Doctors usually perform vasectomy reversals at a surgery center or hospital. The procedure is generally done on an outpatient basis — without an overnight stay.
Your doctor may use general anesthetics to make you unconscious during surgery. Or your surgeon may give you an anesthetic that keeps you from feeling pain, but doesn't put you to sleep — such as an epidural, spinal or local anesthetic.
Vasectomy reversal is more difficult than vasectomy. It requires specialized skills and expertise. Doctors can perform this surgery in one of two ways:
- Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure, the surgeon sews back together the severed ends of the tubes that carry sperm (vas deferentia).
- Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the the small organ at the back of each testicle that holds sperm (epididymis). A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy can't be done or isn't likely to work.
You probably won't know ahead of time which technique is needed. In most cases, the surgeon decides during the operation which technique will work best. Sometimes a combination of the two surgical techniques is needed — a vasovasostomy on one side and a vasoepididymostomy on the other.
During the procedure
During surgery, your doctor will make a small cut (incision) on the underside of your scrotum. This will expose the testicle and release it from surrounding tissues. Next, the doctor will cut open the tube that carries sperm (vas deferens) and examine the fluid inside. When sperm are present in the fluid, the ends of the vas deferens can be connected to re-establish the passageway for sperm.
If the fluid is thick or pasty, or if it contains no sperm or partial sperm, scar tissue may be blocking sperm flow. In this case, your doctor may choose to perform a vasoepididymostomy.
Immediately after surgery, your doctor will cover the incisions with bandages. You'll put on an athletic supporter to hold bandages in place and to apply pressure to reduce swelling and limit movement.
You may be sore for several days. If your doctor places bandages after your surgery, ask when it's OK to take them off. Any stitches should dissolve in seven to 10 days.
After you return home, take it easy. Periodically using an ice pack on your scrotum will help reduce swelling. As the anesthetic wears off, you may have some pain and cramping. For most men, the pain isn't severe and gets better after a few days to a week.
Your doctor may also give you the following instructions:
- Wear an athletic supporter for several weeks at all times, except when showering. After that, you'll need to continue to wear it during exercise.
- For the first two days after surgery, avoid anything that might get the surgery site wet, such as bathing or swimming.
- Refrain from sports and heavy lifting for two to three weeks.
- If you have a desk job, you'll probably be able to return to work a few days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's safe to go back to work.
- Don't have sexual intercourse or ejaculate until your doctor says it's OK. Most men need to refrain from sex for two to four weeks after surgery.
If your doctor finds sperm during surgery, you may choose to have some frozen in case your vasectomy reversal doesn't work (cryopreservation). If you're not able to father a child through sexual intercourse, your frozen sperm may be injected directly into your partner's egg. This is a type of in vitro fertilization called intracytoplasmic sperm injection (ICSI).
Talk to your doctor about whether freezing sperm may be an option for you. Ask about the possible benefits and cost of the procedure. It isn't always available, and doctors have differing opinions about its effectiveness.
Feb. 09, 2013
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