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To better understand what makes vasectomy reversals challenging, a quick review of anatomy and physiology is helpful. Sperm are produced in the male sex gland or testicle. From here they exit the testes (efferent ductules) and enter a “storage site” or epididymis. The epididymis is essentially a single, 18 foot long, tightly coiled, small tube, within which sperm mature so that they can move, swim and fertilize eggs. Testicular sperm are not able to fertilize eggs naturally (but can if they are injected directly into the egg in the laboratory), as this is learned in the epididymis. From the epididymis, a 14 inch muscular tube called the vas deferens carries the sperm to the urethra near the base of the penis. The urethra then carries the sperm through the penis during ejaculation. A vasectomy interrupts sperm flow within the vas deferens. After a vasectomy, the testes still make sperm, but because the exit is blocked, the sperm die and are reabsorbed by the body.
One issue that makes a vasectomy reversal challenging is that a problem can develop in the delicate tubes of epididymis over time after vasectomy. The longer the time since vasectomy, the greater the “back-pressure” behind the vasectomy. This “back-pressure” may cause a “blowout” in the delicate epididymal tubule, the weakest point in the system. The blowout may or may not cause symptoms, but will likely scar off the epididymal tubule, thus blocking sperm flow at a second point. To summarize, a man with a vasectomy can develop a second obstruction deeper in the reproductive tract that can make the vasectomy more challenging to reverse. Having the skill to detect and fix this difficult problem during vasectomy reversal is the essence of a great urologic microsurgeon. In Dr. Turek’s practice, 40% of men seeking vasectomy reversal have this obstruction and 25% of his cases are patients who are previous vasectomy reversal failures by other surgeons. Dr. Turek is also comfortable tackling the technically challenging cases of traumatic, infectious or congenital blockages that require microsurgery.
If the surgeon simply reconnects the vas deferens without examining for a second, deeper obstruction, then the vasectomy reversal procedure can fail, as sperm will not be able to flow out of the “corrected” system. With epididymal obstruction, the vas deferens must be connected to the epididymis in front of the this blockage, to bypass both blockages and allow the sperm to reenter the urethra and ejaculate. Since the epididymal tubule is much smaller (0.3 mm diameter) than the vas deferens (3mm diameter, 10 fold larger), epididymal surgery is far more complicated, challenging and precise than the simple vas-to-vas connection and should only be undertaken by an experienced, skilled microsurgeon who performs them routinely. BACK TO TOP
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