Welcome To The Best Life Microsurgery Clinic
What is Vasectomy Reversal ?
Vasectomy reversal (Snip Reversals or Reversal of Male Sterilisation) is the operation to identify the cut ends of the vas (which has minute diameter of 0.2 - 0.4 mm) that carrries sperms from Testis to the penis and reconnect them to give the chance to become fertile again.
The main principles of this operation inlcude the following
Achieve the best possible alignment of the minute openings (lumens) of both cut ends that could be of different diameters
Connect them in a leak proof manner as leakage can cause blockage of the connection
Preserve the blood supply to the vas throughout the procedure as careless handling may compromise the blood supply and cause scarring & blockage.
If these principles are not adhered to, the operation is likely to fail due to blockage at the connection.
What are the types of Reversal Operations & How the procedure is chosen at the time of the operation?
Two types of procedures are available to deal with the intentional blockage caused by the vasectomy. If your surgeon or the clinic does not have the skills and resources to do both type of procedures, the reversal will be incomplete in a proportion of men who had late consequences of vasectomy such as blow-out or blockage upstream at the level of epidydimis.
Vaso-vasostomy: This means connecting the cut ends (segments) of the vas. This is the most common reversal procedure needed that carries the best possible outcome.
Vaso-Epididymostomy: If there is blockage upstream at the level of epididymis due to damage by back pressure called Blow-out, simply connecting the cut ends will not be helpful. The vas will need to be connected directly to the even more minute tube, epididymis.This is called Vaso-epididymostomy. Not many surgeons in the UK take steps to diagnose the blow out and do vaso-epididymostomy. You need to check that with the surgeon. The risk of blow-out goes up with every passing year since vasectomy.
How are Vasectomy Reversals performed in the UK?
Unfortunately there is no standardised way of doing the vasectomy reversal in the UK.The reversal operations are done in the following ways.The type of procedures is chosen mostly due to limitations in surgeon's experience, resources, need to limit the operation time and the need to offer the procedure in a cost effective way. Therefore it may not necesssarily be at the only interest of the patient. So you need to make your research and choose the clinic and surgeon diligently.
Reversal without Microscope and using larger stitches with bigger needles (substandard currently and don't even consider this option)
Surgeons use magnifying loupes that give atmost 2-3 times magnification and 6-0 stitches that contain needle that is as thick as the half of the lumen of the vas. This is a very basic way of doing this procedure. The tube ends are joined with 6 stiches on a single layer. It may take 60 to 90 minutes to do this procedure.This is a no-go area if you want to have a predictable result.
Reversal using Operating Microscope but larger needles and stitches (Not current Best Standard)
Surgeons use similar material as above but with the help of an operating microscope. Here the operating microscope provides bit more magnification. But its power of magnification is not put to full use as surgeons choose the easy and less demanding way of using larger sutures (with larger needles) and conventional instruments. The operation is done in one layer of 6 - 8 stiches and will take just about 90 minutes. This technique is widely used in the UK to drive down the costs by limiting the expensive operating theatre and surgeon time while claiming it as microsurgery (arguably incorrect in our opinion). This procedure will work only if the quality and dimension of the tubes are relatively strait forward. But the patient or the surgeon cannot assure that until at the time of the operation. Please see in the pictures below, which is from one of the patients who came to us for redo-reversal surgery after the failed reversal from another high volume centre in the UK. In the previous centre, they have used 6-0 stitches (bluish coloured) which are thick stitches with thicker needles that has unfortunately blocked up. You can see the second photo below and compare the size of the 10-0 black suture that was used in our redo-procedure and the finished product that shows the nicely aligned vas.
Reversal using operating Microscope and Advanced Multilayer Microsurgery ( Current Best Standard)
The best possible alignment of the tubes can be only achived by multilayer microsurgery reversal using very minute 10-0 or 9-0 stitches. It is so important to connect the inner layers (mucosal layer) of the vas separately to keep the connection site (anaestamosis) open or patent. In real life, during the operation, the inner layer can look very collapsed with diameter of the opening varying from 0.2-0.4mm. That is the reason, the multilayer surgery carries a distinct advantage. This method using two layers was initially described by two different surgeons (Silber and Owen) in 1977. They described two layer technique which raised the successful outcomes from over 40% to more than 90%. Further development brought by Professor Goldstein at New York’s Cornell University was called Microdot Multilayer Microsurgical Vasovasostomy (MMMV) which is the world’s gold standard procedure. This involves using three or more layers to reconnect the tubes. This helps to realign the tubes of varying diameters even in the mist of challenging situations such as extremely thin tubes.
What do we offer in Best Life Clinic? Only the Current Best Standard.
We offer the same advanced Microdot Multilayer Microsurgical Vasovasostomy (MMMV). This service is unique in the UK. We are very cost effective and may be even less expensive than some of those clinics offering basic procedures. You can very easily identify from how long the actual operation takes and what size stiches the surgeons are using. Please do not hesitate to ask that question. We have not come across any other surgeon in the UK fully transparent that they do this multilayered procedure though this is the standard of care in most male-infertility centres in the United States. This operation usually takes four hours using expensive purpose made sutures. The full magnification power of the operating microscope will have to be used during the difficult and minute steps of the procedure.
We also perform Vaso-Epididymostomy in the event of Blow-out that is diagnosed at the time of the operation. So there is hope even if there is a blow-out. At the time of the procedure, we check the fluid from the testicular end of the vas multiple times. This is to ensure that the procedure we are doing carries the highest possible chances of success.
Which procedure should you choose?
Please do your research and read through the materials on our website. Based on that, it is upto you to make your informed choice. The surgeons using basic techniques may claim that their techniques are working. It is true, the nature's healing mechanism is so wonderful, there is even a chance of spontaneous natural reversal in one out of 2400 men undergoing vasectomy. So all procedures will work to some extent, but do you want to settle for some thing less than the current best-standard. If the surgeon can do only one type of basic reversal procedure, the outcome is left to the chance of you being the right patient for that surgeon. But it should be other way round. The surgeon should have skills and resources to make the procedure right for you as per the needs arising at the time of the operation. The needs can be very challenging such as loss or damage to long segment of vas, extremely thin vas, varying diameters of the cut-ends of the vas, vas being cut very close to the epidydimis and blow outs.
We can assure that we are capable and resourced to deal with all of these Challenging situations because of our unique factors and resources mentioned below.
- Ability to offer Advanced Multilayer reversal
- Allocation of four operating hours
- Resources & skills to do vaso-epidydimostomy at the same sitting
We are here to help with the assurance that Best Life Clinic always offers the current Best standard of service and try our Best to make the procedure right for you. So call us today Tel: 01642 939798
The clinic in its previous name Dawson Micro-Surgery Clinic was founded in 1994 by Dr Dawson. After performing more than 2000 reversals and having helped to create literally many hundreds of new lives and happy families, Dr Dawson has retired. The service and the rest of the highly experienced and dedicated team is currently based in Best Life clinic in Stockton on Tees and the service is led by Mr Manohar Jesuraj, Consultant Urological surgeon. This service is going from strength to strength with the same team of highly experienced nurses and support staff.
At Best Life Clinic, our style and philosophy of care is to put you at the centre of our attention while striving to achieve higher levels of excellence. We fully appreciate that our customers (patients) come from all walks of lives and backgrounds. But they all have a single higher dream of having the priceless gift ' a New Baby'. Whatever the situation you are coming from, we are here to welcome you and have the privilege and honour of helping you to achieve your dream of becoming a parent again. We will put to the full use of all our Efforts, Expertise, Equipments and Experience in serving you.
Vasectomy Reversals Service
To find out more about our reversal service and also its potential suitability click on the links below or contact us for free Telephone consultation and you will receive a free consultation document with personalised chances of outcome to help you to make the decision.