What is it?

Vasovasostomy is a minor surgical technique used to reverse sterility for men who have had a vasectomy and wish to become fertile again and conceive.  Unlike a vasectomy, this delicate microsurgery consists of establishing patency of the vas deferens by reconnecting the tubes that were occluded during vasectomy that will once again allow passage of the sperm cells from the testicles into the semen.  Even with a positive result, pregnancy is not guaranteed.

Many factors will influence the final outcome, the main one being the time elapsed between the vasectomy and the vasovasostomy. There are other options to this procedure, like direct retrieval of sperm cells for the testicles, insemination with donor sperm, or even adoption, but vasovasostomy remains the procedure of choice for procreation after vasectomy.  These can all be discussed prior with your urologist.

How is the surgery performed?

The procedure is performed under sterile conditions to prevent infection after the intervention.  You will be awake and conscious during the surgery.  After being positioned on your back, a local antiseptic and sterile drape will be applied to the genital area.  Unlike a vasectomy, local anesthesia of the entire spermatic cord on either side is necessary. A spermatic cord block is performed by injecting an anesthetic agent in the inguinal area under ultrasound guidance which might cause mild burning that lasts for a few seconds.  The skin on the side of the scrotum is then locally infiltrated with a local anesthetic and a small incision (generally longer than that performed for vasectomy) is made.  Once the area is frozen and numb, you will no longer experience pain but will still feel the urologist touching you.

During this complex intervention performed with a microscope, both ends of the tube are then identified and connected together with microscopic sutures and the incision closed. Although very rare, it is sometimes impossible to join the ends together.  Rapidly resorbable stitches will be used to close the small incision and a transparent liquid bandage applied over them.  The same procedure is applied to either side. The stitches will start to go away in 7 to 10 days. The surgery usually takes between sixty to ninety minutes to complete and there is generally no need for any recovery period at the office. Wearing tight underwear after will help in reducing discomfort. You will be able to leave the office quickly by your own means.  Although you may wish to be accompanied it is not obligatory.  You may take a shower 24hrs after.

Is it painful?

The effect of the local anesthetic will last a few hours, and once normal sensation returns, the pain will vary from one patient to the other.  Pain is often minimal and will often be proportional to the degree of swelling; therefore, application of ice to the scrotum for about 10-20 minutes at a time 5-6 times per day for 1-2 days is highly recommended to limit swelling, which in turn will limit pain and speed up recovery. Extra-strength Tylenol or a mild narcotic prescribed by your urologist is usually sufficient to control pain which usually greatly subsides over the course of 1 to 3 days.

What do I need to do before the intervention?

There is no special preparation necessary prior to the procedure. Fasting is not necessary.  Shaving of the genital area6 is optional. You should make yourself available for 2 hours at the clinic. You may want to be accompanied but this is not absolutely necessary. Please arrive on time for your appointment. Any anticoagulants (blood thinners) should be discontinued prior to the surgery as per your urologist’s recommendations and any allergies noted. Written consent is mandatory.

What are the risks of a vasectomy reversal?

Although complications are possible, these are generally rare, mild and self-limiting. Short-term possible complications include infection, bruising and bleeding into the scrotum resulting in a collection of blood known as a hematoma. Certain men experience persistent pain upto a few months which usually disappears with time without any specific treatment but may persist in very rare cases. Obstruction of the surgical connections is possible and can lead to absence of sperm cells in the semen. Note that a vasectomy does not alter sexual function and there is no need to think that it may cause other health problems.

After the procedure:

It is best to avoid any intense physical activity, lifting heavy objects, or sports during the first week which could cause bleeding or swelling. You should avoid sexual activity for three weeks to allow for adequate healing of the tubes to occur.  Return of sperm cells in the semen can occur almost immediately in some cases but can be much longer in others. Optimal semen parameters may take up to 12-24 months to be achieved and a first semen analysis will be performed approximately three months after the surgery to verify the quality of the sperm.

Note that even if sperm cells are present within the sperm, this does not guarantee a pregnancy.

Many couples have been able to achieve pregnancy after a vasovasostomy, even after more than 10 years after the vasectomy.



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