The Vasectomy Reversal Procedure
Microsurgical Vasectomy Reversal: Vasovasostomy & Vasoepididymostomy
In an effort to help educate our patients, we have provided a detailed explanation of the vasectomy reversal process, including the microsurgical vasovasostomy and the more complex vasoepididymostomy.
Vasectomy Reversal Surgery Preparation
Vasectomy reversal is a surgical procedure used to restore the flow of sperm through the vas deferens. In preparation for the procedure, the patient is placed under general anesthesia. If desired, the procedure can be done with a local anesthesia like an epidural or with a spinal anesthesia. The procedure takes approximately 2 to 3 hours to perform.
The vasovasostomy is the standard procedure and most commonly performed vasectomy reversal surgery. During a vasovasostomy, the separated ends of the vas deferens are reconnected. This is done after the examination of the vas fluid. The vas fluid is examined under the microscope and considered to be good quality if it has a clear non-opaque consistency and contains completely formed, healthy sperm. Motile sperm is even better. See Dr. Bastuba perform a vasovasostomy
Microsurgical Vasectomy Reversal - Multi-layer Microdot Technique
Dr. Bastuba uses a high-powered surgical microscope for the vasovasostomy. Via a 1-inch incision on the original vasectomy site, six sutures of 10-0 or 11-0 (finer than a human hair) are used to reconnect the inner lumen (tubes) and the outer layer separately using the formal Multi-layer Microdot technique. The advanced Multi-layer Microdot vasectomy reversal technique has helped contribute to Dr. Bastuba’s high success rates, low risk of scarring and minimal recovery time for his patients.
In about 30% of Dr. Bastuba’s vasectomy reversal cases no vas fluid or low quality vas fluid is found during the procedure. In these cases, the more complex vas-to-epididymis surgery (vasoepididymostomy or VE) is required. During the procedure, Dr Bastuba expresses fluid from the vas deferens coming from the testicle. If there is no sperm in this fluid, it must be concluded that there is a blockage upstream closer to the testicle. This blockage will not allow sperm to pass through to the vas deferens. Therefore simply connecting vas deferens to vas deferens and performing a vasovasostomy does not make sense. Blockage in the epididymis upstream following a vasectomy may have been caused by inflammation, too much pressure in the epididymis or scarring at the time of the vasectomy. See Dr. Bastuba perform a vasoepididymostomy.
Microsurgical Two-suture Longitudinal Intussusception Technique (Microsurgical Longitudinal Intussusception Vasoepididymostomy)
Dr. Bastuba currently employs the state-of-the-art Microsurgical Longitudinal Intussusception Vasoepididymostomy technique. This technique is sometimes referred to as the two-suture longitudinal intussusception technique and requires two 10-0 or 11-0 sutures. The technique allows a larger opening between the extremely small epididymal tubule and the larger vasal tubule. The technical aspects of this technique are simplified, allowing for higher success rates. By utilizing this technique, Dr. Bastuba has achieved the 87% patency rate in his vasoepididymostomy patients.
During a vasoepididymostomy, the vas deferens is connected directly to the epididymal tubule in the epididymis to bypass the blockage. This is one of the most complex and demanding procedures in microsurgery and only physicians who perform vasoepididymostomies on a regular basis should attempt the surgery. For Dr. Bastuba, this demanding procedure is routine and performed at no extra cost. His success rates for vasoepididymostomy are indistinguishable from those of the world’s foremost male fertility microsurgeons.