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Vasectomy Reversal

When the vas deferens is divided at the time of vasectomy, sperm continue to be produced in the testicles on each side. Most of this sperm is either reabsorbed by the body or accumulates in the epididymis, the small gland located behind each testicle where sperm normally mature and gain the ability to swim.

The epididymis is a very fine, single tube that is prone to blockage when a long time interval has occurred between vasectomy and vasectomy reversal.

There are two possible operations that should be offered to complete a successful vasectomy reversal. Both operations are performed through small incisions in the scrotal area. The decision for which procedure to do will be decided at the time of surgery when the present fluid at the testicular side of the vasectomy site in the vas tube is examined.

Two Possible Operations

If there are sperm present at this site, a two-layer, microsurgical connection of the two ends of the vas will be performed. This is known as a vasovasostomy. If there are no sperm present, that means obstruction to the sperm flow has occurred in the epididymis. In this instance, a standard vasovasostomy will not be successful and the second option of surgery will be performed.

The second option of surgery consists of connecting the vas tubes to the epididymal tube in a location close to the testicle, thereby passing the blocked site in the epididymal tube. This is known as an epididymovasostomy.

As mentioned above the decision to perform which operation is made at the time of surgery. However, there are some factors that can help predict which operation will be necessary.

Here are some factors that would favor the ability to perform a vasovasostomy:

  1. Time from vasectomy < 10 years
  2. Vasectomy performed higher in the scrotum away from the epididymis
  3. The presence of a small “pea-sized” lump at the vasectomy area

Conclusion

It should be noted that the findings at the time of surgery may not be the same on each side. This means that it may be possible for a vasovasostomy on one side and an epididymovasostomy on the other side.

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