What is Vasectomy Reversal?
This is the operation performed for men to regain fertility after previous vasectomy (Snip). Though men undergo vasectomy with the intention of achieving permanent contraception, due to changing life’s situations, six percent of men regret their decision and some of them prefer to undergo reversal operation.
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.
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: 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: 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 manage 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 if the quality and dimension of the tubes are relatively straitforward. But the patient or the surgeon cannot assure that until at the time of the operation.
- Reversal using operating Microscope and advanced Multilayer Microsurgery: 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. Thats is the reason the multilayer surgery carries 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?
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 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. 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.
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. Preserving the patency of the ultra minute lumen (opening) of the vas is the essence of the procedure. This can be only achieved by highly skilled and Experienced team and specialist equipment.
We also perform Vaso-Epididymostomy in the event of Blow-out that is disgnosed 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.
Who is suitable for vasectomy reversal?
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. If you had vasectomy within the last 10 years and if your partner is less than 35 years, you are best placed to have a reversal and achive a natural pregnancy. Even if the interval since vasectomy is longer, still there is fair chance of achieving patency but the success in achieving the pregnancy depends on other factors.
What sort of men have a vasectomy reversal?
The patients cover a range in age from 24 to 60. Majority 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. The remainder just feel dissatisfied with their vasectomy or have post vasectomy pain syndrome and wish to be returned to ‘normal’.