THE PROCEDURE

A vasectomy reversal is a microsurgical procedure to restore the connection of the vas deferens that was previously cut during a vasectomy.  The vas deferens is the tube that carries sperm to the ejaculate.  At the Vasectomy Reversal Center of America, Dr. Karen Elizabeth Boyle and Dr. David M. Fenig are microsurgeons whose success rates with vasectomy reversals are over 90 percent.  They are experienced in both the vasovasostomy surgery and in the more delicate microsurgery called epididymovasostomy.   

A vasovasostomy is the procedure to reconnect the severed ends of the vas deferens.  A second, more difficult procedure is sometimes performed when there is a blockage in the epididymis, which is next to the  testis. 

Both procedures require microsurgery. The channel of the vas deferens through which the sperm swim is only .3 to .4 millimeters in diameter.  Therefore, it is necessary to use a state-of-the-art microscope that provides 16 times magnification of the operating image. The training and precise skill of the surgeon is of the utmost importance.

Sperm are produced in the testis. They are stored and reach maturation in the epididymis, a tightly coiled, muscular tube that is 15 to 18 feet long and leads into the vas deferens.  The muscle of the epididymis contracts to propel the sperm through the vas deferens and into the urethra at the far end of the penis so the sperm can fertilize an egg. 

The decision to perform a vasovasostomy or an epididymovasostomy depends upon the quality of the fluid contained in the testicular side of the vas deferens. To check this, the surgeon expresses the fluid during surgery and examines it under a microscope. 

Once the sperm is analyzed, there are three possibilities:

If sperm are present in the fluid, a vasovasostomy connecting the two severed ends of the vas can be performed.  The success rate for this type of patient is 95 percent for a return of sperm to the ejaculate with an associated 75 percent pregnancy rate. 

If no sperm are present in the fluid, but the vasal fluid is abundant, clear and watery, then the right conditions are present for sperm production, and the vasovasostomy can still be performed.   Under these circumstances,  less than 80 percent of men have sperm return to their ejaculate. 

However, when the fluid is thick and pasty, which indicates poor quality, and if sperm are absent or there is no fluid at all, this means there is a blockage that requires an epididymovasostomy.  Instead of connecting the two ends of the vas deferens, the surgeon will connect the end of the vas deferens to the epididymis.  Approximately 60 percent of men have a return of sperm to their ejaculate following an epididymovasostomy.   

 

Two Types of  Microsurgical Vasectomy Reversal

Your surgeon will choose the type of vasectomy reversal that is right for you.  The operating time for either type of vasectomy reversal is approximately three to four hours.  A general anesthetic is used.

Vasovasostomy:  Though there are various techniques for performing a vasovasostomy, we prefer a strict, two-layer procedure that produces the most optimal watertight result when reconnecting the vas deferens.  This is done with microscopic sutures, using the most advanced microsurgical equipment and the Zeiss operating microscope.  The two-layer procedure involves suturing the mucosal inner layer and a muscular tissue layer of the vas deferens. Not only do we believe this is superior to the single-layer full thickness closure, but facilitating the two-layer sutures properly requires a higher level of training and experience, which our surgeons have.  It is very important for the closure be watertight so that sperm do not leak out at the closure site, potentially causing inflammation. 

 

Epididymovasostomy:  This is an even more complex and delicate procedure  that is performed when a blockage is discovered in the epididymis.  The epididymovasostomy requires greater surgical expertise that the vasovasostomy.  The vas deferens is attached directly to the epididymis.  An incision is made to an epididymal tubule, where sperm are stored, just prior to the obstruction.  The tubule is gently squeezed for fluid.  The fluid is checked for sperm. If sperm are absent, a more proximal incision is made and checked again.  For epididymovasostomy to be successful, sperm must be present within the tubule at the site of the anastomosis, which is where the sutures will join the two streams (the tubule and the end of the vas deferens).  The anastomosis is performed using two layers of very fine suture and is also done using the operating microscope.