Abstract Introduction Obstructive azoospermia represents a treatable form of male factor infertility. With greater demand for assisted reproductive technologies, the general urologist may be tasked with initiation of the infertility evaluation and providing counsel for treatment options. This review discusses appropriate laboratory, radiographic, and genetic testing for the patient with obstructive azoospermia in addition to outlining surgical treatment options. Methods The Medline database was searched for relevant studies pertaining to the evaluation and treatment of men with obstructive azoospermia. Key words included: obstructive azoospermia, vasovasostomy, vasoepididymostomy, testicular sperm extraction, sperm aspiration, and sperm retrieval. Results The majority of published reports were based upon small cohorts followed at single institutions. There was sufficient data to characterize the current state-of-the-art and to review the standard of practice. Conclusions The initial evaluation of azoospermia is primarily based upon differentiating obstructive from nonobstructive etiologies with a substantial reliance upon history, physical, and screening laboratories. For those patients with obstructive causes a variety of treatment options exists, including reproductive tract reconstruction (vasovasostomy or vasoepididymostomy) or numerous surgical sperm extraction approaches.