Vasectomy Reversal USA

The ultimate success of a reconstructive procedure is dependent on several factors. Here we consider the two main procedures of male vas deferens reconnection procedures.

Vasovasectomy (Vasectomy Reversal)

Vasovasectomy involves a straightforward surgical reversal of a previous vasectomy with the goal of producing sperm in the ejaculate. The procedure is ordinarily performed in an effort to produce sperm sufficient in number to achieve pregnancy. However, other reasons for doing the procedure include chronic pain following the vasectomy, as well as fears regarding change in cardiac status or possible malignancy associated with vasectomy. The procedure involves identification of the vas deferens, usually done through a single, midline scrotal incision under general or local anesthesia. The procedure involves transection of the sperm duct (or vas deferens) on the testicular ends of the vas deferens and prostatic ends of the vas deferens, as well as dilation of the internal opening or the center of the vas deferens, on the prostate side. Ordinarily, the testicular ends of the vas deferens are dilated sufficiently so that no special procedures are necessary on this end. The ends are sutured using microscopic enhancement, usually in two layers involving the mucus membrane or mucosal lining of the vas deferens. The second layer involves the outer covering (serosa) and the muscular layers of the vas deferens. The sutures used for the procedure are usually of a permanent variety such as Proline, with the size range from 7.0 to 9.0. Proline is a very small suture and has to be handled with microsurgical instruments. After placement of the sutures, the wound is closed and the patient is sent home.

If the individual has had an uncomplicated vasectomy, and if that vasectomy was performed within six years of the time of vasectomy reversal, an approximate 90% sperm productivity rate is achieved. If the vasectomy is once again uneventful and if the reversal takes place at ten years post vasectomy, the sperm productive rate is approximately 50%. At fifteen years, under similar circumstances, the sperm productive rate drops to 2%. Pregnancy rates are not related to sperm production. Often a new partner is involved in the equation and a pregnancy may not have been achieved at any point in that individual's life. On the other hand, sperm present in the ejaculate may appear perfectly healthy, and there is no change in the marital relationship but pregnancy may not occur - which makes it difficult to give pregnancy rates. A general rule, however, if sperm are present, the pregnancy rate is about 55%.

Epididymovasostomy

It is important to realize that the longer the interval of vasectomy, the more likely that a more complex reconstruction may be necessary. This more complex operation is called an epididymovasostomy (EV). At the time of the surgery, it may be determined that this procedure will be necessary, based on the quality of the fluid obtained from the vas deferens tube. The epididymovasostomy connects the vas to the very small tubes of the epididymis. The epididymis is a structure situated behind the testicle that contains very small caliber tubes, which is the first part of the male reproductive duct system. The success rate for epididymovasostomy is lower than for the standard vasectomy reversal (vasovasostomy or VV). Overall success rate for this procedure is about 40 to 60 percent that sperm will be present in the semen, and 25 to 40 percent change in terms of pregnancy.

Postoperative period

We request that support underwear be worn in the postoperative phase, ice bags be maintained for at least forty-eight hours, and that the patient essentially remains at home rest for at least four days. Early attempts at ejaculation are recommended beginning on about the fourth day and, if possible, unprotected intercourse at that time. The patient usually is prescribed an antibiotic for five days postoperatively, and it is recommended that he use Nolvadex twice a day for at least three months in an effort to stimulate sperm production.