title: Outcomes of microsurgical vasovasostomy for vasectomy reversal: a meta-analysis and systematic review.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis of the published literature evaluating vasovasostomy for vasectomy reversal outcomes.
  
  
  METHODS
  We conducted a review of English language articles describing results of microscopic vasovasostomy for vasectomy reversal. Two reviewers independently examined the studies for eligibility and evaluated data from each study. Meta-analysis was performed using a random effects model.
  
  
  RESULTS
  Thirty-one studies with 6633 patients met inclusion criteria. Mean patient age at time of vasectomy reversal was 38.9 years with a mean obstructive interval of 7.2 years. The mean postprocedure patency and pregnancy rates weighted by sample size were 89.4% and 73.0%, respectively. A meta-analysis comparing an obstructive interval (OI) of <10 years to an OI of at least 10 years duration produced a pooled incidence ratios (IR; meta-IR) of 1.17 (95% confidence interval [CI], 1.09-1.25) for patency and 1.24 (95% CI, 1.12-1.38) for pregnancy. Incidence of patency for modified 1-layer technique was similar to that after a 2-layer procedure with a meta-IR of 1.04 (95% CI, 1.00-1.08). Because of a small number of relevant studies, a meta-analysis for other predictors of success such as sperm granuloma, quality of vasal fluid, and female factors was not feasible.
  
  
  CONCLUSIONS
  We found no statistically significant difference in vasovasostomy outcomes when comparing the impact of single vs multilayer anastomoses. Patients with an OI <10 years showed higher patency and pregnancy rates compared with those with an OI ≥10 years. Uniform definitions of patency are necessary to characterize success and standardize outcome reporting.
authors: Department of Urology, Emory University School of Medicine, Atlanta, GA.
authors: Lindsey A
authors: LA
authors: Herrel
authors: Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, GA.
authors: Michael
authors: M
authors: Goodman
authors: Department of Male Reproductive Medicine, Weill Cornell Medical College, School of Medicine, New York, NY.
authors: Marc
authors: M
authors: Goldstein
authors: Department of Urology, Oakland Medical Center, Kaiser Permanente, Oakland, CA. Electronic address: wayland.hsiao@kp.org.
authors: Wayland
authors: W
authors: Hsiao
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery; D011247:Pregnancy; D018873:Pregnancy Rate; D013997:Time Factors; D016896:Treatment Outcome; D014669:Vasovasostomy / Q000009:adverse effects / Q000379:methods