(ASA). These are proteins that are created by the body to counter material seen as foreign. Our own sperms are not usually exposed to the blood stream and men do not normally have ASA. However, after vasectomy over 80% of men have ASA. Although commonly present in reversal patients they very rarely spoil post reversal fertility (a common myth in the UK).
An American term meaning rupture of the epididymis following vasectomy. Blow out is painless and can only be detected at operation. Blow out does not happen where granuloma is present. Otherwise the chances of blow out occurring increase (from zero) by 2 % per year after vasectomy.
The first 2-3 cm of vas above the epididymis is convoluted. It can be very narrow indeed with an unbelievably small lumen. Reversal in the convoluted vas is surgically challenging and requires the best microsurgery to make an effective connection in this area.
The process of preservation by freezing. We recommend that all reversal patients have some whole semen frozen after reversal when a good sperm count has been achieved (usually from 2-6 months post op).
The very long, thin tube connecting the testis to the vas. It is 6 metres long and just 0.2 mm in diameter. Thin, flimsy and prone to rupture when pressurised (blow out). It is tightly coiled and compacted. It feels like a cap on top the rugby ball shape of the testis. The sperm matures on it’s long journey from one end of the epididymis to the other.
A term adopted by the medical profession denoting the very best technique ever described for any particular procedure. The technique which all doctors should aspire to perform.
A swelling on the cut end of the vas, usually pea-size and shape but can be smaller or larger and lozenge shaped. Granulomata occur within days of vasectomy and are caused by imperfect closure of the vas leading to leakage of sperm. The body's reaction is to form a scar to contain the irritant fluid. Granulomas act as a pressure release valve, minimising back pressure on the epididymis, preventing "blow-out".
Literally, a collection of blood. Causes swelling of the wound after surgery. Haematoma is virtually the only possible complication of reversal. Only about 2% suffer from this. It resolves spontaneously and only very rarely affects the outcome.
Trade name for Midazolam, the sedative medication that we use. We have given over 5000 doses with only one mild reaction.
A tiny, temporary ink dot. Six or eight of these are evenly spaced on the cut end of the vas to enable super accurate re-connection of the vas. The Microdot was developed by Prof Goldstein in New York.
The Goldstandard reversal technique which rebuilds each layer of the vas in turn. Leads to higher sperm counts and less post reversal scarring.
The muscular wall of the vas, forms by far the greatest part of the wall and acts as a pump at ejaculation.
The appearance of any number (however tiny) of sperms in the ejaculate after reversal.
These are microscopic, globular cells present in the vas fluid at the time of reversal. To find a few is a normal occurrence if accompanied by sperms. However the finding of nothing but round cells in vas fluid indicates with certainty that blow out has occurred.
"Conscious sedation". An exciting, fast developing form of anaesthesia. A simple, safe sedative medication is injected into a vein to send the patient to sleep. In addition to this, local anaesthetic completely numbs the area being operated on. Ideal for day surgery because there are no nasty after effects, the effect is easily reversible and best of all is extremely safe.
The layers refer to the 3 layers of the tissue forming the vas. From inside to out these are the mucosa (skin), muscularis (muscle) and adventitia (sinews and blood vessels supplying nourishment) on the outside. A single layer reversal (vasovasostomy) involves stitching all 3 layers together with one suture. An old, simple- to- perform procedure that is prone to leaving a narrowing at the connection site.
Rugby ball shaped organ with two functions, sperm and testosterone formation. Both hormone and sperm generation continue almost indefinitely after vasectomy.
(Vas deferens). A thick, strong tube with a wall formed of smooth muscle. Contraction of this muscle during ejaculation acts as a very effective pump, propelling the sperms along the urethra and out! The outside diameter of the vas is 1.5 to 3 mm and the inside diameter (lumen) is just 0.2mm or less. The first 2-3 cm. of vas is convoluted to aid the pumping action and above there the vas is straight.
A connection between the vas and the epididymis. This is used to overcome absence of testicular end of the vas or blow out. Technically very demanding with worthwhile results only in a very few centres of excellence in the USA.
The operation to join two lengths of vas. A conventional ‘reversal’. There are many, perhaps 25 different ways to perform this procedure. These have been tried and clinically assessed. The best is termed the "goldstandard" procedure.
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