Vasectomy Reversals

Vasectomy Reversals

Over the years surgeons have tried many techniques to reverse vasectomy, these include insertion of plastic pipes (stents), protein glue, and laser guided stitching etc but trials have shown that the goldstandard procedure is reconstruction of this living tube with microsurgery. The inside diameter of the vas is just 0.2-0.4mm, so infinite care and microscopic stitches that do not obstruct the flow of sperms are required to make a reconnection that will be as close to the original as possible. Experience, training and specialist equipment leads to good operations and good results (see below).

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Suitability for vasectomy reversal

First of all - let me say that we treat all patients with the same non judgmental attitude. We accept that when you chose to have a vasectomy you did so with the best of intentions and in the belief that under the circumstances you made the correct decision for you at that time. Personal circumstances change and we are simply here to help you regain your fertility.

What sort of people have a vasectomy reversal?

Our patients cover a range in age from 24 to 54 , and interestingly there are as many in the 38-54 age bracket as there are in the 28-37 years old bracket. Approximately 88 % of patients have formed a new relationship and wish to consolidate this with a child between them, 10% of patients just decide they just want to change their minds and want more children (usually as they become better off or their children grow up and are less demanding). The remainder just feel dissatisfied with their vasectomy or have post vasectomy pain syndrome and wish to be returned to 'normal'.

The reversal process Consists of the following simple steps:

  • Visit to the Clinic for discussion, counselling and examination.
  • Appointment made for operation.
  • Operation - Monday,Tuesday afternoons and Wednesday morning.
  • Recuperation. Strict rest for 4 days (until the weekend) then back to sedentary work the following Monday.
  • No sex for 3 weeks. Semen tests after 6-8 weeks . See below for details.

Out of town patients

Our patients come from all over Britain and abroad. Obviously it is impractical to pre-examine these patients. We therefore arrange an appointment for them to come along for examination followed immediately by operation - providing they are suitable. Fortunately approx. 90% of patients are suitable so there is only a slim chance of not being able to proceed on the day. We give you details of local overnight accommodation, usually at the local Travel Inn which overlooks the local marina.

What happens at the pre-op Examination? 

  • Physical examination. Assessment of the work needed to repair the tube (vas). Estimation of the diameter of the vas (occasionally the vas is very fine and fragile), the positioning of the original vasectomy along the length of the tube to assess the length of the distal remnant and finally the ease of access to the vas. Also important is the patient's general health (diabetes, blood pressure etc.) and any previous surgery to the groin area. Finally an important factor is that you must be happy and relaxed at the prospect of having a local anaesthetic operation with the help of sedation therapy.
  • Explanation of the factors that make for successful reversal.
  • Review of the literature and research on reversal.
  • Video and or slide show of the operation taking place.

What features make for a successful reversal?

Put very briefly five main items :-

A long distal remnant.
The original vasectomy can be done anywhere between the convoluted vas and the groin ! The longer the tube left on the testicular end of the vas the greater the surface of tube there is to disperse the pressure build up following vasectomy which in turn lessens the chances of a 'blow out' blockage in the epididymis.

Sperm granuloma.
This is swelling the size of a small pea on the top end of the distal vas. A granuloma acts as a pressure release valve and reduces the chances of blockage in the epididymis.

Recent vasectomy.
Reversals up to ten years after vasectomy carry a high success rate but after this time there is a steady decline although we have known success even after 20 years !! Microsurgery. This means the placing of the stitches used to repair the tube very accurately with the aid of a microscope. The inner tube of the vas (lumen) measures only 0.2 mm so ultra fine stitches (9.0 and 10.0 - as fine as a human hair) are needed to repair the tube without obstructing it.

Microsurgical training.
Microsurgery requires special training and constant practice to acquire the necessary skills and maintain them. Dr Dawson performs microsurgical reversals at least twice a week and was trained in one of the finest microsurgery centresin the world at New York's Cornell University.
What do these medical terms mean? Testis - generates sperm cells and testosterone (male hormone).

Epidiymis
very long thin walled supercoiled tube lying on top of the testis rather like a beret on top of a rugby ball. The sperms enter this structure as babes and emerge at the far end as lively young men.

Vas
the tube that carries sperms from the testis to the sperm reservoirs at the base of the bladder. This measures from 1.5-2.5 mm in diameter with a thick muscular wall and a tiny inner tube (lumen) measuring just 0.2 mm.

Convoluted vas
the first portion of vas after the epididymis the vas here is still thin walled and maybe only 1 mm in diameter still tightly coiled.

Vasectomy
literally 'vas'+'ectomy' i.e. removal of a portion of vas to block the passage of sperms.

Vasovasotomy
a connection between two lengths of vas.

Distal vas
the lower portion of vas still attached to the testis after a vasectomy.

Proximal vas
the upper portion of vas still attached to the body.

Vasoepididymostomy - a connection from the vas to the epididymis.
How is the operation performed? In brief, very much the same way the operation is done in the USA ('the home' of reversal surgery).

Premed
We give a sedative premed injection which provides relaxation and pain relief.

Local anaesthetic
This is chosen to act quickly - within seconds - and last for hours. We proceed carefully and slowly - freezing each area in turn.

Operation
Lasts approx. 1½ hour each side.

  • We locate the vas and the site where the original vasectomy blocked the tube.
  • Then we section the tube above and below this area to locate fresh open vas. At this stage we check that the reproductive tract is still functioning by flushing the upper vas with saline and sampling fluid from the testicular vas under the microscope.
  • Vasovasostomy ie. joining the ends of vas together using special very fine stitches thinner than a human eyelash (10.0 double armed Nylon sutures specially made in the USA). The medical description of our operation is 'Multi-layer, microdot microsurgical vasocasostomy'. In this exquisite procedure devised by professor Goldstein, the inner tube of the vas that carries the sperms is microsurgically stitched together followed by the muscle of the wall of the vas. Then the overlying tissue is closed over the top of the repair for strength and to ensure blood supply.

Afterwards.
There are two scars approx. 3 cm long - one on each side of the scrotum. We usually close these with a dissolving stitch buried under the skin so that there is no need for further visits to the Clinic. After taking tea and biscuits the patient is accompanied home to rest.

On the night of operation
We recommend that if you live further than an hour's drive away then you stay the night in a local hotel. We recommend the local Travel Inn. This clean and inexpensive hotel (approx £30 ($43) is well located overlooking the yachts in Hartlepool Marina.

Return to work.
Most reversals are performed at the beginning of the week with a view to rest until Saturday then mobilisation over the weekend and back to work the following Monday just five to seven days after operation.

How will I know if the operation was successful?
We arrange an initial semen test for 6-8 weeks post-operatively by which time we would expect a return of small numbers of sperm to the semen. Return to full fertility can take 6-8 months so we ask your local GP to arrange for further tests at a pathology lab near you.

What are my chances of becoming fertile again?
This depends on many factors but chiefly the length of time since your vasectomy was performed. This is because the likelihood of the tubes being blocked increases with each year that goes by, however, the operation is successful in more than 80 % of men who have the reversal within up to 10 years after vasectomy. Even if the vasectomy was done more than 10 years ago there is still a worthwhile chance of success

Table to show success rates of last 517 consecutive patients treated in the Hartlepool Clinic

Yrs post vasy No. Patients Not tested Neg Pos %
1-5 148 26 6 115 94%
6-10 182 36 26 120 82%
11-15 101 31 14 56 80%
16-20 53 19 8 26 76%
21-24 17 3 4 10 59%
25-30 16 7 1 8 N/A
Total No. 517        

Comments

The table covers over 500 patients treated here over the last 3 or so, the largest and most successful series ever produced by a UK surgeon. The patients in the ‘not tested’ column have either been too recent to submit a test or have been ‘lost to follow up’ usually because they do not wish to be tested or have emigrated or moved. The results show much a slower than expected decline in success with advancing years after the vasectomy confirming that vasectomy reversal is always the procedure of first choice.

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Successful reversal after 20 years + Ian and Lucia from Scotland started their fertility quest back in 2009.... https://t.co/2siJ2qtUmb
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the 7 steps

Information about the microdot multilayer procedure.

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