Professionally, vasectomy reversal is one of my favorite things to do as a surgeon. It is a great blend of art, architecture and biology.”
If you are ready to schedule a consultation for your vasectomy reversal, please request a consultation here.
The most common reason for vasectomy reversal is remarriage and a desire for more children. Other men in long-standing relationships have changed their minds and would like more children. There are occasional unfortunate individuals who have lost children and want to have more children. Although vasectomy has historically been considered a permanent procedure, current advances in microsurgery over the past 10 years have greatly improved the success rate of vasectomy reversal.
As a board-certified microsurgeon and accomplished vasectomy reversalist, Dr. Turek regularly sees both national and international patients for vasectomy reversal. He prefers to meet patients the day prior to surgery and perform a history and physical examination, answer questions and plan the next day’s procedure. Given that either a vasovasostomy or epididymovasostomy is possible, his goal for each patient is to do the “right” procedure and “do it only once” for a single packaged price.
In addition, he follows his patients after surgery regularly through a proprietary, web-based e-medicine program that allows each patient to report pain, swelling, send pictures and discuss any other concerns with Dr. Turek and his staff as often as they would like from their own computer during their recovery.
And as you make your decision about vasectomy reversal, keep in mind that the surgeon’s experience matters greatly. For example, one form of vasectomy reversal, the epididymovasostomy, is one of the most complex surgical procedures in all of microsurgery. Testing the limits of human hand-eye coordination, an epididymovasostomy involves connecting tubes that are less than 1/10th of a millimeter in size. For comparison, the trained human hand can control movements down to a distance of about 1/30th of a millimeter. In most other kinds of microsurgery, such as microvascular surgery, tubes (blood vessels) are generally 1-2 millimeters or larger in size, a full order of magnitude larger than that tackled with a vasectomy reversal epididymovasostomy. Among Dr. Turek’s vasectomy reversal cases, the average vasectomy age is 15 years and roughly 40% of cases involve the epididymo- vasostomy procedure. Please see our section on questions for a vasectomy reversal doctor and how to choose a vasectomy reversal doctor.
Decision Making During Vasectomy Reversal
Dr. Turek has undergone fellowship training in microsurgery and also has a history of teaching residents and fellows the vasectomy reversal procedure for 15 years. He is considered a master surgeon. Surgery for vasectomy reversal is performed in an ambulatory care facility on a come-and-go basis. A general anesthetic is most commonly used, as this offers Dr. Turek the least interruption by patient movement for this difficult, exacting microsurgery. A regional anesthetic such as a spinal or epidural block, can also be used. The patient returns home or to a hotel room after the vasectomy reversal procedure, but Dr. Turek requests that out-of-town patients stay in the San Francisco area for at least one day following the vasectomy reversal procedure before returning home. More details in our vasectomy reversal patient information.
The actual operating time for a vasectomy reversal procedure can range from 2-4 hours, depending on its complexity. About half of that time, Dr. Turek evaluates the vas deferens and epididymis to decide whether and where an epididymal obstruction exists, and the other half is spent reconnecting the system with microsurgery. After anesthesia and scrubbing the scrotum with soap and water, the vas deferens is exposed through a small 1-2 cm (one half-inch) incision in the upper scrotum on each side, just below the pubic hair. The vas deferens is gently placed into a grooved nerve clamp and cut sharply in half with a special blade under the microscope, both above and below the vasectomy site. A special bipolar microcautery is used to judiciously control any bleeding.
One end of the vas deferens, termed the abdominal end, is flushed with salt solution to ensure that the vas deferens is open from the scrotum to the prostate (a “saline vasogram”). The testicle end of the vas deferens is then inspected for fluid. This fluid is examined in the operating room under a second microscope for color, consistency and sperm. This information is used to decide whether or not a secondary epididymal obstruction is present (see Table).
If sperm are found at the testis end of the vas deferens, then it is assumed that an epididymal obstruction has not occurred and a vas deferens-to-vas deferens reconnection (vasovasostomy) is planned. If sperm are not found, then an epididymis to vas deferens connection (epididymovasostomy) is needed to restore sperm flow. Other, more subtle findings that can be observed in the fluid—including sperm fragments and clear, good quality fluid without any sperm—require keen surgical decision-making to successfully treat. This again emphasizes the strong role that surgical experience plays in the success of vasectomy reversal procedures.
Read Dr. Turek’s published research paper on: Does the Need for Epididymovasostomy Relate to the Patient Age at the Time of Vasectomy?
Table 1. Testis Vasal Fluid Findings During Vasectomy Reversal and Optimal Procedure
|Grade||Vasal Fluid Findings||Procedure Suggested|
|1||Normal appearing sperm with motility||Vasovasostomy|
|2||Mostly normal appearing, nonmotile||Vasovasostomy|
|3||Mostly sperms heads without tails, nonmotile||Vasovasostomy|
|4||Only sperm heads||Vasovasostomy|
|5||No sperm, creamy fluid||Epididymovasostomy|
|Clear fluid, no sperm||It depends!|
Vasovasostomy and Epididymovasostomy
For vasovasostomy, two microsurgical approaches are possible and Dr. Turek has extensive experience with both procedures. Neither vasovasostomy procedure has proven superior to the other. What is most important for success, however, is that the surgeon use high-power optical magnification to perform the vasovasostomy, as success rates are significantly higher with an operating microscope. One approach is the modified 1-layer vasovasostomy and the other is a formal, two-layer vasovasostomy. More details about vasovasostomy…
For a vasectomy reversal procedure termed epididymovasostomy, there are also two microsurgical approaches commonly employed; Dr. Turek is experienced with both. Again, neither procedure has proven superior to the other, although Dr. Turek certainly has a preference for epididymovasostomy surgery. More details about epididymovastostomy…