Vasectomy Reversal Anatomy
The life cycle of a sperm starts in the testicle where sperm are created in an immature state. The epididymis is a whitish mass of tightly coiled tubes cupped against the testicles. It acts as a maturation and storage place for sperm before they pass into the vas deferens (vas). The vas is the transport tube that takes sperm from the scrotum around the bladder and into the prostate. It is in the prostate where the sperm mixes with prostatic secretions to become semen.
During a vasectomy the vas is obstructed while still in the scrotum. It may be clipped, cauterized, or sewn shut (or any combination of the three). A vasectomy reversal is intended to bypass this obstruction. It does not matter how the vasectomy was done. All are reversible.
During a vasectomy the vas is obstructed while still in the scrotum. It may be clipped, cauterized, or sewn shut (or any combination of the three). A vasectomy reversal is intended to bypass this obstruction. It does not matter how the vasectomy was done. All are reversible.
Vasovasostomy (VV) vs Vasoepididymostomy (VE)
Vasovasostomy and vasoepididymostomy are very different operations. A VV is a reconnection of the vas where it was cut and destroyed at the time of vasectomy. Most of the time, a VV is performed by lifting the vas tubes out of the scrotum through a small incision as occurred at the vasectomy. The vasectomy site is found, the ends of the vas are cut back to healthy tissue, and the ends are sutured together under the microscope.
A VE is a more complicated and difficult procedure. During a VE a larger incision is made in the scrotum. The vas is cut on the abdominal end to find healthy tissue, and then the testicle is dissected to find a tubule of the epididymis. This is much smaller than the vas. Under the microscope the tubule of the epididymis and the vas are stitched together. Since this tubule is very fragile and the size difference between the tubule and the vas are typically quite large, this is a weaker repair than a VV. The success rate of a bilateral VE is much lower than VV.
A VE is a more complicated and difficult procedure. During a VE a larger incision is made in the scrotum. The vas is cut on the abdominal end to find healthy tissue, and then the testicle is dissected to find a tubule of the epididymis. This is much smaller than the vas. Under the microscope the tubule of the epididymis and the vas are stitched together. Since this tubule is very fragile and the size difference between the tubule and the vas are typically quite large, this is a weaker repair than a VV. The success rate of a bilateral VE is much lower than VV.
The Vasovasostomy Procedure in detail:
The procedure starts with sterilizing the skin. The skin and the vas are numbed with lidocaine by a spray from the Madajet injector. After confirming the area to be operated on is numb, the vas deferens is examined through a small opening in the scrotum. The area of the vasectomy is determined, and a section of vas above and below the site of blockage is prepared to be re-joined. A sample of fluid from the testicle is put aside for evaluation under a table-top microscope. Under intense magnification of our operating microscope, these ends of the vas are re-united with a two layer closure of tiny sutures of 10-0 Nylon which are barely visible to the naked eye. Approximately 8-10 sutures are used on each repair while using a modified two layer technique. After confirming there is no tension on the new junction, the skin is closed with dissolvable stitches and the procedure is repeated on the other side.
Post-Operative Restrictions
- Call or text if you have any concerns. You may e-mail of course for less serious concerns.
- Take 600 mg Ibuprofen (Advil) every 4-6 hours for the first 24 hours. After that take as needed.
- You may take a shower after surgery.
- The outside stitches will dissolve in 7-10 days. If they fall out at any time, this is fine.
- A small amount of bleeding will occur for 36 to 48 hours after surgery. There is the possibility of very light bleeding from the wounds for 2 weeks. This is easily controlled with gauze in the underwear.
- There will be some swelling and bruising after surgery. Bruising typically extends up the shaft of the penis. This is normal.
- Infections are rare. If you have significant redness around the wound, fever, oozing of pus from the wound, or tenderness that worsens (especially 2-3 days after surgery), call us! We have never had a postoperative infection in our clinic.
- This repair is with very fine suture. To let the repaired vas heal, it is very important to limit activities which would traumatize the testicle. This includes exercise, heavy lifting (anything over 15 lbs). This should be restricted for three weeks. Sexual activity should be restricted for two weeks. The first day or two after the surgery should be spent resting. It is particularly important to limit your activity in the 36 hours immediately following surgery. If you have a job which requires limited physical activity, you may return to work within 4 days. If you have a job that requires activities which would put your reversal at risk, please ask for a note for work to limit you to light duty.
Risks of the Procedure:
Any surgical procedure carries with it some risks. Vasectomy reversal is no different. Possible complications include:
- Bruising: assured to happen, and it can be extensive but painless.
- Hematoma: a blood collection within the scrotum. This typically dissolves on it's own. Rarely it may need to be removed.
- Infection: despite sterile procedures during the surgery, infection is always a possibility. We use antibiotics during the surgery to limit this risk.
- Loss of testicle: due to infection, excessive bleeding. This is rare in the literature and never happened in our practice.