John J. Bauer, M.D.
www.flinturology.com Urology Services, Inc.
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Contents
General information
Pre-operative instructions
Risks and Complications
Detailed Surgery Description
Family waiting instructions
Post-operative instructions
Printing tip: If you want to print only one portion of this entire document, you should be able to do this depending on your software. To print a selection, highlight the section you want to print using your mouse, then click on print, and then in the print menu, choose "selection."
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary?.
See also: overview of Vasectomy Reversal.
Vasovasostomy
Vasovasostomy, or vas reversal, refers to the repair of a previous vasectomy or iatrogenic injury to the vas deferens. The vas deferens is the tube that transports sperm from the testis to the urethra. Some men have elected to have the tube tied and cut as a form of sterilization. Other men may have had previous hernia operations or other groin surgery that resulted in complete blockage of both tubes. In both cases, the tube can be repaired to restore patency.
In experienced hands, vasovasostomy results in greater than 90 percent patency and greater than 75 percent pregnancy rates. The success of surgery depends on many factors including when the original surgery occurred, the technique used, and the degree of scarring. In most cases, a thorough history combined with the physical examination can help predict the likelihood of success.
Vasovasostomy surgery takes between 2 and 3 hours. It is performed under regional or general anesthesia with an operating microscope. The patient can return to desk work as early as 3-5 days after surgery, however, strenuous physical activity (jogging, weight lifting, sex) is prohibited for one month.
The follow up care consists of an office visit one month after surgery to check the incisions and to analyze a semen specimen. The specimen must be produced at home and brought in to the office within one hour of production. If no sperm are seen, the next specimen is obtained in two months. In some cases, it may take up to a year for sperm to return to the ejaculate. In most cases, however, sperm are seen in the initial specimen. If at the initial evaluation a patient is determined to be a less than optimal candidate for vasectomy reversal, plans can be made to freeze sperm at the time of vasovasostomy. The sperm is retrieved at the time of the operation and preserved in a special medium. The sample is then cryopreserved by the IVF specialists and is available for future use, if necessary. The fees for cryopreserving and storing sperm are available at the IVF office.
Vasoepididymostomy
Vasoepididymostomy refers to the surgical procedure in which the vas deferens is connected to a single epididymal tubule in order to bypass a blockage in the epididymis. Blockages in the epididymis can result from infections in the epididymis (epididymitis), previous vasectomy, trauma to the epididymis, or injury from previous scrotal surgery.
In experienced hands, vasoepididymostomy results in greater than 75 percent potency rates and greater than 50 percent pregnancy rates. The success of surgery depends on many factors including when the original surgery occurred, the technique used, and the degree of scarring. In most cases, a thorough history combined with the physical examination can help predict the likelihood of success after vasoepididymostomy.
Vasoepididymostomy takes between 3 and 5 hours. It is performed under general or regional anesthesia with the assistance of an operating microscope. The patient can return to desk work as early as 3 days after surgery, however, strenuous physical activity (jogging, weight lifting, sex) is limited for one month. The follow-up care consists of an office visit one month after surgery to check the incisions and to analyze a semen specimen. The specimen must be produced at home and brought in to the office within one hour of production. If no sperm are seen, the next specimen is obtained in two months. In some cases, it may take over a year for sperm to return to the ejaculate. In most cases, however, sperm is seen in the initial specimen.
At the time of vasoepididymostomy, sperm are routinely retrieved for cryopreservation. The epididymal fluid, which is typically rich in sperm, is retrieved at the time of the operation and preserved in a special medium. The sample is then cryopreserved by the IVF specialists and is available for future use, if necessary. The fees for cryopreserving and storing sperm are available at the IVF office.
Your pre-operative appointments
Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up.
Change In Health Status
Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery.
Pre-Operative Medication Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:
Pre-Operative Diet Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:
Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.
Pre-Operative Cleaning Instructions (bathing and showering instructions)
Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:
On The Day Of Surgery
The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery.
After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.
Time To Arrive For Your Surgery
During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery.
ARRIVAL TIME:
WHERE TO ARRIVE:
The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below.
Indications:
Patient is a male patient with a previous vasectomy that would like to have reversal to restore his fertility.
Alternatives:
Alternatives are artificial reproductive techniques for intracytoplasmic sperm injection (ICSI), donor sperm or adoption.
Risks/Complications:
The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, myocardial infarction, heart failure, stroke, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal head-ache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary.
The specific risks of this procedure include, but are not limited to: failure of the procedure to allow transmission of viable sperm into the ejaculate, chronic epididymal or testicular pain, late stricture, may need to wait up to one year before the procedure can be called a failure, complete breakdown of the re-anastomosis if strenuous activity or ejaculation occur within 2-3 weeks after the procedure, there may be abnormal spermatogenesis secondary to autoimmune antibodies or other cause that despite adequate anastomosis of the tubes there will be no viable sperm elements in the semen, if the procedure fails additional procedures may be necessary to determine the patency of the connection or to provide sperm for artificial reproductive techniques in the future.
You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.
To view the actual printable form for this surgery, click here: Counseling Note for Vasovastomy/Vasoepididymostomy. To print the document, simply select print after you have opened the page. You can use that copy to sign before your surgery.
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary?.
Indications: Sterile male wishing a vasectomy reversal.Sample Procedure Dictation:
The patient was given general anesthesia, placed in the supine position and then prepped and draped in the usual standard sterile manner. A vertical midline scrotal incision was made through the skin, subcutaneous tissue and the dartos layer. The sperm granuloma was palpated and delivered through the incision. The vas deferens was then isolated secured with an adjustable vas clip. The vas was cut on both sides of the granuloma until a lumen was identified. The proximal vas was freely injected with 5cc of methylene blue without resistance suggesting no proximal obstruction. The testicle and epididymis were then massaged until semen fluid was expressed from the distal vas lumen. A small capillary tube was used to collect the fluid and the contents were then viewed under low power microscopy. The right side revealed normal motile sperm/ non-motile sperm/immature sperm elements. The left side revealed normal motile sperm/ non-motile sperm/immature sperm elements. The two vas deferens ends were then re-anastomosed using a high-power operating microscope. Six 9-0 prolene full thickness sutures were placed. Interspersed between these multiple adventitial sutures were placed. The operative sites were inspected and bleeders were coagulated. Both sides were completed in a similar manner. The scrotal contents were inspected and noted to be normal. The dartos layer was closed with a running 3-0 chromic suture and the skin was closed with running 4-0 chromic sutures. Patient was then awaken from anesthesia without complications and transferred to the Recovery Room (RR). The patient arrived to the RR in stable condition and without complications.
To the family and friends of patients undergoing surgery.
SCHEDULED STARTING TIME OF SURGERY:ESTIMATED LENGTH OF SURGERY:
You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation.
The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria.
We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us.
Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor.
Your operation Vasovasostomy or Vasoepidimostomy was performed in an attempt to restore the flow of sperm from the testicles. It is important that you follow these instructions to maximize your chances for fertility.
Wear a jockey strap for two (2) weeks after the surgery.
You may shower 48 hours after the surgery once the bandages have been removed.
You may swim or take a tub bath one week after surgery.
Do not ejaculate for four (4) weeks after the surgery. The tubes must heal before sperm can travel through the area of surgery. A leak can occur and the operation may fail if this recommendation is not followed.
The scrotum will be tender and swelling is expected for one to two weeks after surgery. This soreness will gradually improve over time. If the scrotum or incision site becomes red, pus begins to drain or pain becomes progressively worse rather than better please call your physician. Expect some spotting of blood from the incision site for up to one week after the surgery, if bleeding becomes progressively worse over the next week please call your physician.
You should be able to resume exercise and full un-restricted activity two (2) weeks following the surgery. If discomfort returns then reduce activity, take it easy, and more gradually resume activities.
You must get a semen analysis (sperm count) eight weeks after the surgery. It can take up to one year for the sperm to be seen in the semen. If you have an initial positive sperm count you should plan to have it repeated one year later. The repairs can re-stricture (close) in the future.
In case of an emergency, please go to your nearest emergency room for evaluation.
FOLLOW-UP INTRUCTIONS: Make an appointment approximately one week after the surgery for a wound check. (810)-733-6440
Frequently Asked Questions after surgery
This section is under construction.