To evaluate the clinical outcomes of a modified single-armed 2-suture longitudinal intussusception vasoepididymostomy.Additionally, to identify factors that might be associated with improved patency rate and pregnancy rate for epididymal obstructive azoospermia.From July 2007 to July 2013, 318 patients with epididymal obstruction azoospermia had undergone vasoepididymostomy at our hospital.Patency was assessed by return of sperm in the semen.The outcomes and clinical findings of microsurgical procedure, site of microsurgical anastomosis, epididymal fluid findings and sperm cryopreservation were documented and evaluated.The mean age was 32.1 years (range 23-50 years).The mean follow-up period was 17 months (range 12-26 months).The overall patency rate was 64.5％ at the follow-up of 12 to 26 months, and the natural pregnancy rate was 33.0 ％ by use of the modified single-armed 2-suture longitudinal intussusception vasoepididymostomy.The patency rate was 75.3％ for bilateral surgery, 37.2％ and 68.7％ for the site of proximal (caput) anastomosis and distal (corpus or caudal) anastomosis, respectively.And it was 78.2％ for flowing fluid with motile sperm.The natural pregnancy rate was 39.5％ for bilateral surgery, 36.7％ for the site of distal anastomosis, and 40.3％ for flowing fluid with motile sperm, respectively.However, the sperm was banked during operation, 58 couples got pregnant by intracytoplasmic sperm injection using frozen sperm collected at operation, the total pregnancy rate was 51.3％.By use of the single-armed 2-suture longitudinal intussusception vasoepididymostomy is also able to achieve a favorable patency and pregnancy.The modified single-armed microsurgical vasoepididymostomy is a practical and effective alternative microsurgical approach.