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PROCEDURE
With the patient under local anesthesia, a ½ inch incision is made in the scrotal skin over the old vasectomy site. Using a microscope, the two ends of the vas deferens are found and freed from the surrounding scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope. Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm. There are 3 possible situations that may be encountered when examining the vassal fluid. The first, most common, and best situation is that the vassal fluid will contain whole sperm. The second possible scenario is that the fluid is thin and contains only sperm parts or no sperm. The third is that the fluid is thick, pasty and contains no sperm. This last phenomenon usually means that there is an obstruction called an epididymal blowout. This means that the vas is obstructed at two levels; at the vasectomy site and by rupture of the tube in the epididymis. In addition to the vasovasostomy, a vasoepididymostomy must be performed. The surgeon cannot make this determination by age of vasectomy but only by examination of the semen. Both sites require repair for a successful outcome, and these procedures can be accomplished at the same time. If the second procedure must also be done, there is not an additional charge.
The microsurgical repair is done using a Carl Zeiss OPMI-MDM operating microscope using 10-0 nylon suture. This suture is as delicate as a spider’s web. The repair requires 12-15 stitches. The goal is to create direct and careful alignment of the lumen of the two ends of the vas and a watertight closure. The technique for VE (vasoepididymostomy) is a microsurgical invagination of the epidymal tube into the lumen of the vas deferens also using 10-0 nylon suture.
SOME ANSWERS
WOUND PROBLEMS - Should you have any concerns about the wound, it helps to e-mail a picture (dean@vas-reversals.com) along with your phone call so we may discuss the concern. Please remember, do not hesitate to call if you need an immediate answer.
It is possible to have a small amount of occasional discomfort for up to a year after surgery, especially in the groin and/or inguinal area.
Only healthy sperm will fertilize an egg. There is NO need to be concerned about old sperm that has not cleared through the system.
SEMEN ANALYSIS - If you are not pregnant in 4 months, have a semen analysis at your local lab (anywhere you would get blood drawn - hospital lab or outpatient lab) using the prescription given to you the day of surgery (call or e-mail if you need a new one). Your insurance may or may not cover this expense. You do not need to see another doctor for this. The lab will fax the results to Dr. Roeder (830-629-0224) usually within a week, and he will then call you with the results. For this reason, make sure to let us know if your telephone number changes. We recommend waiting 4 months because if you give yourself a chance to get pregnant, there may be no need for the trouble and expense of having this lab work done. Also, waiting a few months usually gives a more accurate result.
Many people are concerned because they had intercourse before 21 days, had an ejaculation during their sleep, or may have done physically more than they should have. Do not let this worry you. These are precautionary measures. DO WHAT YOU CAN TO FOLLOW THE INSTRUCTION, but do not let a mistake upset you too much. There is simply no way of knowing whether or not you have caused any damage. Some people do everything right and do not have a successful outcome, whereas others make mistakes with no repercussions.
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