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Updated: Jun 16, 2026
A Modified Vessel-Sparing Microsurgical Vasoepididymostomy
Published on: June 8, 2022
Long-term pregnancy outcomes after deferential vessel‑sparing microsurgical vasoepididymostomy
Shi-Ying Long1,2, Ming-Kuan Zhou1, Kun-Long Lyu1,3
1Department of Urology and Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Background:
Low pregnancy rates after microsurgical vasoepididymostomy (MVE) are an essential factor that affects the outcome of treatment for epididymal obstruction. The obstructive interval (OI) is considered an important prognostic factor for MVE success. The OI in patients with epididymal obstruction not caused by vasectomy is often undetermined, and the postoperative pregnancy rates remain unknown. This study aims to assess the long-term pregnancy rate after MVE for epididymal obstruction that was not secondary to vasectomy.
Methods:
A retrospective study was conducted on 197 patients with epididymal obstruction who had no history of vasectomy and underwent deferential vessel sparing MVE. Postoperative patency and long-term pregnancy rates were assessed, and associated influencing factors were analyzed.
Results:
One hundred and ninety-seven patients with epididymal obstructive azoospermia due to infection, idiopathy, or trauma who underwent surgical treatment with deferential vessel-sparing MVE were followed up for 18 months postoperatively. The anastomosis patency rate was 80.1% (141/176). Of the patients with patent anastomosis, 81% (114/141) received long-term follow-up, with an average follow-up time of 56 months. The natural pregnancy rate among these patients was 72.8% (83/114). For patients who did not conceive within 1 year after regaining patency, approximately 39.2% (20/51) of the couples conceived naturally within 1 to 3 years after patency. Female age ≥35 years, combined left spermatic varicoceles may predict decreased natural pregnancy rates.
Conclusions:
The epididymal obstructions that are not secondary to vasectomy are associated with a higher postoperative pregnancy rate, although OI cannot be determined. Previous vasoepididymostomy (VE) studies may have underestimated the natural pregnancy rate after VE because they had a short follow-up period and recommended in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) for couples with patency too early. Therefore, we believe that it may be better to wait 2 to 3 years after VE patency before doing IVF/ICSI, as long as the spouse's condition permits.
