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Updated: Mar 6, 2026

A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

Published on: June 8, 2022

Factors and practice patterns that affect the decision for vasoepididymostomy.

Kevin A Ostrowski¹, Nicholas N Tadros, A Scott Polackwich

¹Department of Urology, Oregon Health & Science University, Portland, Oregon, USA.

The Canadian Journal of Urology

|March 7, 2017

Summary

Microsurgical vasectomy reversal decisions between vasovasostomy (VV) and vasoepididymostomy (VE) vary among surgeons. Most perform VE for specific epididymal fluid conditions, with significant technique and timing variations noted.

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Area of Science:

Urology
Reproductive Medicine
Microsurgery

Background:

Microsurgical vasectomy reversal involves choosing between vasovasostomy (VV) and vasoepididymostomy (VE).
Factors influencing this decision among microsurgeons are not fully elucidated.

Purpose of the Study:

To identify the decision-making factors for VV versus VE in microsurgical vasectomy reversal.
To understand current practices among specialists in male reproduction.

Main Methods:

An online questionnaire was distributed to members of the Society for the Study of Male Reproduction (SSMR).
The survey collected data on surgical techniques, decision criteria, and outcome assessments for vasectomy reversals.

Main Results:

72% of respondents perform fewer than 50 reversals annually, with 71% performing <20% vasoepididymostomies.
87% opt for VE with pasty epididymal fluid, 66% with creamy fluid lacking sperm heads.
The Berger end-to-side intussusception technique is favored by 78% for VE; success is often defined by sperm presence in analysis 6-18 months post-op.

Conclusions:

Vasoepididymostomy is primarily performed for specific epididymal fluid characteristics (pasty or creamy without sperm heads).
The Berger technique is widely adopted, but significant variability exists in VE decision-making and outcome evaluation.
Further research is required to establish optimal guidelines for performing vasoepididymostomy.