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Vasectomy Reversals
Vasectomy reversal - a specialised procedure. Over the years surgeons have tried many
techniques to reverse vasectomy, these include insertion of plastic pipes (stents),
protein glue, and laser guided stitching etc but trials have shown that the goldstandard
procedure is reconstruction of this living tube with microsurgery. The inside diameter
of the vas is just 0.2-0.4mm, so infinite care and microscopic stitches that do not
obstruct the flow of sperms are required to make a reconnection that will be as close
to the original as possible. Experience, training and specialist equipment leads to
good operations and good results (see below).
Suitability for reversal
First of all - let me say that we treat all patients with the same non judgmental attitude.
We accept that when you chose to have a vasectomy you did so with the best of intentions
and in the belief that under the circumstances you made the correct decision for you
at that time. Personal circumstances change and we are simply here to help you regain
your fertility.
What sort of people have a vasectomy reversal?
Our patients cover a range in age from 24 to 54 , and interestingly there are as many
in the 38-54 age bracket as there are in the 28-37 years old bracket. Approximately 88 %
of patients have formed a new relationship and wish to consolidate this with a child
between them, 10% of patients just decide they just want to change their minds and want
more children (usually as they become better off or their children grow up and are less
demanding). The remainder just feel dissatisfied with their vasectomy or have post
vasectomy pain syndrome and wish to be returned to 'normal'.
The reversal process
Consists of the following simple steps:
Visit to the Clinic for discussion, counselling and examination.
Appointment made for operation.
Operation - Monday,Tuesday afternoons and Wednesday morning.
Recuperation. Strict rest for 4 days (until the weekend) then back to sedentary work
the following Monday.
No sex for 3 weeks. Semen tests after 6-8 weeks . See below for details.
Out of town patients
Our patients come from all over Britain and abroad. Obviously it is impractical to
pre-examine these patients. We therefore arrange an appointment for them to come along
for examination followed immediately by operation - providing they are suitable.
Fortunately approx. 90% of patients are suitable so there is only a slim chance of not
being able to proceed on the day. We give you details of local overnight accommodation,
usually at the local Travel Inn which overlooks the local marina.
What happens at the pre-op Examination?
Physical examination. Assessment of the work needed to repair the tube (vas).
Estimation of the diameter of the vas (occasionally the vas is very fine and fragile),
the positioning of the original vasectomy along the length of the tube to assess the
length of the distal remnant and finally the ease of access to the vas. Also important
is the patient's general health (diabetes, blood pressure etc.) and any previous
surgery to the groin area. Finally an important factor is that you must be happy and
relaxed at the prospect of having a local anaesthetic operation with the help of sedation
therapy.
Explanation of the factors that make for successful reversal.
Review of the literature and research on reversal.
Video and or slide show of the operation taking place.
What features make for a successful reversal?
Put very briefly five main items :-
A long distal remnant.
The original vasectomy can be done anywhere between the convoluted vas and the groin !
The longer the tube left on the testicular end of the vas the greater the surface of
tube there is to disperse the pressure build up following vasectomy which in turn lessens
the chances of a 'blow out' blockage in the epididymis.
Sperm granuloma.
This is swelling the size of a small pea on the top end of the distal vas. A granuloma
acts as a pressure release valve and reduces the chances of blockage in the epididymis.
Recent vasectomy.
Reversals up to ten years after vasectomy carry a high success rate but after this time
there is a steady decline although we have known success even after 20 years !!
Microsurgery. This means the placing of the stitches used to repair the tube very
accurately with the aid of a microscope. The inner tube of the vas (lumen) measures only
0.2 mm so ultra fine stitches (9.0 and 10.0 - as fine as a human hair) are needed to
repair the tube without obstructing it.
Microsurgical training.
Microsurgery requires special training and constant practice to acquire the necessary
skills and maintain them. Dr Dawson performs microsurgical reversals at least twice a
week and was trained in one of the finest microsurgery centresin the world at New York's
Cornell University.
What do these medical terms mean?
Testis - generates sperm cells and testosterone (male hormone).
Epidiymis - very long thin walled supercoiled tube lying on top of the testis rather
like a beret on top of a rugby ball. The sperms enter this structure as babes and
emerge at the far end as lively young men.
Vas - the tube that carries sperms from the testis to the sperm reservoirs at the base
of the bladder. This measures from 1.5-2.5 mm in diameter with a thick muscular wall
and a tiny inner tube (lumen) measuring just 0.2 mm.
Convoluted vas - the first portion of vas after the epididymis the vas here is still
thin walled and maybe only 1 mm in diameter still tightly coiled.
Vasectomy - literally 'vas'+'ectomy' i.e. removal of a portion of vas to block the
passage of sperms.
Vasovasotomy - a connection between two lengths of vas.
Distal vas - the lower portion of vas still attached to the testis after a vasectomy.
Proximal vas - the upper portion of vas still attached to the body.
Vasoepididymostomy - a connection from the vas to the epididymis.
How is the operation performed?
In brief, very much the same way the operation is done in the USA ('the home' of
reversal surgery).
Premed
We give a sedative premed injection which provides relaxation and pain relief.
Local anaesthetic
This is chosen to act quickly - within seconds - and last for hours. We proceed
carefully and slowly - freezing each area in turn.
Operation
Lasts approx. 1½ hour each side.
We locate the vas and the site where the original vasectomy blocked the tube.
Then we section the tube above and below this area to locate fresh open vas. At this
stage we check that the reproductive tract is still functioning by flushing the upper
vas with saline and sampling fluid from the testicular vas under the microscope.
Vasovasostomy ie. joining the ends of vas together using special very fine stitches
thinner than a human hair (9.0 double armed Nylon sutures). The medical description of
our operation is 'microsurgical modified single layer end to end vasovasostomy'.
Afterwards.
There are two scars approx. 3 cm long - one on each side of the scrotum. We usually
close these with a dissolving stitch buried under the skin so that there is no need
for further visits to the Clinic. After taking tea and biscuits the patient is
accompanied home to rest.
On the night of operation
We recommend that if you live further than an hour's drive away then you stay the night
in a local hotel. We recommend the local Travel Inn. This clean and inexpensive hotel
(approx £30 ($43) is well located overlooking the yachts in Hartlepool Marina.
Return to work.
Most reversals are performed at the beginning of the week with a view to rest until
Saturday then mobilisation over the weekend and back to work the following Monday just
five to seven days after operation.
How will I know if the operation was successful?
We arrange an initial semen test for 6-8 weeks post-operatively by which time we would
expect a return of small numbers of sperm to the semen. Return to full fertility can
take 6-8 months so we ask your local GP to arrange for further tests at a pathology lab
near you.
What are my chances of becoming fertile again?
This depends on many factors but chiefly the length of time since your vasectomy was
performed. This is because the likelihood of the tubes being blocked increases with
each year that goes by, however, the operation is successful in more than 80 % of men
who have the reversal within up to 10 years after vasectomy. Even if the vasectomy was
done more than 10 years ago there is still a worthwhile chance of success
Results of 165 consectutive operations
Years after vasectomy Total pts.
Pts. not tested
Pos
Neg
Overall (%)
1-2 15
2
13
0
100
3-4 35
6
24
5
83
5-6 33
9
17
7
70
7-8 22
7
12
3
80
9-10 30
7
18
5
78
11-12 11
5
5
1
83
13-15 19
5
11
3
78
16-25 10
3
3
4
42
Comments
A positive result means that there is return of sperm to the semen, so called patency.
Overall pregnancy rates after 18-30 months follow up are 46% with potential to reach 65%
after the usually quoted 5 year follow up.
Obviously the above are not statistically significant for each age range but reflect
our record.
The high success rate for the 1-2 year post vasectomy group reflects the success of the
procedure.
The success rate for the 16-25 yrs. Group confirms that reversal is worthwhile even many
years after the vasectomy. Indeed one gentleman aged 53 developed a very healthy sperm
count 25 years after vasectomy!
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