Microsurgical Vasectomy Reversal

Although intended to be a permanent procedure, circumstances can change and a vasectomy reversal procedure is available to men who wish to father children naturally after vasectomy. It is estimated that 2-6% of men seek reversal after vasectomy.

The vasectomy reversal procedure relies on accurately rejoining the cut ends of the vas deferens (vaso-vasostomy), the inner surface of which measures only 0.3mm in diameter.   The success of the procedure depends on the skill of your surgeon and their use of modern microsurgical techniques.   A microscope should be used to perform this delicate work with precision, using a multilayer microdot technique.

Success rates (defined by sperm returning to the ejaculate) can be upward of 90%. The natural pregnancy rates following a vaso-vasostomy are over 50%.  These rates can decrease if it has been a long time since your vasectomy or if there are other problems with your testicular health or the fertility of your partner.

Under general anaesthetic two small incisions are made on the scrotal skin to allow access to the vasectomy site.  The vas deferens is isolated and any scar tissue or unhealthy vas from the previous vasectomy is removed.  A microscope is used to analyse the fluid coming from the reopened vas deferens to confirm the presence of sperm.  The microscope is then used to perform a two layer microdot assisted vasectomy reversal.  This involves using an inner layer of 6 fine (0.025mm diameter) sutures to make sure the inner sperm carrying tube of the vas rejoins, and then using 10 or more outer sutures to ensure a solid and robust closure.  The skin is then closed with dissolvable sutures and local anaesthetic is applied. 

The old vasectomy site is identified and scar tissue is removed until there are two healthy ends of the vas deferens
The sperm carrying lumen (inner tube) can be seen within the thicker wall of the vas
A microsurgical marker is used to plan the surgical approach and ensure eventual alignment with a watertight seal
The back wall of the anastomosis is approximated with  3 microsurgical (0.025mm diameter) sutures
The front wall is approximated with 3 more sutures
After carefully tying the sutures, the result is a beautifully aligned and sealed lumen
8-10 Heavier sutures are used to secure the outer layer of the vas and ensure a durable result

If there is no fluid (or no sperm within the fluid) from the reopened vas deferens, it may indicate scarring within the tube downstream.  Attempts will be made to find a segment of vas which is able to drain sperm, but if this is not possible a vaso-epididymostomy will be performed.  This involves attaching the vas directly to the epididymus, which is the system of fine tubes where the sperm collects before draining into the vas deferens.  This is a much more demanding and delicate procedure than a regular vasectomy reversal and the outcomes are not as good.  

Generally you will be able to go home the same day.  You will need to take it easy for a few weeks to allow recovery.  More detailed instructions about recovery are available here.