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Vasectomy Reversal

Vasectomy Reversal

There are many reasons to reverse a vasectomy like remarriage following a divorce, having a change of heart, or starting a family over after the loss of a wife or child. Regardless of your reason, there are now advanced methods to restore your fertility. A vasectomy is a minor surgical procedure in which the sperm duct, or vas deferens, is cut in order to achieve sterility. Vasectomy reversal restores fertility by reconnecting the ends of the previously severed vas deferens. This procedure is performed using microsurgery and ultimately restores the tubal passage for sperm to be ejaculated.

Vasectomy reversals are generally performed in an outpatient area of a hospital or in an ambulatory surgery center. The operation is usually performed with general anesthesia. Once the patient is anesthetized, the urologist will make a small cut on each side of the scrotum and first remove the scarred ends of the vas deferens at the point of blockage created by the previous vasectomy. The urologist will then extract a fluid sample from the end closest to the testicle to see if the fluid contains sperm.

The presence of sperm in the fluid is an indication that there is no obstruction between the testicle and the location in the vas from which the fluid was obtained.  When sperm are present in the fluid, the ends of the vas can be connected to reestablish the passageway for sperm. The medical term for reconnecting the ends of the vas is vasovasostomy.

The microsurgical approach is recommended and uses a high-powered microscope to magnify structures. Use of an operating microscope provides better results, as it allows the urologist to manipulate stitches smaller in diameter than an eyelash to join the ends of the vas deferens. When microsurgery is used, vasovasostomy results in return of sperm to the semen in 70-95 percent of patients and resulting pregnancy in 30-75 percent of female partners.  These numbers however depend upon the length of time from the vasectomy until the reversal but more importantly the microscopic finding of sperm during the operation under a microscope. Dr. Ramasamy has published on the factors that influence success after vasectomy reversal and determined that intraoperative microscopy is the most important factor. If the urologist does not find sperm in the fluid sample, it may be because the original vasectomy resulted in back pressure causing a break in the epididymal tubule. Because any break in this single, continuous tube can result in a blockage, the urologist will have to employ a more complicated reversal technique called an epididymovasostomy or vasoepididymostomy. In this procedure, the urologist must bypass the blockage in the epididymis by connecting the "upper" end of the vas deferens to the epididymis above the point of the blockage. While vasoepididymostomy is a more complex procedure than vasovasostomy due to the very small size of the tube inside the epididymis, recent advances in the surgical technique have made outcomes nearly as successful as vasovasostomy. You may need a combination of the two techniques, with a vasovasostomy done on one side and a vasoepididymostomy on the other side. Vasoepididymostomy usually requires a longer incision into the scrotum.

Dr. Ramasamy is an expert in vasectomy reversal in Miami, Florida and has published several studies on vasectomy reversal. 

1. Bernie AM, Osterberg EC, Stahl PJ, Ramasamy R, Goldstein M. Vasectomy reversal in humans. Spermatogenesis. 201; 1;2(4):273-278

2. Ramasamy R, Schlegel PN Vasectomy and Vasectomy Reversal: An Update. Indian J Urol. 2011; 27:92-7

He recently demonstrated that success following vasectomy reversal depends on microscopic examination of vasal fluid during vasectomy reversal 

1. Ramasamy R, Mata DM, Jain L, Perkins A, Marks SF, Lipshultz LI: Microscopic visualization of intravasal sperm is positively associated with patency after bilateral microsurgical vasovasostomy. Andrology 2015 (In Press)

2. Scovell J, Mata D, Ramasamy R, Herrell L, Hisao W, Lipshultz LI: Association between the presence of sperm in the vasal fluid during vasectomy reversal and postoperative patency: a systematic review and meta-analysis. Urology 2015 85(4): 809-13. 

Fore a handout about vasectomy reversal, click here. For detailed postoperative instructions, click here 

For more information, please visit Dr. Ramasamy's YouTube channel.

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