Reversal of Vasectomy

Vas reversal can be done as a day case under general anaesthesia and takes up to 3 hours, depending on technical difficulty. The operation is performed in one of two ways.

a) Vasovasostomy

This is the most commonly used technique. Scar tissue is first removed between the vas ends and the fluid from the testicle end is examined for presence of sperms. As the lumen within the vas deferens is only 0.2 to 0.3 mm in diameter, an operating microscope is needed to place fine sutures as precisely as possible. These fine sutures are half the thickness of a human hair. Some 6 interrupted sutures are placed in the inner layer of the vas, followed by another 6 sutures on the outer layer to ensure that the repair is water-tight. This is very important because a common reason for vasectomy reversal failure is sperm leak which then cause inflammation and re-blockage.

b) Vasoepididymostomy

Vasoepididymostomy is a more complicated procedure that involves joining the vas deferens directly to the epididymis. This technique is used if there is no sperm found at the testicle end of the vas. This technique bypasses any blockage within the vas deferens du

The success of vasectomy reversal can be categorized into patency rate (chances of sperm present after reversal) and pregnancy rate. The patency rate for a vasovasostomy should be about 90% and depends state of the epididymis, surgical technique, and any excessive scarring around the anastomotic site. Patency rate for vasoepididymostomy is lower, around 60%. Pregnancy rate depends on age of the female partner, sperm quality and the presence of sperm antibodies. In general, vasectomy reversals performed 10 years or more after vasectomy have a lower pregnancy rate.

Complications include:

  • scrotal haematoma (blood clot). This is due to excess bleeding and may need surgical evacuation if it is large
  • infection. The skin wound or epididymis may be infected, resulting in pain and fever. This may require 2 to 3 weeks of antibiotics.
  • sperm granuloma. This is a small lump that forms when sperm leaks from the vas into the surrounding tissue..

Desired outcomes:

  • no haematoma
  • low infection rate ( < 3% )
  • success rate > 80% for men < 10 years post-vasectomy