Advanced Techniques of Vasoepididymostomy

  • Wayland HsiaoEmail author
  • Marc Goldstein


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.


Vasoepididymostomy techniques Epididymal obstruction Obstructive azoospermia Anastomosis Anastomotic technique End-to-side intussusception Anastomotic site Transseptal vasoepididymostomy 



Dr. Hsiao is supported by a grant from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust.


  1. 1.
    Jequier AM. Edward Martin (1859–1938). The founding father of modern clinical andrology. Int J Androl. 1991;14(1):1–10.PubMedCrossRefGoogle Scholar
  2. 2.
    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
  3. 3.
    Martin E. The operation of epididymo-vasostomy for the relief of sterility. Therapeutic Gazette. 1909;1–19.Google Scholar
  4. 4.
    Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978;30(5):565–71.PubMedGoogle Scholar
  5. 5.
    Schlegel PN, Goldstein M. Microsurgical vasoepididymostomy: refinements and results. J Urol. 1993;150(4):1165–8.PubMedGoogle Scholar
  6. 6.
    Chan PT, Brandell RA, Goldstein M. Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy. BJU Int. 2005;96(4):598–601.PubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Wagenknecht LV, Klosterhalfen H, Schirren C. Microsurgery in andrologic urology. I. Refertilization. J Microsurg. 1980;1(5):370–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Krylov VS, Borovikov AM. Microsurgical method of reuniting ductus epididymis. Fertil Steril. 1984;41(3):418–23.PubMedGoogle Scholar
  10. 10.
    Fogdestam I, Fall M, Nilsson S. Microsurgical epididymovasostomy in the treatment of occlusive azoospermia. Fertil Steril. 1986;46(5):925–9.PubMedGoogle Scholar
  11. 11.
    Thomas Jr AJ. Vasoepididymostomy. Urol Clin North Am. 1987;14(3):527–38.PubMedGoogle Scholar
  12. 12.
    Matthews GJ, Schlegel PN, Goldstein M. Patency following microsurgical vasoepididymostomy and vasovasostomy: temporal considerations. J Urol. 1995;154(6):2070–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Sheynkin YR, Starr C, Li PS, Goldstein M. Effect of methylene blue, indigo carmine, and Renografin on human sperm motility. Urology. 1999;53(1):214–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Berger RE. Triangulation end-to-side vasoepididymostomy. J Urol. 1998;159(6):1951–3.PubMedCrossRefGoogle Scholar
  15. 15.
    Goldstein M, Li PS, Matthews GJ. Microsurgical vasovasostomy: the microdot technique of precision suture placement. J Urol. 1998;159(1):188–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Monoski MA, Schiff J, Li PS, Chan PT, Goldstein M. Innovative single-armed suture technique for microsurgical vasoepididymostomy. Urology. 2007;69(4):800–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Prentiss RJ, Weickgenant CJ, Moses JJ, Frazier DB. Surgical repair of undescended testicle. Calif Med. 1962;96:401–5.PubMedGoogle Scholar
  18. 18.
    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
  19. 19.
    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
  20. 20.
    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
  21. 21.
    Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol. 2000;163(2):483–6.PubMedCrossRefGoogle Scholar
  22. 22.
    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
  23. 23.
    Silber SJ. Role of epididymis in sperm maturation. Urology. 1989;33(1):47–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Matthews GJ, Goldstein M. A simplified method of epididymal sperm aspiration. Urology. 1996;47(1):123–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of UrologyEmory UniversityAtlantaUSA
  2. 2.Cornell Institute for Reproductive Medicine, New York Presbyterian Hospital/Weill Cornell Medical CenterWeill Cornell Medical College of Cornell UniversityNew YorkUSA

Personalised recommendations