The purpose of this document is to provided a synopsis of the latest techniques used in vasectomy and reversal. British Journal of Medical and Surgical Urology. Users online: Current Issue. Ahead of print. Editorial Board. Year : Volume : 27 Issue : 1 Page : Vasectomy and vasectomy reversal: An update.
Indian J Urol ; Indian J Urol [serial online] [cited Nov 13]; Surgical Technique. Preparation and Antimicrobial Prophylaxis. Figure 1: Atraumatic vasectomy technique demonstrating vas isolation and lidocaine injection.
Courtesy of the Brady Urology Foundation Click here to view. Vasal Access. Figure 2: Use of ring clamp to facilitate vasal fixation.
Vasal Occlusion. Figure 3: Vasal occlusion with thermal cautery and clips. Postvasectomy Follow-Up. Vasectomy Reversal. Table 1: Factors affecting the success of vasectomy reversal Click here to view. The final 3 sutures have been placed and are ready to be tied. Reproduced with permission from Goldstein M.
Surgical management of male infertility and other scrotal disorders. In: Walsh PC, editors. Campbell's Urology. Philadelphia: WB Saunders; Figure 5: Microsurgical end-to-side 2-suture intussusception vasoepididymostomy. Once the tubule is incised, the sutures are pulled through bottom inset.
The double-arm needles are placed in-to-out through the vasal lumen. The suture points are labeled to indicate where they run a1 to a1, etc. The suture points at the completed anastomosis are indicated by a1, a2, b1, and b2.
Outcomes for vasovasostomy performed when only sperm parts are present in the vasal fluid. J Androl ; Vij says. You can go back to work in a day or two, if you have a desk job. Or in three or four days if you have a more strenuous job. This is a surprise to many men, Dr. But after a vasectomy, your testicles continue to produce sperm. It just no longer has a way out of the body. Because of this, your normal fertility is restored by a reversal.
They start to decline when a man has had his vasectomy 15 years ago. There are several factors that will contribute to pregnancy chances even after a successful reversal.
People who are thinking about undergoing vasectomy reversal may need to pay out of pocket, Dr. The health of your partner and her fertility also must be taken into consideration, Dr.
However, these antibodies rarely prevent the sperm from fertilizing the egg. Therefore, we counsel patients that it is usually unnecessary to routinely test for antibodies, as they rarely will have a bad effect upon the success rate. There was a report several years ago stating that men with vasectomies had a higher rate of prostate cancer. This report has since been challenged and, for the most part, disproven. There is also no evidence to show that reversal of the vasectomy would have any effect upon risk of cancer.
There is no maximum number of times that a man can have a reversal, although the success rate may decrease with increased number of reversals.
The more surgery is performed, the greater the likelihood of scarring in the scrotum, making subsequent surgeries more difficult.
If the surgeon is experienced in doing vasectomy reversals, they should be able to find the blockage, which is likely to be in the epididymis, and perform the bypass above that point. However, if the surgeon is not able to perform this bypass, then the best thing to do is reattach to two ends of the vas and hope for the best.
That is why it is important that prior to surgery, the patient question the surgeon regarding their experience in vasectomy reversals to determine if they would be able to perform both types of reconstruction.
Scarring can occur at any time after a vasectomy reversal although it typically occurs within the first six months. Therefore, even if there was sperm in the ejaculate after six weeks, it is possible that scarring could occur later on. We typically offer sperm banking in case late scarring does occur.
It is important to choose a surgeon who performs reversals on a regular basis, preferably someone with fellowship training or other special training in male infertility. Patients should ask the surgeon how often they perform the procedure, what their own personal success rate is, both in obtaining sperm and pregnancy rates, and if they have the ability to perform both types of reversals. The sperm quality should return to normal 3 to 6 months following a reversal as it takes that long for the testicles to make new sperm.
However, the count and the motility may be lower after reversal due to partial blockage or scarring. We typically recommend checking every 3 months, and we offer sperm banking based upon the quality of the sample. The chance of scarring is approximately 7 to 10 percent in the first 1 to 2 years following a successful reversal. The incidence of male infertility is not well known, however, approximately 15 percent of U.
Therefore, in any couple that is having fertility problems, there is a 50 percent chance that the male may be involved and therefore he should be evaluated. Vasectomy reversals do not always work and in someone who is both young and never fathered children, it is probably not a good idea. We would counsel this patient to reconsider having a vasectomy. Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children. There are no special preparations in terms of abstaining from ejaculation prior to either the vasectomy or the reversal.
The patient should be aware that a vasectomy reversal is a more expensive procedure than the original vasectomy and likely will take longer to recover.
Most men will recover from a vasectomy in a couple of days. We typically recommend taking it easy for 2 days, using ice packs and scrotal support, and then going back to work 2 or 3 days later.
However, vasectomy reversals tend to take longer, depending on the type of work that the patient does. While some men can return to a desk job in 3 or 4 days, we recommend that heavy construction and lifting should be avoided for 4 weeks after a vasectomy reversal.
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