Microsurgical Vascetomy Reversal
This Web page is designed to give the couple general information concerning the microsurgical vasectomy reversal. Approximately, 600,000 vasectomies are performed each year for birth control in the United States, of which 5-10% of men choose to have a vasectomy reversal performed in the future. Reversals are performed for several reasons: new partner, change of mind, change in religious beliefs, persistent pain after a vasectomy, psychological reasons, or loss of a child.
The reversal is usually performed in light of a prior vasectomy, however, it may be performed because of a blockage resulting from infection, trauma, previous surgery, or genetic anomaly. There are two types of reversal or reconstruction which are performed, depending on the site of previous blockage. The two types include vasovasostomy which involves reconnecting the two ends of the vas deferens together, whereas a vasoepididymostomy involves connecting the vas deferens to the epididymis. The decision on which procedure is to be performed depends on what is seen at the time of the operation by the experienced microsurgeon. An understanding of the anatomy of the reproductive tract, as seen below, will give the couple a better idea of what really is involved.
A vasovasostomy is the most common way of reestablishing the reproductive tract so that sperm can make their way to the ejaculate. As seen in Figure 1. below, the ends of the vas are brought together with suture smaller than human hair in two separate layers.
The decision to perform a vasoepididymostomy occurs depending on the appearance of the fluid coming from the testicle side of the vas deferens when it is cut open. If the fluid is clear or if sperm are seen in the fluid then a vasovasostomy is performed. However, if the fluid looks like toothpaste then this shows that the blockage is probably in the epididymis and that a vasoepididymostomy will need to be performed, as seen in Figure 2. below.
The procedure is performed on both sides under the operating microscope with the patient completely asleep (general anesthesia). The procedure usually takes 3-4 hours as an outpatient procedure, with somebody else taking the patient home later that day. Plenty of pain medication, an ice pack, and a scrotal support will be prescribed for comfort. No activity other than walking is allowed for 4 weeks to allow the connection to completely heal and not be pulled apart. Patients can go back to “desk” work in a few days. Semen analyses are then performed at 2 month intervals to see at what point sperm return to the ejaculate. We usually recommend freezing semen samples once sperm are identified in the analyses as “insurance”, in case the connection scars down, which can occur in 6% of men. We perform these procedures on a routine basis, approximately 40-50/year, and have noted the following success rates (defined as the successful return of sperm to the ejaculate) which are comparable to those reported nationally:
Since this procedure is not covered by insurance companies, we have fixed the rates so that the charge to the patient remains as low as possible. We are happy to answer any questions you may have.