Vasectomy and Vasovasostomy - Surgery

Reversal Surgery (Vasovasostomy and Vasoepididymostomy)

Although men should consider vasectomy a permanent decision, reversal procedures can restore fertility in some men who change their minds. The main reasons for requesting a vasectomy reversal are remarriage or the death of a child.

Vasectomy reversal can also sometimes provide pain relief for some of the small number of men who suffer post-vasectomy pain, but these patients should first be treated with pain management therapies. For men who desire a vasectomy reversal for psychological reasons, counseling is a better option.

Vasovasostomy Reversal Surgery Procedures

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There are two types of vasectomy reversal surgical procedures:

• Vasovasostomy. The severed ends of the vas deferens are sewn back together.
• Vasoepididymostomy. The vas deferens is surgically reattached directly to the epididymis. This procedure is more difficult to perform and is used when vasovasostomy cannot be performed or does not work.

These procedures help restore sperm flow so that sperm can be ejaculated out of the urethra. Both types of procedures are performed on an outpatient basis and the patient can return home the same day.

It is not possible to know in advance which procedure will be performed. The surgeon will make the decision whether to use vasovasostomy or vasoepididymostomy based on a fluid sample taken at the start of the operation. The fluid is removed from the vas end closest to the testicle and examined for its appearance and the presence of sperm.

If sperm are present or the fluid is clear, it indicates that there is no blockage in the epididymis, and a vasovasostomy can be performed. No sperm, or a creamy, thick appearance of fluid, is a sign of blockage, and the vasoepididymostomy surgical approach to bypass the blockage should be used. Other factors may also determine the surgeon's choice of reversal surgical procedure. In some cases, a combination of the two surgeries may be used, with vasovasostomy performed on one side and vasoepididymostomy on the other side.