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However, existing studies report inconsistent pregnancy and patency rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To comprehensively review the therapeutic effects of various MVE techniques on EOA, address prior research controversies, and identify factors influencing MVE efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>\n                      Eligible studies focused on MVE outcomes, such as patency, pregnancy, or natural pregnancy rates. Relative pregnancy rate refers to natural pregnancies occurring in partners of patients with post\u2010operative patency. Meta\u2010analyses were performed using the \u201cmeta\u201d R package. Heterogeneity was assessed with\n                      <jats:italic>Q<\/jats:italic>\n                      and\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 56 studies involving 3204 patients were included. End\u2010to\u2010end\/end\u2010to\u2010side (EE\/ES) techniques were associated with patency, pregnancy, and relative pregnancy rates of 65.0%, 23.0%, and 38.0%, respectively, whereas longitudinal intussusception vasoepididymostomy (LIVE) technique demonstrated slightly higher rates (68.0%, 27.0%, 40.0%). However these differences were not statistically significant (all\n                      <jats:italic>p<\/jats:italic>\n                      &gt; 0.05). Compared with the 2\u2010suture TIVE (72.0%) and LIVE (58.0%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01) techniques, the 3\u2010suture transverse intussusception vasoepididymostomy (TIVE) technique demonstrated significantly higher patency rates (89.0%). Pregnancy rates (33.0% vs. 26.0% vs. 28.0%) and relative pregnancy rates (38.0% vs. 33.0% vs. 42.0%) did not significantly differ among the three techniques (\n                      <jats:italic>p<\/jats:italic>\n                      &gt; 0.05). Single\u2010armed LIVE (SA\u2010LIVE) demonstrated numerically higher patency (69.0% vs. 64.0%), pregnancy (31.0% vs. 26.0%), and relative pregnancy rates (46.0% vs. 39.0%) compared with double\u2010armed LIVE (DA\u2010LIVE). However, these differences were not statistically significant (all\n                      <jats:italic>p<\/jats:italic>\n                      &gt; 0.05). Vessel\u2010sparing SA\u2010LIVE demonstrated superior patency (83.0%) compared with classical SA\u2010LIVE (67.0%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.01), whereas pregnancy (38.0% vs. 31.0%) and relative pregnancy rates (both 47.0%) were not significantly different (\n                      <jats:italic>p<\/jats:italic>\n                      &gt; 0.05). Bilateral MVE, genital infections, and the presence of motile spermatozoa were associated with increased patency rates. The overall late failure rate was 23.0%, with significantly higher rates for the EE\/ES techniques (32.0%) than the IVE technique (15.0%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This meta\u2010analysis confirms the efficacy of MVE for EOA. IVE has supplanted ES\/EE, likely owing to its technical superiority and reduced rate of late failures, with LIVE emerging as the dominant approach. SA\u2010LIVE and DA\u2010LIVE yield comparable outcomes, and both should be recommended. Bilateral cases, infectious etiology, and motile epididymal spermatozoa predict increased patency rate. The relative pregnancy rate may better reflect effectiveness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/andr.70145","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T05:45:19Z","timestamp":1763444719000},"page":"651-660","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Treatment Efficacy of Microsurgical Vasoepididymostomy for Obstructive Azoospermia: An Updated Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"14","author":[{"given":"Jun","family":"Zhu","sequence":"first","affiliation":[{"name":"Andrology Center Peking University First Hospital  Beijing China"},{"name":"Department of Urology Peking University First Hospital  Beijing China"},{"name":"Institute of Urology Peking University National Urological Cancer Center  Beijing 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