8.PubMedGoogle Scholar
Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005;96(4):598–601.PubMedCrossRefGoogle Scholar
Lee R, Goldstein M, Ullery BW, Ehrlich J, Soares M, Razzano RA, et al. Value of serum antisperm antibodies in diagnosing obstructive azoospermia. J Urol. 2009;181(1):264–9.PubMedCrossRefGoogle Scholar
Wagenknecht LV, Klosterhalfen H, Schirren C. Microsurgery in andrologic urology. I. Refertilization. J Microsurg. 1980;1(5):370–6.PubMedCrossRefGoogle Scholar
Pasqualotto FF, Agarwal A, Srivastava M, Nelson DR, Thomas Jr AJ. Fertility outcome after repeat vasoepididymostomy. J Urol. 1999;162(5):1626–8.PubMedCrossRefGoogle Scholar
Kolettis PN, Thomas Jr AJ. Vasoepididymostomy for vasectomy reversal: a critical assessment in the era of intracytoplasmic sperm injection. J Urol. 1997;158(2):467–70.PubMedCrossRefGoogle Scholar
Schiff J, Chan P, Li PS, Finkelberg S, Goldstein M. Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men. J Urol. 2005;174(2):651–5. quiz 801.PubMedCrossRefGoogle Scholar
Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol. 2000;163(2):483–6.PubMedCrossRefGoogle Scholar
Brandell AR, Goldstein M. Reconstruction of the male reproductive tract using the microsurgical triangulation technique for vasoepididymostomy. J Urol. 1999;161(Suppl):350.CrossRefGoogle Scholar