Association Between the Presence
of Sperm in the Vasal Fluid During
Vasectomy Reversal and Postoperative
Patency: A Systematic Review and
Jason M. Scovell, Douglas A. Mata, Ranjith Ramasamy, Lindsey A. Herrel, Wayland Hsiao,
and Larry I. Lipshultz
To investigate the association between the presence of sperm in the vasal
uid during vasectomy
reversal (VR) and postoperative patency.
We performed a systematic review and meta-analysis of the English-language literature reporting
on the association between the presence of sperm in the intraoperative vasal
uid (ie, whole or
parts vs none) and patency (ie, patent or not) after microsurgical vasovasostomy for men with
obstructive azoospermia due to vasectomy. Odds ratios (OR) and 95% con
dence intervals were
calculated to quantify the strength of the association reported by each study. Meta-analysis was
performed using a random-effects model.
Four case series and 2 retrospective cohort studies of a total of 1293 eligible patients were
ed. The mean age at VR was 37.8 years, and the mean obstructive interval was 7.1 years.
The unadjusted OR of postoperative patency was 4.1 times higher (95% con
dence interval, 2.3-
7.3) given the presence of intravasal sperm or sperm parts as opposed to their absence at the time
of VR (Q
22%). The pooled OR should be interpreted with caution as
only the 2 retrospective cohort studies reported meaningful data on this association. Because of
inconsistent reporting, analysis of other vasal
uid characteristics (eg, consistency) and outcomes
(eg, pregnancy) was not possible.
The presence of whole sperm or sperm parts in the vasal
uid during VR is positively associated
with postoperative patency. Our review highlights the poor methodological quality of existing
evidence and underscores the need for more thorough follow up and higher standards of reporting
in future studies.
2015 Elsevier Inc.
bout 175,000 to 354,000 vasectomies are per-
formed in the United States each year,
to 6% of patients who undergo this procedure
later choose to undergo vasectomy reversal (VR).
landmark multicenter study on the outcomes of 1469
patients who underwent VR was published by the Vaso-
vasostomy Study Group in 1991.
that a longer obstructive interval and an absence of sperm
granuloma on physical examination were associated with
decreased patency after VR. Other factors that appeared
uence success of VR were the character of the vasal
uid and the presence of sperm or sperm parts at the time
During surgery, the physician
s decision to proceed
with vasovasostomy (VV) or epididymovasostomy (EV)
depends on the gross quality of
uid expressed from the
testicular end of the vas deferens and on the microscopic
examination of the
uid for sperm. Findings may include
motile or nonmotile whole sperm, sperm parts (ie, sperm
heads or tails alone), or no sperm. VV is routinely per-
formed if whole sperm are identi
ed in the vasal
uid or if
uid appears clear and copious, even in the absence of
In contrast, when the
uid quality is poor (ie,
paste-like) and sperm are absent, EV is generally required.
Modern series indicate that patency after VV approaches
99.5% when whole sperm are identi
Even in cases of
bilateral intravasal azoospermia, patency in some series
Jason M. Scovell and Douglas A. Mata contributed equally to this work.
The authors declare that they have no relevant
From the Scott Department of Urology, Baylor College of Medicine, Houston, TX;
the Department of Pathology, Brigham and Women's Hospital, Boston, MA; the
Department of Urology, Emory University School of Medicine, Atlanta, GA; and the
Department of Urology, Kaiser Permanente, Oakland, CA
Address correspondence to: Larry I. Lipshultz, M.D., Department of Urology, Baylor
College of Medicine, 6624 Fannin Street, Suite 1700, Houston, TX 77030. E-mail:
Submitted: June 3, 2014, accepted (with revisions): September 8, 2014
2015 Elsevier Inc.
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