Vasectomy Reversal

A vasectomy reversal is a surgical procedure that restores the flow of sperm through the vas deferens. After successful vasectomy reversal, sperm are present in the semen again and you may be able to get your partner pregnant. It is usually performed by an experienced surgeon with microsurgical skill using specialized instruments, including an operating microscope. The sutures used in vasectomy reversal are finer than human hair.

There are two types of vasectomy reversals: vasovasostomy and vasoepididymostomy.

A vasovasostomy is the operation most frequently performed for vasectomy reversal. It involves stitching the cut ends of the vas deferens together as illustrated in Figure 1. It is the surgery of choice for vasectomy reversal. However, if excessive inflammation or scarring has occurred in the epididymis, sperm may be blocked from getting to the vas deferens. If a blockage has occurred in the epididymis, merely connecting the two cut ends of the vas deferens will not solve the problem. To bypass the blockage in the epididymis, a vasoepididymostomy must be performed.

A vasoepididymostomy is performed by connecting the vas deferens directly to the epididymis as illustrated in Figure 2. One end of the vas deferens is stitched directly to the epididymis. .

 
 


Varicocele

Vasectomy

Vasectomy Reversal

Erectile Dysfunction

Penis Curvature

   
 

How is the procedure done?

The vasectomy reversal is usually carried out on an outpatient basis. Most surgeons prefer patients to be under general anesthesia because of the length of time required to perform the operation. A vasovasostomy usually takes 3 to 4 hours to complete depending on the complexity of the surgery. Initially a 2 to 3 cm incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are found and freed from the surrounding scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope. This is a crucial part of the operation because the information obtained is used to decide what type of microsurgical reconstruction needs to be performed.

Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm. There are 3 possible scenarios that may be encountered when examining the vasal fluid. The first and best scenario is that the vasal fluid contains whole sperm. The second possible finding is that the fluid is clear with water consistency, copious and contains only sperm parts or no sperm. When this occurs, even if sperm is absent from the vasal fluid, a vasovasostomy is performed. The third is that the fluid is thick, cheesy and contains no sperm. This last scenario usually means that a "blow out" or rupture has occurred in the epididymis. Sperm leak out if the pressure in the tubule becomes greater than the resistance in the wall of the tubule, similar to the way a pipe breaks in the basement when the water pressure gets too high. The body tries to heal this tubule and a scar forms. This causes a second blockage in the epididymis, which needs to be bypassed to allow the sperm to get out into the vas. If this second blockage is present and is not recognized then the operation is doomed to failure. A surgeon who has microsurgical expertise can then move from vasovasostomy to a more complicated vasoepididymostomy.

   
 

What to expect after the operation?

Vasectomy reversal is generally a safe procedure but there may be side effects to the operation. Localized swelling and bruising may be experienced after a vasectomy reversal, as with a vasectomy. Ice packs should be applied even after you have left the clinic to minimize the swelling. It may be necessary to take pain medication, which will be prescribed by the surgeon, for a few days following the vasectomy reversal.

It is possible to engage in sexual intercourse 4 weeks post surgery. Non strenuous work can be undertaken after approximately 3 days and physically demanding jobs after about 4 weeks. You can shower after two days but refrain from bathing or soaking the wounds for up to two weeks following the vasectomy reversal. The stitches should dissolve after 2 weeks.