Patency, Pregnancy, and Live Birth Outcomes of Microsurgical Vasovasostomy Com-pared with Vasoepididymostomy for Vasectomy Reversal: A Systematic Review and Me-ta-Analysis.

PURPOSE: To compare patency, pregnancy, and overall live-birth outcomes after microsurgical vasovasostomy (VV) versus vasoepididymostomy (VE), and to evaluate mixed bilateral procedures as a distinct analytic category. MATERIALS AND METHODS: A systematic search of four databases was conducted. Eligible studies were observational cohorts reporting patency, pregnancy, or overall live-birth outcomes of men undergoing microsurgical VV, VE, or mixed bilateral reversal for post-vasectomy obstructive azoospermia. The quality of studies was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis using restricted maximum likelihood was performed in R, reporting pooled odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI). Heterogeneity was quantified using I2. The protocol was registered in PROSPERO (CRD420261357366). RESULTS: Thirteen studies encompassing 6,867 patients (4,053 VV; 1,430 VE; 1,384 mixed) were included. VV was associated with significantly higher patency than VE (OR 6.98, 95% CI 4.23 to 11.50; I2=52.6%), higher natural pregnancy odds (OR 2.01, 95% CI 1.38 to 2.91), higher overall live-birth odds (OR 2.79, 95% CI 1.67 to 4.67), and earlier sperm return (MD -1.95 months). Mixed procedures yielded intermediate patency. Findings were robust across all sensitivity analyses; small-study effects could not be fully excluded given the limited number of studies contributing to some outcomes. CONCLUSIONS: VV is associated with higher patency, pregnancy, and overall live-birth rates than VE, reflecting more favorable anatomical conditions. Mixed bilateral procedures yield intermediate outcomes from asymmetric anatomy. These findings support VV and VE as complementary techniques selected according to intraoperative vasal fluid findings.