Vasectomy Reversal Introduction: Approximately 500,000 men request vasectomies each year and it is recognized that 5% of them will change their minds, usually due to remarriage, death of a child or improved circumstances allowing for more children. Over the past 20 years, the surgical technique of vasovasostomy has provided excellent results in permitting men to re-establish their fertility. The surgery is performed on an outpatient basis with over 99% success for those men who have sperm at the time of surgery.      For those couples experiencing infertility due to a man's vasectomy, there are the alternatives of T.D.I. (therapeutic donor insemination) or IVF/ICSI (in-vitro fertilization with intra-cytoplasmic sperm injection), but restoration of a man's fertility by reconnecting the vasa at the site of the previous vasectomy appears to provide couples with the most optimal and least expensive option for building a family.

How is Vasectomy Reversal Performed: With the patient under local or general anesthesia, a 1-2 inch 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.  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, most common, and best scenario is that the vasal fluid will contain whole sperm. The second possible finding is that the fluid is thin and contains only sperm parts or no sperm. The third is that the fluid is thick, pasty and contains no sperm. The consistency is something like toothpaste.  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 will need 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 usually not going to be successful.    Micro-Surgical Vasovasostomy:  If the vasal fluid contains sperm then the two ends of the vas deferens may be sewn together. This procedure is known as a vasovasostomy. The associated pictures were taken through the operating microscope during a vasovasostomy . An artist drawing is depicted to the right for illustration purposes. The lumen or channel inside the vas deferens through which the sperm swim is only 0.2 millimeters in diameter (about the size of a pen dot or a thick hair). An operating microscope is used to magnify the operating field, but it depends on the microscope used. The vas can then be better visualized and the sutures can be precisely placed. Without the use of the microscope this operation would be very difficult, if not impossible to perform successfully or with the same precision. All studies have demonstrated that microsurgical vasectomy reversal is more successful than those procedures performed without the microscope or with loupes (magnifying glasses worn by the surgeon).      The technique we prefer is a two layer closure using 10-0 and 9-0 suture which is difficult to even see without magnification. Sutures are placed on the inside as well as the outside layer (figure 2).  The outer layer of the vas is then reinforced with additional sutures to add strength to the repair and return the anatomy of the vas to its original appearance (figure 3). The surrounding connective tissue is also brought together as a third layer to take any tension off of the repair site. The skin incision is then closed.   Photographs taken though the operating microscope during a vasectomy reversal: The back side of the vas is sewn together with 10-0 size suture seen connecting the inner layer posteriorly. The diameter of the inside channel is usually about 0.2 millimeters.   All the inside sutures have been placed. The inner layer sutures have been tied and a micro needle is seen going though the muscular layer of the vas deferens. The second layer adds strength to the repair.   The outer layer is closed over the inner layer. The picture shows the completed vasovasostomy.

        

Microsurgical Vasoepididymostomy: If it appears that there has been an epididymal blowout and a second blockage must be bypassed, then a vasoepididymostomy may be chosen.  To do this, the epididymis is closely examined and a tubule is opened and the fluid checked for the presence of sperm. If sperm are found, the vas can be sewn to the open epididymal tubule (pictures above). This is called a vasoepididymostomy.  The vas is sewn to the epididymis, bypassing the first portion of the vasa.  A vasoepididymostomy is a technically more difficult procedure to perform than a vasovasostomy because the epididymal tubules are very thin and delicate. Understandably, the  results of vasoepididymostomy are not as good as with vasovasostomy.

The vas deferens (stained blue) is brought into close proximity to the epididymal tubles in preparation for the connection.
Sutures have been placed through an epididymal tubule and an opening has been cut to allow the sperm to pass though.
The epididymal tubule has been connected to the vas and sutures have been tied.
The outer layer of the vas is closed over the outer covering of the epididymis to add strength to the surgical repair. The finished connection is seen in the drawing.

Re-do Vasectomy Reversals: Vasectomy reversals typically fail either because of scarring at the surgery site, imprecise suture placement or because a blockage in the epididymis was present and not recognized. Just because a vasectomy reversal has failed does not mean all hope is lost. Re-doing the surgery using meticulous and proper technique can produce success in more than 80% of cases. Dr. Daniel performs no more than 2 vasectomy reversals per day. Many patients travel great distances for this procedure and our staff will help you with accommodations.  We have a discounted arrangement with some of the local hotels for both regular rooms and suites.  The initial evaluation can be performed a day prior to the procedure and the patient may return home one day after the procedure minimizing the stay in NC to 3 days.     We offer patients every possible option and combination of treatments so you may choose what is best for you.  For more information on vasectomy reversals, or to speak with Dr. Daniel. Please go to our contact page to contact Michael P Daniel MD ( Contact Us )

       We Specialize in affordable Vasectomy Reversal Procedures. This type procedure may be done in the hospital or in our office.

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