title: Association between the presence of sperm in the vasal fluid during vasectomy reversal and postoperative patency: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the association between the presence of sperm in the vasal fluid during vasectomy reversal (VR) and postoperative patency.
  
  
  METHODS
  We performed a systematic review and meta-analysis of the English-language literature reporting on the association between the presence of sperm in the intraoperative vasal fluid (ie, whole or parts vs none) and patency (ie, patent or not) after microsurgical vasovasostomy for men with obstructive azoospermia due to vasectomy. Odds ratios (OR) and 95% confidence intervals were calculated to quantify the strength of the association reported by each study. Meta-analysis was performed using a random-effects model.
  
  
  RESULTS
  Four case series and 2 retrospective cohort studies of a total of 1293 eligible patients were identified. The mean age at VR was 37.8 years, and the mean obstructive interval was 7.1 years. The unadjusted OR of postoperative patency was 4.1 times higher (95% confidence interval, 2.3-7.3) given the presence of intravasal sperm or sperm parts as opposed to their absence at the time of VR (Q = 3.4; df = 5; P = .6; I(2) = 22%). The pooled OR should be interpreted with caution as only the 2 retrospective cohort studies reported meaningful data on this association. Because of inconsistent reporting, analysis of other vasal fluid characteristics (eg, consistency) and outcomes (eg, pregnancy) was not possible.
  
  
  CONCLUSIONS
  The presence of whole sperm or sperm parts in the vasal fluid during VR is positively associated with postoperative patency. Our review highlights the poor methodological quality of existing evidence and underscores the need for more thorough follow up and higher standards of reporting in future studies.
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Scovell
authors.affiliation: Department of Pathology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Mata
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX.
authors.forename: Ranjith
authors.initials: R
authors.lastname: Ramasamy
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Lindsey A
authors.initials: LA
authors.lastname: Herrel
authors.affiliation: Department of Urology, Kaiser Permanente, Oakland, CA.
authors.forename: Wayland
authors.initials: W
authors.lastname: Hsiao
authors.affiliation: Scott Department of Urology, Baylor College of Medicine, Houston, TX. Electronic address: larryl@bcm.edu.
authors.forename: Larry I
authors.initials: LI
authors.lastname: Lipshultz
mesh_terms: D001826:Body Fluids / Q000166:cytology*; D006801:Humans; D008297:Male; D013094:Spermatozoa; D014649:Vas Deferens; D014669:Vasovasostomy