[Vasectomy reversal : Literature review]

Vasectomy is a highly effective method of permanent male contraception but remains surgically reversible. Approximately 5-7% of men seek restoration of fertility, most commonly due to changes in life circumstances, while chronic post-vasectomy pain syndrome (PVPS) represents an additional indication. Microsurgical vasovasostomy (VVS) and vasoepididymostomy (VES) are the cornerstone procedures for restoring vasal continuity. The choice of technique is guided by intraoperative findings, particularly the quality of epididymal fluid and the presence of sperm. VES is more frequently required in cases of suspected epididymal obstruction, especially when the interval since vasectomy exceeds 10 years. Reported patency and pregnancy rates following VVS reach approximately 88% and 47%, respectively, whereas VES is associated with lower success rates (patency ~64%, pregnancy ~31%). Although emerging approaches such as robot-assisted microsurgery show promising early results, conventional microsurgery remains the current gold standard. Recent efforts to improve patient selection have led to the development of predictive scoring systems aimed at identifying individuals at risk of vasectomy regret and optimizing preoperative counseling.