In order to regain your reproductive potential, a vasectomy reversal is required to be performed by skilled specialists having extensive experience with these types of surgical procedures. At Cedars-Sinai Marina del Rey Hospital you will find the most dedicated medical staff able to help you achieve the results you desire.
Although most men undergo a vasectomy as it is considered a permanent method of sterilization, approximately 2-6% of them seek vasectomy reversal.
Vasectomy reversal is a surgical procedure in which the cut ends of the vas deferens are reconnected. This allows sperm to flow into the semen. In few cases, the ends of the vas deferens are attached to the epididymis. This surgery is done using a special microscope (microsurgery). The rate of success of vasectomy reversal ranges between 40-90%.
The most common reason to decide a reversal of the previous vasectomy is to regain the reproductive potential in men desiring to be fertile again. A less common indication is as a treatment for testicular pain linked to a vasectomy or post-vasectomy pain syndrome.
Vasectomy reversal is generally done as an outpatient procedure, and you can return home on the day of your surgery.
The surgery is done under general anesthesia, and a microsurgical technique is used. During the surgery, a high-powered surgical microscope is used to magnify the tiny vas deferens 5 to 40 times their actual size.
The surgeon makes a small incision on each side of the scrotum. The vasectomy site is delivered through this incision, and the operating microscope is placed in such a way that both the surgeon and the assistant can visualize the operative field. Then, the trimming of the scarred ends of the vas deferens is done. The surgeon then identifies the testicular end of the vas and withdraws the vasal fluid into a glass capillary tube. This fluid is subjected to microscopic examination to check for the presence of sperm. At this stage, the surgeon decides on the type of reversal procedure to be performed.
When the vasal fluid contains sperm, it means the passageway between the testis and the cut end of the vas deferens is clear, and the severed ends of the vas can be reconnected. This procedure is called vasovasostomy.
When there is no sign of sperm or its components in the vasal fluid, there may be scar tissue blocking the flow of the sperm, therefore, the testicular portion of the vas is cut back further or a procedure called vasoepididymostomy is considered. If the back pressure from the vasectomy has caused a kind of "blowout" in the epididymal tube, which has eventually led to the block, then the surgeon goes around the block and connects the upper end of the vas to the epididymis, an organ that stores sperm. This procedure is called vasoepididymostomy.
The surgeon utilizes thin sutures to rejoin the ends of the vas. Once the reversal is complete, the vas is returned through the incision back to the scrotum. The scrotal incision is then closed with an absorbable suture. A sterile gauze dressing is placed over the incision, which is held in place with a scrotal support garment.
Vasectomy reversal rarely involves any risks. As with any surgical procedure, there may be potential complications that include:
- Bleeding: It is the most common complication and may lead to a hematoma (collection of blood). Hematomas are generally small, do not require surgical drainage, and resolve within 6-12 weeks.
- Infection at the site of surgery: Rarely occurs, may be treated with antibiotics.
- Postoperative reobstruction: It may occur due to scar formation at the site of repair. The incidence of postoperative reobstruction is between 3-12% after vasovasostomy and approximately 21% after vasoepididymostomy.
After a vasectomy reversal, healing occurs quickly, and to manage pain after surgery, you will be prescribed pain medications for a week. Most men can return to routine activities and a light amount of work within 1 week. If you perform strenuous activities at the workplace, you may need more time to return to the job.
Testing the sperm count is the only method to measure the success rate of vasectomy reversal. Your urologist tests your semen every 3 months until your sperm counts become steady. Often, sperm appears in the semen within a few months after a vasovasostomy, but it may take at least 3 to 15 months after a vasoepididymostomy procedure.
Your surgeon may give you certain advice to be followed, which include:
- Avoid activities such as jogging, sports, biking, lifting heavy objects for at least 2-4 weeks after surgery.
- For the initial 2 days following surgery, keep the surgery site dry, avoid bathing or swimming.
- Wear an athletic supporter at all times for a few weeks, except while bathing. Then, you can continue wearing it during exercise.
- Refrain from sexual intercourse for 2-3 weeks following surgery.