Reversal of Vasectomy

Reversal of Vasectomy

Vasectomy reversal can be done as a day case. It is done under general anaesthesia and takes up to 3 hours, depending on technical difficulty. The operation is performed in one of two ways

a) Vasovasostomy

This is the most commonly used technique. Scar tissue is first removed between the vas ends and the fluid from the testicle end examined for presence of sperms. If the vasal fluid contain sperm, the two ends of the vas deferens can be joined together. As the lumen within the vas deferens is only 0.2 to 0.3 mm in diameter, an operating microscope is needed so that fine sutures can be precisely placed. These fine sutures are half the thickness of a human hair. Some 6 sutures are placed in the inner layer of the vas to ensure that the repair is water-tight. This is very important because the most common reason for failure is because of sperm leak out of the vas tp cause inflammation and re-blockage. Hence, the importance of a leak-proof closure.

b) Vasoepididymostomy

Vasoepididymostomy is a more complicated procedure that involves joining the vas deferens directly to the epididymis. This technique is employed if there is no sperm found at the testicle end of the vas. This technique bypasses any blockage within the vas as a consequence of extensive scarring from the previous vasectomy.

The success of vasectomy reversal can be categorized into patency rate (chances of having sperm present after reversal) and pregnancy rate. The patency rate for a vasovasostomy is about 90%. Patency rate for vasoepididymostomy is lower, around 60%. The pregnancy rate varies widely depending on which procedure is performed, age of the female partner, and the presence of sperm antibodies. In general, vasectomy reversals performed 10 years or more after vasectomy have a lower pregnancy rate.

Complications include:

  • scrotal haematoma (blood clot). This is due to excess bleeding and may need surgical evacuation if significant.
  • infection. The wound or epididymis may be infected, resulting in pain and fever. This may require 2 to 3 weeks of antibiotics.
  • sperm granuloma. This is a small lump that forms when sperm leaks from the vas into the surrounding tissue