Every patient and situation requires careful evaluation.
If you have experienced the frustration and disappointment of an unsuccessful reversal procedure, it's reasonable to wonder if another attempt is worthwhile. The good news is that an unsuccessful first reversal can sometimes be successful the second time around.
The following information may help you better understand the reasons behind an unsuccessful reversal, and some of the factors to consider if you are thinking about a reversal "redo."
Some of the factors that influence the chances of success or failure in vasectomy reversal surgery include the age of the original vasectomy, the age and health of the patient, the skills and experience of the surgeon.
"What Went Wrong the First Time?"
Generally, if the surgeon finds the vas deferens have little damage from the original vasectomy, the chances of a successful reversal are greater. There are two basic procedures for vasectomy reversal and each is specific to the condition of the vas deferens as determined by the surgeon after the initial incision.
In reversal surgery, the incision is usually made directly over the old vasectomy incision site. After examining the condition of the cut ends and interior of exposed vas tubes, the surgeon will decide which reversal procedure is indicated. In cases where the vas deferens appear healthy and unobstructed, the typical procedure, a vasovasostomy, is usually performed.
However, if injury to the ends of the vas deferens is more extensive, or if scarring or blockage of the epididymis is suspected or detected, a surgeon may instead perform the more complicated and lengthy procedure known as a vasoepididymostomy. This procedure attempts to bypass the obstructed or damaged portion of the vas in order to successfully reconnect the tiny tubes at a higher point near the epididymis. In some instances, a vasovasostomy is performed when a vasoepididymostomy was required, resulting in a failed reversal attempt. A subsequent vasoepididymostomy can result in a successful outcome.
Microsurgical Skill and Experience Matter
A vasectomy reversal is a meticulous microsurgical procedure that normally takes several hours. A powerful surgical microscope is usually used, and precision and accuracy are crucial. The effective reconnection of the vas tubes requires many tiny sutures, using a delicate suture material that is finer than the thickness of a human hair, usually through multiple, microscopic layers of tissue.
Consequently, experienced board-certified urologists or fertility specialists usually perform reversals. Even so, success rates for "redo" reversals are slightly lower than for first-time reversals. This is usually because the length of time the vas has been obstructed is longer for repeat reversal surgery, and increased scarring results each time surgery is performed.
The Best and Worst Candidates for "Redo" Surgery
Patients who are likely candidates for vasectomy reversal "redo" surgery are those who evidenced healthy sperm in the seminal fluid somewhere in the vas or epididymis during their first reversal surgery. Failure of the initial reversal may have been the result of other factors. Consequently, the chances of a successful second reversal attempt are considered high enough to offer hope, and encourage these candidates to give vasectomy reversal another try.
However, some men may not be good candidates for a second reversal attempt and "redo" surgery. A surgeon may determine that a second attempt may be more difficult to perform and less likely to succeed if there is increased scarring and damage resulting from the first reversal procedure. When an initial reversal has compromised the length or quality of the vas nearest the testicle, reconnection is more difficult and must be made higher up, closer to the testes and epididymis. Re-operation may not be a strong option in these cases.
Discuss the Options with Your Doctor.
Circumstances and likelihood of success can vary, and you should discuss the details of your case with a qualified and experienced surgeon. It is possible that a second attempt or "redo" can be successful for some individuals.
In Summary:
- Many factors influence the likelihood of success in a reversal "redo."
- Damage sustained by the vas tubes during both vasectomy and initial reversal surgeries often have much to do with the success of "redo" surgery.
- Like reversals, skilled, board-certified urologists or fertility experts who specialize in microsurgery most often perform second attempt reversals.
- The best candidates for reversal "redo" surgery are those men whose vas are the least scarred, blocked or damaged from prior surgery, and in which healthy, unclouded and potent seminal fluid is evidenced.
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