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Vasectomy reversal: lessons learned to optimize clinical outcomes

International Journal of Impotence Research (2026)Cite this article

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Abstract

Vasectomy reversal (VR) has remained the longstanding gold standard for men seeking paternity following a history of vasectomy. Ever since its initial description, numerous innovations have occurred in the field of reproductive urology to optimize perioperative outcomes. Additional considerations such as preoperative patient and patient’s partner evaluation, medical optimization, and perioperative surveillance protocols are now a paramount component of caring for patients with obstructive azoospermia undergoing vasectomy reversal. Finally, numerous surgical innovations have been described which may lead to increased duration of patency in the postoperative setting. This review aims to provide a comprehensive update on the management of obstructive azoospermia secondary to vasectomy and all salient considerations including preoperative evaluation, intraoperative decision making, surgical technique, and postoperative surveillance.

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Fig. 1: Two-layer VV.
Fig. 2: Modified one-layer VV.
Fig. 3: VE.

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Acknowledgements

The authors would like to thank the Departments of Urology at Wake Forest Baptist Health, Northwestern University Feinberg School of Medicine, and the University of South Alabama for their support and contributions to this work and whose collaboration and dedication to male reproductive health helped facilitate the development of this manuscript. No external funding was received for this study. The authors declare no conflicts of interest related to this work.

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Authors and Affiliations

  1. Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Nicholas A. Deebel, Evan Panken & Robert Brannigan

  2. Department of Urology, University of South Alabama, Mobile, AL, USA

    Hannah Moreland & Kevin Parham

  3. Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Madeline Snipes, Stephen Tranchina, Rafael Carrion & Kimberly Waggener

  4. Department of Urology, Ochsner Health, Jefferson, LA, USA

    Farah Rahman

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Contributions

ND participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. ND also oversaw all figure generation for detail and accuracies. EP participated in manuscript writing for the original and subsequent drafts as well as reviewed & edited subsequent drafts. HM participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. MS participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. ST participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. KP participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. FR participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. RC participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. KW: participated in manuscript writing for the original and subsequent drafts; Review & editing of the drafts, project administration designing methodology as well as served as a final editor and synthesized of final manuscript and documents. She also illustrated all figures for this manuscript. RB: participated in review & editing of each draft, study conception and design, validation of the manuscript as well as served as the principal investigator.

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Correspondence to Nicholas A. Deebel.

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Deebel, N.A., Panken, E., Moreland, H. et al. Vasectomy reversal: lessons learned to optimize clinical outcomes. Int J Impot Res (2026). https://doi.org/10.1038/s41443-026-01230-x

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