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How it's Done
A vasectomy reversal requires delicate microsurgery. Being informed about this procedure-and understanding what's involved-can help reduce your fears.
Here's what to expect.
A typical vasectomy reversal procedure is called a "Vasovasostomy." It is performed in a microsurgical technique that attempts to reconnect the previously cut ends of the vas deferens, in order to rebuild an open vas channel to restore fertility.
Occasionally, the original vasectomy may cause an increase in pressure of the epididymis, a tube upstream from the blocked end of the vas deferens, resulting in a "blow-out" or blockage. This must be bypassed. The surgeon does this by reconnecting the vas end to the epididymis even further upstream from the blockage. This more complicated reversal procedure is known as a "Vasoepididymostomy."
Although your experience may vary somewhat, the following describes what you might expect…
The delicate microsurgical procedure for either form of reversal requires a microscope for magnification and precise visualization in order to stitch the tiny vas and even smaller epididymis. Reconnecting the small vas tubes requires the surgeon to use multiple layers of ultra-fine stitches. This suture material is thinner than a human hair and is nearly invisible to the naked eye.
GENERALLY: Some expectations and considerations.
What a Vasectomy Reversal Is:
- It is generally painless and safe
- A general or epidural (spinal) anesthesia is usually used, and the procedure can be performed in an outpatient surgical center with the patient returning home the same day.
- It is a delicate microsurgical procedure that attempts to reconnect the cut ends of the vas and reestablish an open channel, thus restoring fertility in the man.
- It is not uncommon; approximately 5 percent of the half million men who opt for vasectomy each year later elect to have the vasectomy reversed.
- Success rates are typically higher for men whose vasectomy occurred more recently, and they tend to decline as the time interval since vasectomy lengthens. The most significant decline seems to occur at an interval of 15 years or more. Nonetheless successful reversals can still occur more than 30 years following a vasectomy.
What a Vasectomy Reversal is Not:
- It is not guaranteed, but some success factors can be evaluated in advance by physical examination and history.
- It usually is not painful, as the general or spinal anesthetic is used.
- It is not as costly, not less natural, or statistically less effective in generating pregnancy than sperm aspiration and other assisted reproductive techniques.
- It does not immediately restore fertility, which is also dependent on the quality of the man's sperm production. Some men may unknowingly suffer from poor fertility which developed after their last child was conceived.
What a Vasectomy Reversal Doesn't Do:
- It does not affect or enhance masculinity or sexual prowess, since vasectomy diminishes neither.
- It does not guarantee pregnancy, which depends on many other factors for success.
- It does not have to be your last resort. Since no procedure can guarantee 100 percent success, some men choose to have their sperm harvested and banked at the time of the reversal. (This process has limitations which should be evaluated in advance.)
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BEFORE: Preparing for your vasectomy reversal.
There are some simple things that you can do to prepare for the reversal procedure prior to surgery.
- Prepare questions that you may have for your doctor. You will be asked to sign a consent form stating that you understand the risks involved and that restored fertility cannot be guaranteed. Therefore, arrive a few minutes in advance of your appointment.
- Do not eat or drink anything after midnight the night before surgery.
- Do not take aspirin or other anti-inflammatory medication (e.g. Nuprin ®, Advil ®, Motrin ®) for 10 days before your day of surgery. Such medication can increase the risk of bleeding.
- Your doctor may ask you to shave the front portion of your scrotum on the morning of your surgery. Shower thoroughly and wear, or bring, clean and snug underwear or an athletic supporter on the day of your surgery, as well as loose-fitting outer clothing.
- Arrange in advance for someone to drive you home following the procedure. It is never a good idea to try to drive after a general or spinal anesthetic. You may be groggy and require the assistance of someone to help you briefly once you get home.
- Unlike your original vasectomy, reversal surgery is a major microsurgical procedure that can take several hours
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DURING: The usual steps immediately before and during a vasectomy reversal procedure.
Your doctor will describe the technique to be used during your surgery and your experience may differ from these steps. Generally…
- You will be asked to change into a gown. You may be given a light sedative prior to general or epidural anesthesia.
- The surgical site will be complete shaved and washed.
- Sterile drapes will be placed over you to guard against infection.
- Once you are under anesthesia and 'asleep', the surgeon will perform either the vasovasostomy procedure or the vasoepididymostomy procedure. In the vasovasostomy procedure, the cut ends of the vas deferens are located under the skin of the scrotum and an incision is made.
- The cut vas are lifted out of the scrotum and fluid is expressed from the vas 'tubes.' The fluid is examined for sperm under a microscope. The presence of sperm, even degraded sperm, in the fluid within the vas typically indicates that the vasovasostomy procedure for reversal is appropriate. Then the cut ends of the vas are microscopically stitched together, in either a single-layer or multi-layer technique, and returned to the scrotum, which is then closed with sutures.
- However, if no sperm and thick pasty fluid is detected from the cut vas during the vasectomy reversal procedure, this is typically a sign of a secondary epidimal blockage and the surgeon may instead reconnect the cut vas directly to the epididymis, in an vasoepididymostomy reversal procedure. Surgery is then completed routinely. In cases where no sperm are seen, but the fluid is clear and copious, this is typically a sign that a secondary epididymal blockage has not occurred, and a vasovasostomy is usually performed.
- You will be taken to a recovery area where you can rest until you are completely awake and ready to move. You will be wearing snug underwear or an athletic supporter, and will be most comfortable if you dress in loose pants or sweats. You will not be permitted to leave the surgical facility until the doctor determines that you are safe to travel.
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AFTER: Care following the vasectomy reversal.
Follow your doctor's instructions. It's a good idea to read post-operative instructions in advance of your surgery, and to review them with your spouse so that you can make preparations well in advance.
You can arrange pain medication with your doctor before you leave the office and follow the directions carefully. To ensure a safer, faster recovery, follow your physician's specific instructions. The following are only general guidelines…
- Remain at bed rest for at least the first 24 to 48 hours following surgery.
- Keep all activities to a minimum for at least four to five days, and avoid heavy lifting or physical exertion completely for three to four weeks.
- Do not attempt ejaculation for 3 to 4 weeks.
- Use an ice pack on the scrotal area for one to two days immediately after surgery. You may usually take a shower in one or two days.
- Schedule a doctor's appointment for a post operative exam to ensure you are healing satisfactorily. Subsequent visits may be required as determined by your doctor.
- Semen specimens may be evaluated every few months to measure sperm count, motility, and quality. More advanced sperm tests such as anti-sperm antibody testing may be recommended by your doctor in select cases.
- Call your physician immediately if you develop fever, swelling and/or increased pain at the surgical site.
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In Summary:
- A vasectomy reversal (vasovasostomy) is a delicate, microsurgery for the purpose of restoring natural male fertility.
- You should carefully review this procedure and what to expect with your surgeon as it may vary somewhat from this description.
- If it is not possible to reconnect the ends of the vas deferens, the surgeon may bypass a blocked area and reconnect the vas to the epididymis (vasoepididymostomy).
- Prepare any questions to review with your doctor in order to make an informed decision.
- Unlike a vasectomy, this procedure is usually performed under a general or epidural anesthesia, requires several hours and is done in an outpatient surgical facility.
- Carefully review and follow the instructions and information from your doctor.
Check out related pages from vasectomy.com
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