Vasectomy Reversal



Although vasectomy should be considered an irreversible procedure, this is not technically true. Changing social circumstances may lead to a new desire for fertility. If a man has had a vasectomy in the past, the tubes may be reconnected by bypassing the scarred area that is associated with the previous vasectomy. This is done as an outpatient surgery, usually under general anesthesia.

There are various methods for doing a vasectomy reversal, and your surgeon will discuss the differences in each technique. Typically, insurance does not cover vasectomy reversal; the cost depends on location but is typically around $8,000 for everything, including consultation, surgery, and anesthesia.

Advantages:

Much less expensive than in vitro fertilization (IVF) or most reproductive technologies

Multiple pregnancies are possible after vasectomy reversal, unlike other reproductive technologies (in which each cycle is designed to result in one pregnancy and birth)

Disdvantages:

No sperm or sperm in low numbers, even if the vas is reconnected; this can be because of scarring, chronic congestion or the development of anti-sperm antibodies. If the vasectomy reversal fails, the patient will likely have to go on to IVF or an alternative reproductive technology.

Technical success of the operation or patency (defined as the presence of sperm in semen postoperatively) is dependent on surgical technique and skill of the operating microsurgeon, time interval since vasectomy, quality and nature of vasal fluid, and presence of epididymal obstruction.

Vasectomy Reversal Procedures

Two procedures are generally used for reverse vasectomies:

1. Vasovasostomy

Vasovasostomy is the most common technique for vasectomy reversal. During this three-hour procedure, the cut ends of the vas deferens are sewn back together using a high power surgical operating microscope and sutures finer than a human hair (9-0 and 10-0 sutures). These sutures are so small that they cannot be seen well with the naked eye. We use an operating microscope at 30-40X to ensure that the operation is done well and the tissue is handled meticulously. We perform both one- and two-layered anastomoses (reconnection of the previously severed tubes) as the existing data do not demonstrate the superiority of one procedure over the other.

This procedure involves dissection of the vas deferens, identification of the obstructed segment from the vasectomy, incisions to cut the vas deferens above and below this blockage, and then the placement of six to ten very fine sutures to reconstruct an intact tube. Prior to placing any of the sutures we examine the fluid coming from the testicular end of the vas under the microscope. We only perform this procedure if fluid is still present in the vas deferens at the time of surgery; if no fluid is present, we perform an epididymovasostomy.

2. Epididymovasostomy

Epididymovasostomy is a more complex version of the vasovasostomy. This procedure is chosen if the blockage of sperm is at the level of the epididymis. This procedure is one of the most complex microsurgical procedures performed. We typically use the intussusception technique, which was developed by Dr. Richard Berger, one of Dr. Hotaling’s mentors at the the University of Washington. This technique involves placing two or three 10-0 sutures in the distended epididymal tubule and then connecting them to the vas deferens before opening the tubule. This makes the procedure significantly easier as the surgeon can place the sutures in the enlarged distended tubule rather than the open deflated tubule. Once all the sutures are placed, the tubule is opened with a microsurgical knife and the sutures are sequentially tied down.

To know more please contact :

Dr. Gautam Banga

MBBS,MS,M.Ch (Urology)
Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
Contact no. : 91- 9886624303 | +91-9999062316
Email:- info@urethraandpenilesurgery.com