Vasectomy Reversal

Vasectomy reversal is a microsurgery to revoke a vasectomy, in which a surgeon uses a surgical microscope to magnify the vas deferens. During the procedure, a surgeon reconnects each tube that carries sperm from a testicle into the semen. In a vasectomy reversal, your surgeon has to re-join these tubes back together so that sperm can reach the semen when you ejaculate. Following a successful vasectomy reversal, sperm is again present in the semen, and the patient may be able to get his partner pregnant.  Vasectomy reversal is a very complexed procedure, more difficult and expensive than a vasectomy. It requires specialized skills and expertise.

Patients may decide to undergo a vasectomy reversal for a number of reasons, including change of mind in wanting kids later in life or remarriage. A vasectomy can be reversed for more than 20 years following the original procedure.

Your surgeon will use general anaesthesia.

The surgeon will undertake the surgery in the Vasovasostomy technique as the primary one. Vasovasostomy – with this procedure the surgeon reconnects the ends of the tubes deferens after removing the blockage of each tube that carries sperm. If a vasovasostomy does not work or sperm is not present the surgeon will use another technique called vasoepididymostomy. Vasoepididymostomy – with this procedure the surgeon will attach the tubes deferens directly to the small organ at the back of each testicle that holds sperm. A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy will not work or sperm is not present.

Surgery takes about two to four hours.

Many factors affect whether a reversal is successful in fertility and getting your partner pregnant, including time since a vasectomy, your partner’s age, surgeon’s experience and training, and whether you had fertility issues before your vasectomy.

Please discuss the procedure with your doctor. Many questions will be answered by reviewing the pre-operative instructions given to each patient during the pre op consultation. Following these instructions will benefit the patient both during and following their procedure.

It is important to be aware of your general state of health prior to any surgical procedure. There are a variety of conditions that may affect the outcome of your operation. Please ensure to inform your doctor of your past medical history at the time of your pre-operative consultation. Some patients are asked to obtain cardiology clearance before proceeding with the operation.

You should also review your current medication list with your doctor. Please eliminate the use of blood thinners, including aspirin, and anti-inflammatory medications for several days before the surgery. You will also be asked to bring loose fitting clothing and an athletic supporter when you come to the clinic.

In general, vasectomy reversal is a safe procedure and complication rates are low. There are small chances of infection or bleeding, the latter of which can result in a hematoma or blood clot in the scrotum that needs surgical drainage. It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it might require emergency treatment to drain accumulated blood or blood transfusion.

Infection is unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.

If there is significant scar tissue encountered during the vasectomy reversal, fluid other than blood seroma can also accumulate in a small number of cases. The degree of scar tissue is unpredictable. Sometimes, depending on the location of the scar tissue, the scar tissue must be cut (called “lysis of adhesions”) in order to perform the operation. There are increased risks when a lysis of adhesions is necessary including injury to the intestines, prolonged operative times, and bleeding.

Painful  granulomas, caused by leaking sperm, can develop near the surgical site in some cases. Very rare complications include compartment syndrome or deep venous thrombosis from prolonged positioning, testis atrophy due to damaged blood supply, and reactions to anesthesia.

In rare cases, local allergies to tape, suture material, or topical preparations have been reported. Systemic reaction which are more serious may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.

As with any surgery and general anaesthesia involve risk. Unforeseen complications may result in a prolonged hospital stay.

After the surgery, your doctor will cover the incision with bandages. You’ll put on tightfitting undergarments, such as an athletic supporter. Remove dressings from inside the athletic supporter in 48 hours. Any stitches should dissolve in seven to 10 days.

Apply frequent ice packs (or frozen peas, any brand) to the scrotum the evening after the vasectomy reversal and the day after that for 24 hours to reduce swelling.

You should not drive directly after the surgery and have a driver arranged to take you back to your place.

Wear athletic supporter at all times for the first 4 weeks. After that, you’ll need to continue to wear one when you exercise.

Shower once the dressings are removed. For the first couple of days after surgery, avoid anything that might get the surgery site wet, such as bathing or swimming. Patients should take showers, rather than baths, for the first few days after surgery.

Take prescribed pain medication as directed. You may feel sore for several days. Pain after surgery is most often relieved with pills. Pain usually lasts a few days to a week. For most men, the pain isn’t severe and gets better after a few days to a week.

Resume a normal, well-balanced diet upon returning home or to the hotel. Drink a lot of fluids.

Normal, non-vigorous activity can be restarted after 48 hours or when feeling better. At home, you should relax and try to limit any activities that might cause the testicles to move around excessively.

Heavy activities such as jogging and weight lifting can be resumed in 2 to 4 weeks depending on the particular procedure.

If you have an office work, you’ll probably be able to return to work a few days after the surgery. If you work physically, talk to your doctor first about when it’s safe to go back to work.

Refrain from sexual intercourse for 4 weeks and the surgeon’s recommendations. Patients may resume sexual activity when they are comfortable, usually after 4 weeks. It is best to ask the urologist for their recommendation. Men may notice blood in their semen, which is normal.

The semen is checked for sperm at between 6 and 12 weeks post-operatively and then depending on the results may be requested monthly semen analyses are then obtained for about 6 months or until the semen quality stabilizes.

You may experience discomfort after the vasectomy reversal. Symptoms that may not require a doctor’s attention are: (a) light bruising and discoloration of the scrotal skin and base of penis. This will take one week to go away. b) limited scrotal swelling (a grapefruit is too large); (c) small amounts of thin, clear, pinkish fluid may drain from the incision for a few days after reversal surgery. Keep the area clean and dry and it will stop.

As a result of general anesthesia, a sore throat, nausea, constipation, and general “body ache” may occur. These problems should resolve within 48 hours.

Recovery takes about 2 – 4 weeks.

Consider calling a provider for the following issues: (a) wound infection as suggested by a fever, a warm, swollen, red and painful incision area, with pus draining from the site. Antibiotics are necessary to treat this. (b) scrotal hematoma as suggested by extreme discoloration (black and blue) of the skin and continuing scrotal enlargement from bleeding underneath. This can cause throbbing pain and a bulging of the wound. If the scrotum continues to hurt more and continues to enlarge after 72 hours, then it may need to be drained.

About the procedure

Vasectomy reversal is a microsurgery to revoke a vasectomy, in which a surgeon uses a surgical microscope to magnify the vas deferens. During the procedure, a surgeon reconnects each tube that carries sperm from a testicle into the semen. In a vasectomy reversal, your surgeon has to re-join these tubes back together so that sperm can reach the semen when you ejaculate. Following a successful vasectomy reversal, sperm is again present in the semen, and the patient may be able to get his partner pregnant.  Vasectomy reversal is a very complexed procedure, more difficult and expensive than a vasectomy. It requires specialized skills and expertise.

Patients may decide to undergo a vasectomy reversal for a number of reasons, including change of mind in wanting kids later in life or remarriage. A vasectomy can be reversed for more than 20 years following the original procedure.

Your surgeon will use general anaesthesia.

The surgeon will undertake the surgery in the Vasovasostomy technique as the primary one. Vasovasostomy – with this procedure the surgeon reconnects the ends of the tubes deferens after removing the blockage of each tube that carries sperm. If a vasovasostomy does not work or sperm is not present the surgeon will use another technique called vasoepididymostomy. Vasoepididymostomy – with this procedure the surgeon will attach the tubes deferens directly to the small organ at the back of each testicle that holds sperm. A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy will not work or sperm is not present.

Surgery takes about two to four hours.

Many factors affect whether a reversal is successful in fertility and getting your partner pregnant, including time since a vasectomy, your partner’s age, surgeon’s experience and training, and whether you had fertility issues before your vasectomy.

Preparation

Please discuss the procedure with your doctor. Many questions will be answered by reviewing the pre-operative instructions given to each patient during the pre op consultation. Following these instructions will benefit the patient both during and following their procedure.

It is important to be aware of your general state of health prior to any surgical procedure. There are a variety of conditions that may affect the outcome of your operation. Please ensure to inform your doctor of your past medical history at the time of your pre-operative consultation. Some patients are asked to obtain cardiology clearance before proceeding with the operation.

You should also review your current medication list with your doctor. Please eliminate the use of blood thinners, including aspirin, and anti-inflammatory medications for several days before the surgery. You will also be asked to bring loose fitting clothing and an athletic supporter when you come to the clinic.

Precautions

In general, vasectomy reversal is a safe procedure and complication rates are low. There are small chances of infection or bleeding, the latter of which can result in a hematoma or blood clot in the scrotum that needs surgical drainage. It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it might require emergency treatment to drain accumulated blood or blood transfusion.

Infection is unusual after this type of surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary.

If there is significant scar tissue encountered during the vasectomy reversal, fluid other than blood seroma can also accumulate in a small number of cases. The degree of scar tissue is unpredictable. Sometimes, depending on the location of the scar tissue, the scar tissue must be cut (called “lysis of adhesions”) in order to perform the operation. There are increased risks when a lysis of adhesions is necessary including injury to the intestines, prolonged operative times, and bleeding.

Painful  granulomas, caused by leaking sperm, can develop near the surgical site in some cases. Very rare complications include compartment syndrome or deep venous thrombosis from prolonged positioning, testis atrophy due to damaged blood supply, and reactions to anesthesia.

In rare cases, local allergies to tape, suture material, or topical preparations have been reported. Systemic reaction which are more serious may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.

As with any surgery and general anaesthesia involve risk. Unforeseen complications may result in a prolonged hospital stay.

Convalescence

After the surgery, your doctor will cover the incision with bandages. You’ll put on tightfitting undergarments, such as an athletic supporter. Remove dressings from inside the athletic supporter in 48 hours. Any stitches should dissolve in seven to 10 days.

Apply frequent ice packs (or frozen peas, any brand) to the scrotum the evening after the vasectomy reversal and the day after that for 24 hours to reduce swelling.

You should not drive directly after the surgery and have a driver arranged to take you back to your place.

Wear athletic supporter at all times for the first 4 weeks. After that, you’ll need to continue to wear one when you exercise.

Shower once the dressings are removed. For the first couple of days after surgery, avoid anything that might get the surgery site wet, such as bathing or swimming. Patients should take showers, rather than baths, for the first few days after surgery.

Take prescribed pain medication as directed. You may feel sore for several days. Pain after surgery is most often relieved with pills. Pain usually lasts a few days to a week. For most men, the pain isn’t severe and gets better after a few days to a week.

Resume a normal, well-balanced diet upon returning home or to the hotel. Drink a lot of fluids.

Normal, non-vigorous activity can be restarted after 48 hours or when feeling better. At home, you should relax and try to limit any activities that might cause the testicles to move around excessively.

Heavy activities such as jogging and weight lifting can be resumed in 2 to 4 weeks depending on the particular procedure.

If you have an office work, you’ll probably be able to return to work a few days after the surgery. If you work physically, talk to your doctor first about when it’s safe to go back to work.

Refrain from sexual intercourse for 4 weeks and the surgeon’s recommendations. Patients may resume sexual activity when they are comfortable, usually after 4 weeks. It is best to ask the urologist for their recommendation. Men may notice blood in their semen, which is normal.

The semen is checked for sperm at between 6 and 12 weeks post-operatively and then depending on the results may be requested monthly semen analyses are then obtained for about 6 months or until the semen quality stabilizes.

You may experience discomfort after the vasectomy reversal. Symptoms that may not require a doctor’s attention are: (a) light bruising and discoloration of the scrotal skin and base of penis. This will take one week to go away. b) limited scrotal swelling (a grapefruit is too large); (c) small amounts of thin, clear, pinkish fluid may drain from the incision for a few days after reversal surgery. Keep the area clean and dry and it will stop.

As a result of general anesthesia, a sore throat, nausea, constipation, and general “body ache” may occur. These problems should resolve within 48 hours.

Recovery takes about 2 – 4 weeks.

Consider calling a provider for the following issues: (a) wound infection as suggested by a fever, a warm, swollen, red and painful incision area, with pus draining from the site. Antibiotics are necessary to treat this. (b) scrotal hematoma as suggested by extreme discoloration (black and blue) of the skin and continuing scrotal enlargement from bleeding underneath. This can cause throbbing pain and a bulging of the wound. If the scrotum continues to hurt more and continues to enlarge after 72 hours, then it may need to be drained.

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