Microsurgical vasectomy reversal
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Microsurgical vasectomy reversal
The Surgery
You will shave the scrotum before your appointment. You may have preoperative oral sedation if you desire. After examination noting testicular size, presence of epididymal fullness, vasectomy site location, and length of distal vas segment, local anesthetic (numbing medication) prepared to be both quick acting and long in duration is placed in the skin and soft tissues of the scrotum using a very small, fine-tipped needle, less painful than a pinch. After two or three small "pinches", you may have some occasional pulling sensation, but after instilling the local anesthetic, the procedure is essentially painless for typical cases. It is not unusual for a patient to doze during the procedure.
The surgery is performed with a quality 3X to 23X magnification microscope. A one inch incision is made in the skin for simple cases. The area of scar and the vas ends are dissected. The testicular end of the vas is divided at a level of healthy tissue identified by high power magnification to note the quality of the vas tissue and its blood supply. A sample of vasal fluid is examined under a side table microscope for presence of sperm. The findings are noted, but vas-vas reconnection is planned even if no sperm are seen, as this is the usual accepted practice. The abdominal (upper) end of the vas is divided at a level of normal appearing tissue above the scarred site and gently flushed with saline. Every effort is made to ensure a lack of tension on the anastamosis.
Quality titanium microsurgical instruments are used to repair the vas. This is done with a modified two layer technique as described in the microsurgical literature. The modified inner layer is performed using 9 zero nylon with a 100 micron (4/1000th inch) diameter needle. The outer layer is sutured with 8 zero nylon. An average of 12-13 total sutures are placed, depending on the size of the two ends. The sheath tissue around the vas is brought over the anastamosis with suture to aid in healing and blood supply.
A small rubber drain is placed and the layers below the skin are closed with sutures that absorb. The skin is also closed with fine absorbable sutures. There are no sutures on the outside, and no sutures to remove. For typical cases, about 3 hours are needed to meticulously reverse what was done in just a few minutes at the time of the vasectomy.
Post Operative Period
It is best if you can avoid travel the day of the procedure. You will need to change dressings for drains placed. You can simply remove the drains or the doctors may remove them the day following surgery. Swelling and bruising up to twice normal size is expected. The pain after surgery is the same as after vasectomy in half of the patients. In a fourth of the patients, the pain is less after reversal compared with after vasectomy, and in the remaining quarter of patients, the pain is worse after the reversal. Advil or another medication is sufficient for discomfort the first few days. Good scrotal support is key to relieve any discomfort with standing.
Lifting over 30 pounds, running, sports, or vigorous exercise is discouraged for three weeks. Sexual abstinence is recommended for two weeks. A two week wound check visit is available, but not necessary if distance is a constraint. A semen analysis is recommended at 4 months. The surgeon will give you an order so the lab can fax results to him and I can discuss the findings with you. If sperm are seen in the vasal fluid at operation, 85-95% of patients should have semen in the fluid after a competent microsurgical reversal, with a corresponding pregnancy rate of 50-60% in most cases.
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