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Vasectomy Reversal

Last updated May 1, 2018

Approved by: Maulik P. Purohit MD MPH

Vasectomy is a male sterilization process. The sperms are carried from the testicles via the epididymis, and then through the vas deferens before being released into the urinary system.


Background Information:

What are the other Names for the Procedure?

  • Reversal of Vasectomy
  • Vasoepididymostomy
  • Vasovasostomy

What is the Vasectomy Reversal surgical procedure?

  • Vasectomy is a male sterilization process. The sperms are carried from the testicles via the epididymis, and then through the vas deferens before being released into the urinary system
  • Vasectomy is a surgical procedure which involves cutting and tying of the vas deferens, thereby stopping the flow of sperms

In some cases, an individual might want to reverse the vasectomy procedure - this is called a Vasectomy Reversal procedure.

  • Vasectomy Reversal is a microsurgery. During the surgery, the vas deferens that were cut and tied together, are opened up, thereby reconnecting the tubes. This is called a Vasovasostomy procedure
  • There may be a possibility that the tubes are completely blocked and a Vasovasostomy does not regain the flow of the sperms. In cases, where there is a blockage in the epididymis, a microsurgery is performed to remove the blockage. This is called a Vasoepididymostomy procedure
  • Vasoepididymostomy and Vasovasostomy are terms generally used for a Vasectomy Reversal surgical procedure, depending on the site of reconnection, and/or blockage

The type of surgery required cannot be predicted beforehand. It is decided during the surgery, based on where the blockage has occurred.

What part of the Body does the Procedure involve?

The scrotum, vas deferens, and the epididymis, are the body parts involved, during the Vasectomy Reversal procedure.

Why is the Vasectomy Reversal surgical procedure Performed?

A Vasectomy Reversal procedure is performed to reverse the male sterility procedure ‘vasectomy’ performed earlier. This procedure helps in regaining one’s sterility.

What are some Alternative Choices for the Procedure?

Sperm retrieval and in-vitro fertilization (IVF) are a few alternatives to this procedure.

What are the Recent Advances in the Procedure?

Various methods that involve lesser pain, are less risky, and help in a faster recovery, are being developed, especially in the field of microsurgeries. 

What is the Cost of performing the Vasectomy Reversal surgical procedure?

The cost of Vasectomy Reversal procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused by the information regarding Vasectomy Reversal surgical procedure and on what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
  • They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.vasectomyinfo.com/vasectomy_reversal_surgery.html

http://www.vasectomy.com/proceduredetail.asp?siteid=R&id=4 

The following article link will help you understand Vasectomy.

http://www.dovemed.com/common-procedures/procedures-surgical/vasectomy/

Prior to Vasectomy Reversal surgical procedure:

How is the Vasectomy Reversal surgical procedure Performed?

The Vasectomy Reversal surgical procedure is performed as:

  • The surgical area is cleaned using an antiseptic
  • The vas fluid is then removed and examined, under the microscope. If the fluid is clear, non-opaque, and contains completely formed, healthy sperms; then, the fluid is considered to be good and the separated ends of the vas deferens are reconnected
  • A highly powered surgical microscope is used for the surgery, magnifying the site and thereby allowing precision
  • In almost 30% of the cases, the vas fluid may be opaque and may not show the presence of sperms. This indicates a blockage at the vasectomy site
  • A Vasoepididymostomy procedure is then performed. This surgery is more complex than a Vasovasostomy. In this procedure, vas deferens is connected directly to the epididymal tubule in the epididymis, to bypass the blockage

Where is the Procedure Performed?

The procedure is usually performed in an out-patient surgery facility. The treated individual can go home the same day.

Who Performs the Procedure?

The surgery is performed by a general surgeon or an urologist.

How long will the Procedure take?

  • A Vasovasostomy procedure takes about 2-3 hours
  • However, if Vasoepididymostomy procedure needs to be performed; then, it takes about 4 hours

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

  • Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
  • If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
  • A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Normally, local anesthesia is not used; however, do inform the physician, if you are allergic to any local anesthetics, lidocaine, etc.
  • Avoid application of any deodorant or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
  • For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Vasectomy Reversal procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Vasectomy Reversal surgical procedure?

Routine blood and urine tests are required, prior to the procedure.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

  • What is a Vasectomy Reversal procedure?
  • Why is this procedure necessary? How will it help?
  • What does the procedure involve?
  • Will I need adjunct treatments after the surgery?
  • How soon should I get it done? Is there an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • Are there any lifestyle restrictions or modifications required, after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • Is there any medication that needs to be taken for life, after the procedure?
  • How many such procedures have you (the physician) performed?
  • What are the costs involved?

During the Vasectomy Reversal surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Usually a general anesthesia is administered. However, if preferred, local or spinal anesthesia may be administered.

How much Blood will you lose, during the Procedure?

There is no significant blood loss during the procedure.

What are the possible Risks and Complications during the Vasectomy Reversal surgical procedure?

There is only a small risk of infection. Apart from that there are no risks or complications involved with this process.

What Post-Operative Care is needed at the Healthcare Facility after the Vasectomy Reversal surgical procedure?

Once the surgery is performed, the patient can go home the same day. At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Vasectomy Reversal surgical procedure:

What are the possible Risks and Complications after the Vasectomy Reversal surgical procedure?

There is a very small margin of risks and complications involved with this procedure. Post Vasectomy Reversal, the following complications may arise:

  • Nausea and headaches
  • Infection
  • Scarring, where the ends are connected
  • Epididymitis (inflammation of the epididymis)
  • Urinary retention
  • Swelling and hemorrhage
  • Scrotal hematoma (black and blue, bruised scrotum)
  • Failure of sperm production
  • Anti-sperm antibodies
  • Testicular atrophy

What is the Prognosis after the Surgery?

The type of procedure being performed, Vasovasostomy or Vasoepididymostomy, plays a role in the success rate. The success rate is lower with Vasoepididymostomy procedure.

  • The time period between a vasectomy and the Vasectomy Reversal procedure, plays a role in the success of the surgery. More the numbers of years that have passed, higher are the chances for a Vasoepididymostomy to be performed, thus lowering the chances of a success.
  • A semen analysis is carried out every 2-3 months, after the surgery. In order for the sperms to reappear, it may take about 2 months with a Vasovasostomy procedure and 3-15 months with a Vasoepididymostomy procedure
  • A stabilized sperm count, or a pregnancy, indicates a success of the surgery

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

  • Swelling, redness or bleeding at the site of the surgery
  • Unbearable pain or discomfort
  • Signs of infection
  • Fever

What Post-Operative Care is needed at Home after the Vasectomy Reversal surgical procedure?

At home, the following post-operative care is recommended after a Vasectomy Reversal procedure:

  • Avoid bathing, 24-48 hours after the procedure
  • Ice bags should be applied for 20 minutes, every hour, for the next 6-8 hours
  • Avoid strenuous work for the next 2-3 days
  • Regularly take the pain-killers and antibiotics, prescribed by the physician

How long does it normally take to fully recover, from the Procedure?

It usually takes about 2-3 weeks to completely recover from the surgery.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Vasectomy Reversal surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility
  • General surgeon or urologist
  • An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before the Vasectomy Reversal procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Feb. 23, 2014
Last updated: May 1, 2018