The Procedure The goal of vasectomy reversal is to surgically re-establish the flow of sperm from the testicle through the vas deferens. The vas deferens is a small structure, and the channel on the inside is even smaller due to the thick muscular walls of the vas. Precise surgical technique is essential to try and prevent scar tissue from re-blocking the channel after a reversal.
Vas-to-Vas or Vas-to-Epididymis There are two ways in which a vasectomy reversal can be performed. One option is to attach one end of the vas deferens to the other, which is called a vasovasostomy (or 'vas-to-vas' connection). The scarred, blocked areas (where the vas deferens had been cut, tied, burned, etc. during the original vasectomy procedure) are removed during the reversal procedure so that fresh healthy tissue is brought together for optimal healing. The other option is to connect the vas deferens to the epididymis, a procedure which is called a vasoepididymostomy (or 'vas-to-epididymis' connection). The epididymis is the structure which wraps around the side of the testicle, and is where sperm maturation takes place. The epididymal tubules are smaller than the vas deferens, and therefore it takes less scar tissue to block them off. Therefore, a vas-to-vas connection has a higher chance of success, and is always performed if possible.
Choosing Vas-to-Vas or Vas-to-Epididymis Until the time of the reversal, it is not known whether a vas-to-vas or vas-to-epididymis connection will be needed. The decision is made by examining the fluid that comes from the end of the vas deferens going towards the testicle when it is opened during the reversal procedure. A drop of this fluid is placed on a glass slide and examined under a tabletop microscope in the operating room. Vasal fluid is checked individually on each side. Favorable fluid (clear or thin and milky in appearance, sperm/sperm parts present) indicates that the path flowing from the testicle to the site of the prior vasectomy is not blocked and a vas-to-vas connection can be performed. However, if thick creamy fluid without sperm is found, then one of the delicate epididymal tubules has ruptured under the back-pressure- this typically does not cause any symptoms but does block everything beyond the rupture site. When this occurs, then the vas needs to be attached onto the epididymis above the rupture site (vas-to-epididymis connection). If the surgeon does not know how to perform a vas-to-epididymis connection in this scenario, then the procedure almost certainly will not be successful on this side. The chance of needing a vas-to-epidiymis connection increases with the more time that has passed since the vasectomy was performed.
What is involved in a reversal procedure? If the surgeon is doing a careful two-layered microsurgical reanastomosis, the reversal procedure takes approximately 3 hours of actual operating time. This is an outpatient procedure so there is no hospital admission involved. After the procedure, men are sore for a few days but can typically stay comfortable with several days of light activity, oral pain medications, and icing the area for 48 hours. People with desk-type work can typically return to work in 3-4 days. Men with jobs in which they are on their feet most of time can usually return to work in 5-6 days. Jobs which involve strenuous physical activity or heavy lifting usually require 10-14 days before returning to work.
