Vasovasostomy & Vasoepididymostomy
There are two different types of vasectomy reversal surgeries that may be required to restore sperm to the ejaculate. A vasovasostomy involves simply suturing the two ends of the vas deferens together again. A vasoepididymostomy is a procedure that is required when the sperm in the testicular vasal fluid is either absent or of poor quality.
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Dr. Shep is among the highest trained in the US in both procedures using the most up-to-date technology including the Zeiss surgical microscope. As a fellowship-trained vasectomy reversal specialist, Dr. Shep is often sought out to correct previous surgical errors and failed vasovasostomies & vasoepididymostomies.
Vasovasostomy
A vasovasostomy is the easier of the two surgeries, and is performed roughly 75% of the time. This option is appropriate when there is good sperm quality present from the testicular end of the vas deferens. During a vasectomy, the vas deferens (the tube that carries sperm from the testicle) is severed. A vasovasostomy reconnects the vas deferens to allow the flow of sperm from the testicle into the ejaculate, resulting in fertility. It is a delicate procedure, resulting in very few side effects and a speedy recovery.
Vasoepididymostomy
WARNING: This video contains graphic content.
In roughly 20-25% of patients, the initial vasectomy causes a blockage to occur in a gland behind the testicle, called the epididymis. In this situation, the more challenging and delicate vasoepididymostomy is required. This procedure entails creating a connection between the obstructed gland and the abdominal end of the vas. Please note that some other surgeons do not perform this procedure, so be sure to ask. Dr. Shep has done hundreds of these surgeries! NOTE: If this is the type of reversal needed, please only allow a Fellowship-trained vasectomy reversal physician to perform this delicate surgery.
The Day Before Surgery
All patients are required to visit Dr. Shep's office the day before surgery (or slightly earlier, if the patient prefers), to receive prescriptions, counseling, and to finalize the required paperwork and anesthesia evaluation. Out-of-town patients are encouraged to arrive in town the day before their procedure, both to fill out paperwork and to minimize travel time the morning of surgery.
Day Of Surgery
Please plan to arrive an hour and a half before surgery. You must arrive with a friend or family member, who will remain at the microsurgical suite while you’re in surgery. Your support member must also stay with you for 24 hours after surgery.
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Time at the microsurgical suite is often about 5-6 hours. While vasectomy reversal is a more delicate procedure than the initial vasectomy, surgery time is less than 3 hours.
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All procedures are done in a microsurgical suite in an outpatient setting and patients are discharged the same day as the surgery. The procedure is less than 3 hours and is performed under general anesthesia. All stitches are buried under the skin and do not require removal, minimizing postoperative discomfort.
Getting Home
Your friend or family member that accompanies you to your surgery will need to help you get home and stay with you for 24 hours post-surgery. This precaution will ensure proper recovery procedures and that you get the prescribed medications on time. For patients with short travel times (generally 2 hours or less), it is okay to go home the day of surgery. For longer drives or short flights home, we recommend that you stay in town the night of the surgery. For longer domestic or international flights (2 hours or more), a 2 night stay after your vasectomy reversal surgery is recommended.
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Anesthesia Techniques
With rare exceptions, general anesthesia is recommended for microsurgery. It is important to have a completely comfortable patient who will not move or shift during the procedure. Our goal is to make your procedure as comfortable and as low-stress as possible. Being awake during surgery often creates unnecessary anxiety. Our anesthesia team is adept at minimizing postoperative discomfort and assuring a pleasant, uncomplicated and immediate recovery. For patients with concerns about general anesthesia, it is possible to perform the surgery with epidural anesthesia.
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Recovery
While a vasectomy reversal is a more complicated procedure than the original vasectomy, recovery time tends to be quick and side effects are generally mild.
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You will receive detailed instructions at the time of your discharge about your post-surgical care. We advise that you share this with a loved one who can help you with your care regimen.
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Immediately after surgery, you may experience slight swelling or bruising at the incision site, general pain, and nausea. Learn more here (a link). If you develop chills, fever, escalating or excessive pain, swelling or drainage from the incisions, notify Dr. Shep immediately. These can be signs of an infection and must be treated.
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Plan to be off work 10 days after surgery. If the surgery is on Friday, plan to be off the entire next week, returning to work on the following Monday. Patients with strenuous or physical jobs, especially those that require heavy lifting, should plan for a longer period of recovery time. During the first 5-7 days after your vasectomy reversal procedure, you’ll want to remain at home, staying off your feet as much as possible to minimize swelling and discomfort. After 24 hours, it is safe to shower. However, we recommend that you do not take a bath, as soaking in a tub may increase the risk of infection and increase swelling.
Driving is strongly discouraged (by us and the police), if pain medications are still being used.
After 2 weeks it is permissible to ejaculate, particularly if there is only minimal discomfort.
After 3 weeks, you may resume all physical activities. Please note it is important to wear a supportive garment (snug shorts or athletic supporter) during all physical activity after surgery. If your pain level increases, reduce activity and use ice for 24-48 hours.
Follow-Up Visits
It is important to monitor your progress after surgery, so Dr. Shep will schedule an appointment to evaluate the success of your procedure.
