Reversal of Vasectomy

Reversal of Vasectomy

Vasectomy reversal can be done as a day case. It is done under general anaesthesia and usually 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 is examined for presence of sperms. If the vasal fluid does contain sperm, the two ends of the vas deferens can be joined together. The lumen within the vas deferens is only 0.2 to 0.3 mm in diameter. An operating microscope is used so that fine sutures can be precisely placed. These fine sutures are half the thickness of a human hair. Some 6 interrupted sutures are placed in the inner layer of the vas to ensure that the repair is water-tight. This is very important because one reason that vasectomy reversals fail is that sperm leak out from the vas cause inflammation and re-blockage. Hence, the technique requires a water-tight 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 deferens as a consequence of extensive scarring from the previous vasectomy operation.

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 should be 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.