Vasectomy and Vasovasostomy - Surgery

(Page 2)

Vasovasostomy. Vasovasostomy uses several different surgical approaches. Usually a microsurgical technique is used, in which a microscope helps magnify the surgical area. Vasovasostomy takes 2 - 3 hours to perform. The patient is given local anesthesia and a mild sedative.

Vasoepididymostomy. Vasoepididymostomy is a more complex microsurgical technique. To appreciate the difficulty of this operation, one should realize that the epididymis is 1/300th of an inch wide with a wall thickness of 1/1000th of an inch. Microscopic techniques are critical for the success of this procedure and require a surgeon who specializes in them. Vasoepididymostomy takes up to 4 hours to perform. The patient is given either general anesthesia or an epidural block.

---

---

Recovery and Follow-Up

Pain after reversal surgery is usually not severe and can be controlled with mild analgesics such as acetaminophen (Tylenol). A cold pack placed on the scrotum area can help relieve swelling. Your doctor may recommend that you wear a jockstrap for a few weeks to help provide compression and to keep the surgical incisions in place. Most patients can return to work and resume normal non-strenuous activities within a week, but patients may need to refrain from heavy lifting and other rigorous physical activities for up to 4 weeks following surgery. Patients should wait 2 - 4 weeks before having sex.

The doctor will perform a semen analysis every 2 - 3 months after reversal surgery to check your sperm count. It generally takes about 2 months for sperm to reappear following vasovasostomy, and about 3 - 15 months following vasoepididymostomy. Either a stabilized sperm count, or pregnancy, indicates successful reversal surgery.

If reversal surgery is not successful, a repeat surgery can be performed. However, the success rates for repeat reversals are lower than for an initial reversal.

Pregnancy Results after Reversal Surgery

Vasectomy reversal restores sperm production in about 80 - 90% of men. On average, about 50% of couples achieve a pregnancy within 1 - 2 years after reversal surgery. Microsurgical techniques appear to help produce higher quality grade of sperm and better pregnancy rates than macrosurgical techniques. Several other factors determine the likelihood of a successful outcome. The experience of the surgeon is one critical factor. The time interval between the original vasectomy and the reversal procedure is another important factor. The shorter the time between vasectomy and reversal, the better the chances for fertility recovery.

Sperm removed during vasovasostomy can be frozen and used for assisted reproductive technologies in case of unsuccessful reversal surgery. If reversal surgery is not successful, a doctor may also be able to retrieve sperm from the testes or epididymis using various sperm retrieval techniques such as testicular fine needle aspiration, microsurgical epididymal sperm aspiration, percutaneous epididymal sperm aspiration, or testicular sperm extraction. [For more information, see In-Depth Report #67: Infertility in men.]