The Kinetics of Sperm Return and Late Failure Following Vasovasostomy or Vasoepididymostomy: A Systematic Review

Abstract

PurposeVasovasostomy (VV) and vasoepididymostomy (VE) are technically challenging microsurgical reconstructive procedures necessary for men with obstructive azoospermia at the level of the vas deferens or epididymis. Patency rates following VV or VE have been widely described in the literature. However, few reports have discussed the timing of sperm return to the ejaculate following reconstruction as well as the proportion of men that develop late failure following VV or VE. Therefore, the objective of this article is to review the rates and predictors associated with late failures and the timing of sperm returning to the ejaculate following VV and VE. MethodsA literature search was performed using using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines via the PubMed®/Medline database. We included relevant articles published in English in peer-reviewed journals from 1960 to 2017 that reported outcomes regarding time to patency, time to late failure, or late failure rates after VV or VE. Macroscopic reconstructions were excluded. ResultsTwenty-four articles were included in the review. Mean time to patency after VV and VE ranged from 1.7-4.3 months and 2.8-6.6 months, respectively. Late failure rates after microsurgical VV and VE ranged from 0-12% and 1-50%, respectively. Mean time to late failure after VV and VE ranged from 9.7-13.6 months and 6-14.2 months, respectively. There was significant heterogeneity in the available data, limiting comparisons between series. ConclusionSperm returns to the ejaculate sooner among men undergoing a VV compared to VE. Late failures are heterogeneously defined in the literature but do occur at non-insignificant rates. As such, clinicians should discuss considerations for sperm cryopreservation.