Outcomes of Three Vasovasostomy Surgical Techniques in Vasectomized Men: A Systematic Review of the Current Literature

Abstract

To investigate which surgical technique, macroscopic, microscopic or robot-assisted microscopic, shows highest postoperative patency- and pregnancy rates for vasectomy reversal (VR) by vasovasostomy (VV). This study is an updated version of the systematic review and meta-analysis entitled: “Outcomes of Macrosurgical Versus Microsurgical Vasovasostomy in Vasectomized Men: a Systematic Review and Meta-analysis” published in 2021. We performed a systematic review of the English-, Dutch-, and German-language literature that described postoperative outcomes of macroscopic, microscopic, or robot-assisted microscopic VV for VR. PubMed National Library of Medicine/MEDLINE, Embase, CENTRAL, The Cochrane Library, Web of Science and Scopus were searched from inception to June 2021. Two reviewers independently examined the studies and associated data for eligibility. Primary outcomes were postoperative patency and pregnancy rates. Data on interval to reversal (≤ 7 years and > 7 years) and postoperative complications were also extracted. Forty-nine studies met the inclusion criteria. We identified 46 retrospective studies and three randomized controlled trials (RCT). A total of 10,088 procedures were included. 6822 patients remained after loss to follow-up. The mean age at reversal of vasectomy was 38.0 years, and the mean interval to reversal was 6.5 years. The pooled mean postoperative patency rate was slightly higher after robot-assisted microsurgical VV (92.7%), compared to macrosurgical (81.9%) and pure microsurgical (90.1%) VV. Postoperative pregnancy rates were 42.7%, 69.7%, and 33.3% after macroscopic, pure microscopic and robot-assisted microscopic VV, respectively. Our results showed that microsurgical and robot-assisted microsurgical VV are associated with higher postoperative patency rates compared to the macrosurgical technique. VV with microsurgical assistance showed the highest post-operative pregnancy rates. However, more research is needed due to lack of RCTs and data on robot-assisted microsurgical VV.

Vasovasostomy: A systematic review and meta‐analysis comparing macroscopic, microsurgical, and robot‐assisted microsurgical techniques

“…This study updates the results of the previous meta‐analysis conducted by Duijn et al. in 2023 121 . Our review includes 95 studies that enrolled 48,069 participants, compared with 49 studies ( n = 6822) in the previous review.…”

“…41 This study updates the results of the previous meta-analysis conducted by Duijn et al in 2023. 121 Our review includes 95 studies that enrolled 48,069 participants, compared with 49 studies (n = 6822) in the previous review. Our findings on pooled patency and pregnancy rates were consistent with those of Duijn et al 121 Our review is distinguished by the large number of included studies with different designs and the substantial total sample size.…”

“…121 Our review includes 95 studies that enrolled 48,069 participants, compared with 49 studies (n = 6822) in the previous review. Our findings on pooled patency and pregnancy rates were consistent with those of Duijn et al 121 Our review is distinguished by the large number of included studies with different designs and the substantial total sample size. In addition, the majority of the included studies were of good to fair quality.…”

Assessing Current Interest, Knowledge, and Inquiries About Vasectomies in Urology Patients and Medical Students

“…Most students guessed the reversal rate to be between 70% and 100%. According to a systemic review by Duijn et al, there was a postoperative mean patency of 81.9% (macrosurgical vasovasostomy), 90.1% (microsurgical vasovasostomy), and 92.7% (microsurgical vasovasostomy with robotic assistance) [15]. This demonstrates that most medical students had an idea of a typical vasectomy reversal, whereas patients, by majority, did not.…”