Vasectomy Reversals Blog

Does the technique and the type of sutures matter in vasectomy reversal?

The vas tubes are 3-5 mm wide in humans. The lumen of the tube is only 0.2-0.4 mm diameter. The cut end of the tubes during vasectomy can be disproportionate in diameter.

It makes sense to approximate the cut ends by aligning as perfect as possible. This is achieved by a three layers closure by using extremely fine sutures 10-0 and 9-0. Such fine sutures are used in eye surgery. This takes 1.5 to 2 hours per side and the total operation time can be from 3 to 5 hours depending on the difficulties and challenges encountered during the procedure. This can be only performed under the magnification of an operating microscope. We use three layer closure using 10-0 and 9-0 sutures.

Many surgeon still use old model 6-0 sutures under magnifying loops by one layer closure. This can be done in 1.5 to 2 hours. You need to ask your surgeon what technique they use in the operation and what suture material they use and how fine are those sutures.

Operating theatre costs are high and there will be pressure on the surgeons to do the procedure quickly to make the saving and achieve  profit.

Consultations– What’s Included?

 

When it’s possible, we  always encourages consultations and this is because it gives our team the opportunity to see if our patients are suitable for vasectomy reversals. Approximately 95% of men are able to proceed with a vasectomy reversal but we don’t want to see our patients suffer the inconvenience of a wasted procedure.

A typical consultation will include a discussion about microsurgery and the techniques we use; while there will also be counselling and an examination that allows us to see whether the sufficient tube remains for us to perform the reversal.

An appointment can then be made for your operation, yet it’s important to know that there is no standard vasectomy technique, so it’s important to acquire relevant information from our patients in their consultation. We can then offer you a personalised chance of success.

For overseas patients or patients coming from distant places where consultations are not always possible, we offer an examination that’s immediately followed by an operation, but there is always a slim chance that a patient is not able to proceed on the day.

The fee for face to face consultation is £150. This will be reduced from the procedure costs if you decide to go ahead with the procedure with us.

we also offer free no obligation Telephone consultations to discuss your needs and options and you can be booked for the procedure if  both of us are satisfied that it is the right option for you. Usually we send a summary of consultation and other documents and you may decide at your own choice. The telephone consultation is completely free.

Our patient Co-ordinator  Mrs. Barbara Temple is available weekdays to offer preliminary advice and arrange bookings for consultations. You can contact  her on 01642 939798.

 

Suitability for Vasectomy Reversals

Fortunately, most are suitable for vasectomy reversals (approximately 95%), but it’s important to have an initial consultation beforehand. The Dawson Microsurgery Clinic always encourages patients to visit and it gives us the opportunity to check that the sufficient tube remains for our surgeons to perform the reversal. Our face to face consultation will cost £150 which will be reduced from the procedure fee if you decide to go ahead with the procedure.

Our experienced assessment can save patents time and effort, but in cases where a pre-examination is not possible (such as out of town or overseas patients), we collect as much information as we can over the telephone. We then offer a ‘one-stop’ consultation and operation appointment with an enhanced deposit. Our telephone consultations  are free and we usually send a summary of consultation for you to think and decide.

Our pre-operative physical examinations include an assessment of the work necessary to repair the tube (vas), an estimation of the diameter and positioning of the vas, as well as ease of access. We also check each patient’s general health, while a consultation also includes an explanation on the factors of a successful operation and other practical instructions to follow afterwards.

Our only aim is to help our patients regain their fertility and the first stage is contacting our clinic manager for preliminary advice and consultation bookings. For more information call us  01642 939798.

Sperm extraction during vasectomy reversal – who benefits?

Sounds good. Couples exploring the subject of vasectomy reversal will read many web sites from all over the world. One of the seemingly attractive ad-ons to the procedure is sperm extraction. ‘If the reversal doesn’t work then at least we have benefitted because we have extracted some sperms that you can then use’ is the line. There is a cost, often £400 or so (plus storage charges etc.) which is added to you bill. But is this a good idea?

Using the sperms requires IVF You would think that it should be possible to just implant the sperms into your partner in a simple way like artificial insemination and try to conceive that way. The reality however is that the number of sperms recovered is low, in the region of one million or so. Sounds a lot? Not really, the number of sperms in a normal ejaculate is 80 million per ml, or 160 million in total. So, our million sperms extracted is too small a number for conventional fertilisation and so requires a variety of IVF called ICSI to be effective.

Extracting sperms damages vital tubes.

img1This is a diagram of the testis and the tiny narrow sperm collecting tube, the epididymis which lies on top of the testis.  Sperms mature in the epididymis, starting out as just a head then developing a rudimentary tail finally becoming the full swimming missile over the course of 2 months. The epididymis is 6 meters long and 0.2 millimeters in diameter, a fragile tube indeed.

Following vasectomy the epididymis is packed full of sperms and dead sperm debris, acting like a blown up bag or reservoir of sperms. Sperm extraction (PESA) is done by pushing a large bore needle through the skin and into the epididymis. It is possible, indeed likely that needling the epididymis in this way can rupture the epididymis and causes a blockage or ‘blow out’. Blow out is a scar that blocks the passage of sperms through the epididymis, preventing them reaching the vas which leading to failure of the reversal. So sperm extraction (PESA) may lead to failure of your reversal.

So when is better to do sperm extraction?

Only when all hope of successful surgery have been exhausted.  In the many UK reversal doctors outside this clinic do not test the fluid in the vas for early detection of ‘blow out’ so they don’t know at the time of reversal if this blockage has occurred. In fact we don’t recommend sperm extraction until the semen tests have been performed after reversal, until you have decided that IVF (ICSI) is for you and and you have chosen, after further research of course, your favoured IVF clinic.

Your decision is Ultimate

of course if you are still keen on harvesting the sperm during the reversal, unfortunately we are not attached to a fertility clinic. We can guide you to go to another centre where this facility is available.

Post Vasectomy Pain

Post Vasectomy Pain (PVP)

What is PVP?    

• A chronic relapsing testicular ache whose onset may be as little as 8 weeks to as long as 5 years or more post vasectomy.

• PVP may occur immediately after ejaculation or the pain may be of insidious onset over subsequent days.

• The pain is chronic, lasting for years with relapses usually lasting 1-4 days though very variable in frequency

• Often the pain is unilateral or at least more severe on one side than the other.

• PVP should, where possible, be a diagnosis of exclusion after investigation has failed to identify any other lumbar of urological abnormality’.

Differential diagnosis
We advise exclusion of lumbar spinal problems, prostatic disease, infection in the epididymis  and varicocoele.

Spectrum of severity
As with other diseases there is a spectrum of severity with symptoms varying from trivial and short lived, to severe and persistent. At its most severe PVP can affect the patient’s everyday life leading to irritability, depression and relationship problems. GPs, urologists and ultrasound departments will all be familiar with vasectomy patients reporting post vasectomy discomfort. Most PVP suffers will be reassured by the exclusion of testicular malignancy by a normal US Scan but some will require intervention.
Clinical findings
Examination generally shows a completely normal testis but a swollen, often tender epididymis in which there can be firm swellings, possible concretions due to sperm stasis. On the vas, sperm granuloma may be present but in our experience does not cause PVP.

Aetiology (causation)
Various suggestions have been made, neurological damage at the site of vasectomy, epididymal distension and formation of sperm granuloma. Investigation has shown that there are no histological correlations post vasectomy changes in the vas, epididymis or testis so the presence of PVP is an individual response to the vasectomy. At Dawson Microsurgery we believe that PVP is caused by pressure build up in the epididymis leading to distension of this delicate structure and its overlying fascia. Over the last 10 years we have performed reversal of vasectomy for approximately 24 PVP sufferers. We also have experience PVP as an incidental finding (over 100 cases) in men requiring return of fertility. Overall, reversal in this clinic leads to complete resolution of pain in over 90% of cases.
Treatment
Various teatments have been devised for PVP. These include excision of the  epididymis(Epidydimectomy)  converting the vasectomy to open ended and reversal of vasectomy and in extreme cases removal of testis.  In our view reversal is a good  option as this is a simple day case procedure without risk of significant complication and has a proven high success rate. Reversal of the vasectomy allows the accumulted sperms and fluid to drain freely thus allowing the epididymis to deflate and return to normal One word of caution, if the connection scars and closes the pain is likely to return, so excellence of technique, quality and accuracy of microsurgery, is all important.

As with any treatment for any pain, there is no guarantee of relieving the pain and of course there are risks associated with any treatments medical or surgical including Reversal.