Microsugical Vasectomy Reversal

Consultants at Spire Hull and East Riding Hospital offer microsugical vasectomy reversal to men wishing to have a vasectomy reversed.

What is a vasectomy reversal operation?

Vasectomy reversal is the surgical operation to repair the vas deferens which was cut at the time of vasectomy. It is done with the intention of restoring a man’s fertility. Usually 1 or 2 centimetres of the vas is removed at the time of a vasectomy and the cut ends are either tied off with thread or the opening in the vas is cauterized. After a vasectomy the testicles continue to produce sperm, albeit at a slower rate, these sperm pass into the tubing upstream of the vasectomy site (known as the epididymis), where they eventually shrivel up and die.

The operation of microsurgical vasectomy reversal

The vas deferens has the appearance and is about the same size as a piece of cooked spaghetti. The actual opening or lumen of the vas, through which the sperm pass, is less than 1 millimetre in diameter. The vasectomy reversal is therefore a delicate procedure best done using an operating microscope for magnification. Microsurgical vasectomy reversal offers the best method of accurately rejoining the cut ends of the vas and is known to have the highest success rates.

The operation may take 2 hours to perform, it is usually performed under a general anaesthetic using small incisions made on either side of the scrotal sac. The two ends of the vas are cut back until a healthy opening is found and the fluid which issues from the testicular end is then examined under a microscope to check that sperm or at least pieces of sperm are present. If they are, then the two ends of the vas are carefully joined with extremely fine stitches. This is known as a vaso-vasostomy. If no sperm are found then the vas is explored “up-stream” towards the testicle. Here, the tube which carries the sperm is of a very small diameter and is tightly coiled, this structure is called the epididymis.

After a vasectomy this delicate tubing may get extremely full and little “blow outs” occur. Unfortunately these often heal with scarring and block the epididymis at this level. If such a block has occurred then it is necessary to join the fine tube in the epididymis to the vas (known as an epididymo-vasostomy). Even using the operating microscope the small size of the epididymal tube makes this extremely challenging surgery and the results are not as good as a straight forward vaso-vasostomy.

Blockage at this level becomes more common as the time interval between vasectomy and reversal gets longer and it is one of the reasons that men with a longer time interval will have a lower success rate.

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