Five percent of the male population who have undergone a vasectomy will elect to have a reversal. Thanks to today’s advances in microsurgical technologies, vasectomy reversal success rates are high, but not assured. Of the percentage of failed reversal procedures, 30% can be attributed to an undetected Epididymal obstruction. Whether the obstruction is the result of post-vasectomy inflammation, increased pressure in the epididymis, or scarring, it will prevent the flow of sperm from the epididymis to the seminal fluid even after the successful reconnection of the vas channels. In such cases, a vasoepididymostomy is required. During this procedure, the vas is connected directly to the epididymis, above the site of blockage.
Due to the small size and delicacy of the epididymis duct, (about 0.1 to 0.2 mm in diameter) vasoepididymostomy requires the skill-set of an experienced micro surgeon, like those of Academic Urology and Urogynecology of Arizona. Doctors will determine if this technically demanding variation of vasectomy reversal is needed at the time of surgery, by evaluating the fluid from the vas leading from the testes for the presence or absence of sperm. Blockage of the epididymis may be evident on one or both sides.
During the procedure, the micro surgeons of Academic Urology and Urogynecology of Arizona select a single Epididymal tubule above the point of blockage, make an incision, and confirm the presence of sperm. If motile sperm are detected, the vasoepididymostomy continues, connecting the lumen of the vas deferens to the Epididymal tubule using radially placed sutures. Once complete, the covering around the testis is replaced.
Though more technically demanding than a standard vasovasostomy, vasoepididymostomy is performed as an outpatient procedure. Patients should rest for a period of 24 hours after surgery. Prescribed pain medication and over-the-counter analgesics can be used to relieve the mild discomfort that is the result of surgery and ice-packs applied to relieve swelling. As with vasovasostomy, patients should refrain from strenuous and sexual activities for a period up to four weeks. In general, side effects are mild and include minimal swelling, bruising, and discoloration of the scrotal sac. Complications are rare.
Fertility and pregnancy after vasoepididymostomy is not as high as standard vasectomy reversal procedures and outcomes are dependent on many factors. In general, as many as 85-90% of patients will achieve patency (unobstructed opening) after surgery. Should fertility not be achieved, there are alternate treatments available, including sperm retrieval and in vitro fertilization. Click on the link below to learn more about the fertility treatments of Academic Urology and Urogynecology of Arizona.