Vas Doctor

Vasectomy Reversals

Vasectomy Reversal is a surgical procedure that restores the flow of the sperm through the Vas deferens. It is performed by a Micro surgeon using an operating Microscope and specialized microsurgical instruments.

There are two types of Vasectomy Reversal: Vasovasostomy and Vasoepididyostomy.

We specialise in re-do operations (Failed reversal operations attempted by others) and Vasoepididyostomy.

Why do men want Vasectomy Reversal?

The main reason is a desire to have child after remarriage. A small percentage of men seek a vasectomy reversal for scrotal or testicular pain.

Vasectomy Reversal

The procedure is performed with Zeiss OPMI electronic surgical microscope.

Usually one small incision is made in the front of the scrotum but sometimes two are required depending on the position of the vas. The stumps of the Vas deferens are trimmed and shaped by using micro-scalpels. Once it is certain that the tissue is healthy, each Vas is reconnected in 3 layers using micro-sutures.

The Distal Vas is cumulated and flushed with normal saline to rule out any obstruction. The fluid from the proximal vas is aspirated and examined under a table top microscope. Grading of the sperm is carried out and this most important predictor of the success. If there is no sperm in the aspirate indicating blockage of the epididymal tubules the vasoepididiostomy is performed.

The background testicular function (the ability of the testes to produce good quality sperm in sufficient numbers) and the blockage of the epididimal tubules are the two main predictors for the success of the operation. Other contributory factors are: the number of the years since vasectomy; infection after the vasectomy; use of diathermy at the time of the original vasectomy which destroys the lumen of the long segment of the vas, or a large segment of the vas having been removed at the original vasectomy.

Vasovasostomy: (joining the two ends of the vas) we carry out a three layer anastomoses (Joining). The most inner layer of the vas (mucosa) is joined together with 10/0 nylon by 6 or 7 interrupted sutures (shown in the pictures).
The middle (muscular) layer is joined together with 9/0 nylon by 6-8 interrupted sutures. The outer (adventitial) layer is joined together to cover the anastomoses by 3-4 9/0 or 8/0 sutures. Testicular tunica is fixed to the fascia around the vas with 3/0 nylon by 3or 4 interrupted sutures. It covers and protects the anastomoses and also prevents any tension on it.

Vasoepididostomy: (Joining the vas to epididymis) Once the epididimal tubules have been opened and flow of the sperm identified and examined under the table top microscope the innermost layer of the vas(mucosa) is joined to peritubular tissue of the epididymis with 10/0 nylon by 3 interrupted sutures. The muscular layer of the vas is joined to tunica of the epididymis with 9/0 nylon by 5 interrupted sutures to make it a water tight junction. Testicular tunica is again anchored to the fascia around the vas to cover and protect the anastomoses

Grade of the sperm and blockage of the epididimal tubule requiring vasoepididostomy are two main predictors of the success and these findings are explained to the patient before leaving the clinic.

Success Rates Associated With Vasectomy Reversal

Results of recent studies indicate that following microsurgical vasovasostomy, sperm in the semen appears in approximately 85-97% of men. Approximately 50% of couples subsequently achieve pregnancy.

The modern microsurgical technique for the reversal of a vasectomy has greatly improved the outcome of the procedure. The chance of success also depends on the length of time from the original vasectomy to the reversal procedure as the table here shows;

Years between vasectomy
& reversal 		Sperm return Pregnancy rate
<3 years 97% 76%
3-8 years 88% 53%
9-14 years 79% 44%
>15 years 71% 30%

Anaesthesia

The vasectomy reversal operation is carried out under sedation and a local anaesthetic. An experienced anaesthetist is present during the operation.

Pre-operative advice

The outcome of the operation depends on the original vasectomy operation and the way in which it was performed. This is why a counseling session and examination is undertaken prior to the commencement of the operation.

This is normally done immediately prior to the operation but a patient living locally can elect to have this consultation then agree an appointment for surgery at a later date. Out of town patients are advised to ensure that accommodation is arranged for one overnight stay following the operation.

The night before the operation shave the scrotal and pubic hair and shower with an antibacterial soap. The patient is advised not to have breakfast on the morning of the operation. Advice about the pre-operative medication will be given at the time of booking the operation.

It is a legal obligation for someone to stay with you for 6-8 hours after your operation, if this is a problem we can arrange for someone to stay with you but this would need prior notice & endure extra costs.

Post-operative advice

Complications

The most common occurrence is bleeding from the edges of the scrotal incision but this is only slight and normally stops within twelve hours.

Occasionally bruising of the scrotum develops but usually settles down within two weeks.

Haematoma formation is rare.

Infection may occur to the wound a few days after the surgery and is recognisable due to the pain becoming worse rather than lessening and an inflammation of the scrotum.

If these or other problems occur we would recommend that you telephone the clinic for advice if your own GP or local clinic are unable to assist.

You will be asked to provide a semen sample for analysis 6-8 weeks after the operation. Sometimes the appearance of the spermatozoa in the semen could be delayed up to 6 months. Semen analysis can be carried out at a Path lab in your home vicinity.