Vasovasostomy & Vasoepididymostomy

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WARNING: This video contains graphic content.

When you’re researching vasectomy reversal surgeries, you are undoubtedly quite concerned with the details. Below, you’ll find some information about the procedure options.

There are two different types of vasectomy reversal surgeries that may be required to restore sperm to the ejaculate. One involves simply suturing the two ends of the vas deferens together again – this is referred to as a vasovasostomy. The other is a vasoepididymostomy, a procedure that is required when the sperm in the testicular vasal fluid is either absent or of poor quality.

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

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.

The Day Before Surgery

All patients are required to visit the clinic 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 Louisville the day before their procedure, both to fill out paperwork and to minimize travel time the morning before 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 hospital while you’re in surgery. They must also stay with you for 24 hours after surgery.

Plan to be at the hospital for approximately 5-6 hours. While vasectomy reversal is a more delicate and involved procedure than the initial vasectomy, surgery time runs less than 3 hours.

Dr. Shep performs all procedures in a microsurgical suite in an outpatient setting, which means patients are discharged the day of surgery. The procedure takes less than 3 hours and is performed with general anesthesia. All the stitches are buried under the skin and do not require removal, minimizing post-operative discomfort.

Getting Home

The friend or family member who accompanies you on the day of surgery will be responsible for getting you home, and will need to stay with you for 24 hours. This precaution will ensure you are following proper recovery procedures and receiving 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 patients stay in Louisville the night of the surgery. For longer domestic or international flights (2 hours or more), a 2 night stay after vasectomy reversal surgery is recommended.

Anesthesia Techniques

With rare exceptions, general anesthesia is recommended for microsurgery. During this delicate operation, it is important to have a completely comfortable patient who will not move or shift during the procedure. Our goal is to make the procedure as comfortable and as low-stress as possible, and we believe asking someone to be awake during surgery creates unnecessary anxiety. Our anesthesia team is adept at minimizing post-operative discomfort and assuring a pleasant, uncomplicated and immediate recovery. For patients with significant concerns about general anesthesia, we can perform the surgery with epidural anesthesia as an alternative.

Recovery

You will receive detailed instructions at the time of your discharge about your post-surgical care. We advise that you share this sheet with a loved one who can help you with your care regimen.

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.

Immediately after surgery, you may experience slight swelling or bruising at the incision site, general pain, and nausea. Learn more here. 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.

You will be off work 10 days after surgery. If surgery is on Friday, you will be off the entire next week, returning to work on the following Monday. For those with strenuous jobs, which require heavy lifting, chasing bad guys, etc., you will need to be off for a longer period of time. During the first 5-7 days after your vasectomy reversal procedure, you’ll need to remain at home and stay 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 periodic visits to evaluate the success of your procedure.

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