Vasectomy Reversal

This is unpublished

Overview

For many men, vasectomy was the best choice for contraception, providing a convenient, safe and effective way to prevent a pregnancy. However, as many as 1 in 10 men will have a change in life circumstance such that having children after vasectomy becomes very important. Fortunately, vasectomy can be surgically reversed to restore the natural patency of the male reproductive tract and a man’s fertility potential. In the past decade, microsurgical techniques have improved to the point that a vasectomy reversal is one of the most simple, successful, and cost-effective ways to help a couples achieve pregnancy when the male partner has had a vasectomy.

Dr. Walsh is one of the most highly trained and experienced surgeons in the country specializing in microsurgical vasectomy reversals. Dr. Walsh has extremely high success rate in vasectomy reversals and is a nationally recognized expert in male infertility. This enables him to apply his knowledge of reproductive health to each individual’s unique situation, and recommend the most appropriate treatment.

Description

After an anesthetic is administered, the site of prior vasectomy is identified. The age of the vasectomy and how the vasectomy was performed will determine the size of incision(s) that is required. When possible, Dr. Walsh will perform a Mini-Incision vasectomy reversal, with one or two incisions barely larger than that through which the vasectomy was initially performed.

Vasovasostomy

Using a microscope that magnifies the d vas up to 40 times its actual size, The scarred ends of the vas are removed. Dr. Walsh examines the fluid emerging from the vas for the presence of sperm. If sperm are present, he realigns the healthy ends of the vas and sews them together using two to three layers of extremely fine nylon suture.

Vasoepididymostomy

As sperm are manufactured in the testicle, they must first traverse a complex series of tubules, collectively called the epididymis, before they enter the vas deferens. If sperm are not present in the vasal fluid, it may indicate a blockage of the epididymis and it may be necessary to connect the vas directly to an early segment of the epididymis.

Vasoepididymostomy is a highly technical operation, and is generally only performed by surgeons who specialize in male fertility. Risks for requiring vasoepididymostomy are prolonged time since the original vasectomy (>9 years) and vasectomy performed very close to the testicle.

Preoperative Considerations

  1. In the months, weeks and days prior to surgery, avoid the use of hot tubs or soaking baths as this may impact your production of sperm. Report any fevers greater than 101.5 to your surgeon.
  2. Remove hair from the scrotum the day prior to surgery.
  3. Eat normally the night before surgery, but follow the directions that anesthesia recommends for the morning of surgery. If no specific directions have been given, withhold all food and drink the morning of surgery.
  4. Do not take any aspirin at least 10 days prior to the procedure, as it have a side effect that can reduce platelet function and lower blood clotting ability.

Postoperative Care

  1. Remove all dressings from inside the athletic supporter in 36 to 48 hours; continue with the scrotal support for one week total. You can shower once the dressings are removed. You can take a bath in after one week.
  2. Apply frequent ice packs to the scrotum the night of surgery and the day after. After 24 hours, discontinue the ice. In general, 20 minutes of each hour while awake is sufficient.
  3. Prescribed pain medication can be taken as directed. Two to three days after surgery, Extra-Strength Tylenol or Ibuprofen (Advil, Motrin) may be sufficient for pain relief. These are over-the-counter medications. Do not drive a vehicle while taking the prescribed pain medication.
  4. The incision is closed with absorbable sutures. They do not need to be removed. It may take up to 2 or 3 weeks for sutures to dissolve.
  5. Resume a normal, well-balanced diet when you return home. Be sure to drink a lot of fluid in order to keep yourself well hydrated.
  6. Normal, non-vigorous physical activity can be resumed after 48 hours, or when you feel better. Activities that cause discomfort should be stopped until they can be resumed comfortably. Heavy activities, such as jogging and weightlifting can be resumed in 2 or 3 weeks depending on your particular procedure. You may return to work in 2 to 4 days.
  7. Refrain from sexual intercourse for 2 weeks or 3weeks depending on your procedure.
  8. Please return to the office in 7-14 days for a brief post-operative visit with Dr. Walsh. In general, we will make this appointment for you in advance, but if you are uncertain, please call 206-598-0828 for an appointment time. Alternatively, if you’d prefer to avoid an office visit, you may talk to Dr. Walsh by telephone to discuss healing.
  9. The first semen analysis will be at 6 weeks. Remember, it is important to abstain from intercourse for 2-3 days prior to providing a semen sample.
  10. You may experience discomfort after the procedure. Common discomforts or symptoms include the following and do not require a doctor’s attention:
  11. Bruising and discoloration of the scrotal skin and base of penis. It will become black and blue and this is normal after surgery. This will take one week to go away.
  12. Some scrotal swelling.
  13. A small amount of thin, clear, pinkish fluid may drain from the incision for a few days after surgery. Keep the area clean and dry.
  14. If you received general anesthesia, a sore throat, nausea, constipation, and general “body ache” may occur. These problems should resolve within 48 hours.
  15. Postoperative complications are rare. If either of the following occur, you should seek prompt medical attention by calling our office at 206-598-4294 or one of our associates at 206-598-6190 on the weekends and after hours:
        1. Wound Infection. This may be associated with a fever, a warm, swollen, red and painful incision area, with pus draining from the site. Antibiotics are necessary to treat this.
        2. Scrotal Hematoma. Extreme discoloration (black and blue) of the skin occurs from bleeding underneath and can cause throbbing pain and a bulging of the wound. This may need to be drained.

Long Term Care

Depending on the results of your first semen analysis, additional testing may be required. The ultimate goal of surgery is to help couple achieve their long-term family planning goals.