LODDIE F. ROEDER, Jr., M.D.
Vasectomy Reversal Procedure
Vasectomy reversal surgery involves micro-surgically reconnecting multiple layers of the ends of the vas deferens under a high powered microscope. The most important factor determining the success of this procedure is choosing a skillful and experienced micro-surgeon. It takes a special skill and mind set to be a successful micro-surgeon. Many may be good surgeons, but they may not have the tempermant or patience to be a micro-surgeon. Having performed over 2500 vasectomy reversal surgeries, I have the experience necessary to have successful outcomes.
My vasectomy reversals are performed under a Zeiss OPMI-MDM operating microscope. Some vasectomy reversal surgeons use Loupe lenses which only magnify by 2 to 3 times. Considering the vas lumen, where the sperm travels, is only about 0.5 mm wide, this magnification may not be adequate to make the precise repair that is required for a successful vasectomy reversal.
With the patient under local anesthesia, a ½ inch incision is made in the scrotal skin over the old surgery site. Using a microscope, the two ends of the vas deferens are located and freed from any scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope. Since the testicle continues to produce sperm after a vasectomy, it is optimal if the fluid contains sperm. For the repair, I use 10-0 suture (delicate as a spider's web). It is important to create a direct and careful alignment of the lumen of the two ends of the vas and make a watertight closure. This usually requires 12 to 15 stiches, using a multiple layer closure.
When examining the vassal fluid, there are several possible situations that may be encountered. The first, most common, and best situation is that the vassal fluid will contain whole sperm. Another possible scenario is that the fluid is thin and contains only sperm parts or no sperm. A third possibility is that the fluid is thick, pasty and contains no sperm.
This last phenomenon usually means that there is an obstruction called an epididymal blowout. An epididymal blowout means that the vas is obstructed at two levels: at the vasectomy site and at the level of the epididymis. This is when a vasoepididymostomy (VE) is indicated. A technique for the VE (vasoepididymostomy) is a microsurgical invagination of the epididymal tube into the lumen of the vas also using 10-0 nylon suture.The surgeon cannot make this determination by age of vasectomy and must rely on examination of the vas fluid. If the VE (vasoepididymostomy) procedure must be done, there is not an additional charge.
DAY OF PROCEDURE
It is my policy to interview you and your spouse the morning of the surgery. If you have any questions that have not been answered, we will have an opportunity to talk at that time. I prefer you come as a couple because your spouse will play a significant role in your after surgery care. However, there are times when the husband must come alone, and this works out satisfactorily. You will be dismissed the day after surgery; again, however, some choose to return home the same day, and this usually works out well. The vasectomy reversal on average is a 2 1/2 hour procedure. The surgery is done as a day patient under local anesthesia. The day of surgery - limit your liquid intake, bring some snug fitting underwear, shave the scrotum and 2 inches further up through the base of the penis toward the belly button.
When you underwent your vasectomy, you were informed about the potential complications. The same list of complications still exists for the vasectomy reversal. These complications include, in order of frequency:
1) swelling, 2) pain, 3) hemorrhage/hematoma, 4) infection, 5) testicular atrophy, 6) loss of testicle.
Pain and swelling are common, but quickly disappear. Hemorrhage/hematoma is less common. This complication may need surgical attention. If surgery is required to drain the hematoma, there would be some expenses associated with the trip to the hospital for the drainage (more medication and additional doctor fees (anesthesia), etc.). This is an additional expense to you. Usually, but not always, this is covered by your medical insurance if you have it.
Therefore, if time allows, I recommend staying in New Braunfels, so, in the unlikely event this complication occurs, it can be handled by me rather than another doctor back home. Also, if surgical drainage of the hematoma is necessary, the possibility exists that the recent reversal surgery will be jeopardized. This complication occurs less than 1% of the time. Infections are also less common, and they usually respond very well to antibiotics. Loss of testicle and testicular atrophy are very rare.