Vasectomy Reversal

Vasectomy Reversal, Step-by-Step

A Complete Guide to Vasectomy Reversal Surgery from Martin Bastuba, MD, FACS

By Martin Bastuba, MD, FACS

For many men considering undergoing a vasectomy reversal, they already have the benefit of understanding what the experience will largely entail because of their original vasectomy. Much of the preparation and recovery between the two procedures is similar, though there are some differences. This being said, it’s often the case that years or even decades have passed since the vasectomy was completed, and men can be understandably wary of taking steps toward a reversal.

In order to help relieve any concerns you may be having, I’ve outlined what men thinking about reversing their vasectomy need to know based on some of the most common questions that I hear during my consultations. In addition to the following information, one of the best ways to fully prepare for the procedure is to schedule a consultation with me, your vasectomy surgeon, so we can walk through your individual questions one-on-one.

En Espanol: Reverso De Vasectomia

What is the success rate of a vasectomy reversal?

The average patency success rate of a vasectomy reversal is 70%, and the average pregnancy success rate of a vasectomy reversal is 55%. Dr. Martin Bastuba is proud to provide patients with a vasectomy reversal patency success rate of 98%, and a vasectomy reversal pregnancy success rate of between 65-75%.

Should I be worried about getting a vasectomy reversal?

The greatest remedy to being nervous is a clear understanding of what is going to happen, how it will take place and the risks and benefits of each option provided by an experienced surgeon in open conversations with the patient and his partner. Dr. Bastuba has been performing this surgery for over 27 years and is the go to 2nd opinion physician for many of the insurance carriers when other cases have not been successful. Ask lots of questions. Know that you will have Dr. Bastuba’s cell number for direct access, a patient navigator that will be in contact with you information for up to a year after the vasectomy reversal.

How do I prepare for a vasectomy reversal procedure?

Prior to the vasectomy reversal you need to:

  • Pay the hospital, anesthetic and surgical fees
  • Sign off on all of the consent forms
  • Have a responsible adult arranged to drive you home from the procedure.
  • Do not drink or eat anything after midnight the day before the surgery.
  • Do not take aspirin or other blood thinning agents such as Motrin, Advil, naproxen, herbal products such as vitamin E or fish oil. You can take Tylenol.
  • If you are on blood thinning agents such as Coumadin or warfarin, you need to inform your prescribing doctor prior to the procedure for instruction.
  • Ensure all lab tests ordered by Dr. Bastuba have been completed at least 2 weeks before the surgery.
  • Consider storing sperm that can be recovered at the time of surgery as a backup insurance.

How are vasectomy reversal procedures performed?

Dr. Bastuba performs the vasectomy reversal at a surgery center or hospital. The procedure is done on an outpatient basis — without an overnight stay. General anesthesia is provided to keep you pain free and motionless while Dr. Bastuba is under the microscope working with surgical thread that is thinner than a strand of your hair. Vasectomy reversal is more difficult than a vasectomy. It requires specialized skills and expertise.

Dr. Bastuba is specially trained for this surgery. While most urologists might attempt 2 – 3 cases a year, Dr. Bastuba performs 2 - 5 per week. The duration of the case is 3-4 hours long.

The surgeon usually will re-attach the vas deferens in one of two ways depending on where sperm is found:

  • Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure2 (Goldstein et al. 1998. Journal of Urology), the surgeon reconnects the ends of the vas deferens after removing the blockage of each tube that carries sperm (vas deferens).

  • Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the small organ at the back of each testicle that holds sperm (epididymis). A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy will not work or sperm is not present. Dr. Bastuba utilizes the state-of-the-art techniques as described by Dr. Marc Goldstein3 (Berger 1993. Journal of Urology).

In most cases, the patient will not know ahead of time which technique is required. Dr. Bastuba determines during the operation which procedure will work best and provide the best chance for a successful pregnancy. Sometimes a combination of the two surgical techniques is needed — a vasovasostomy on one side and a vasoepididymostomy on the other. The decision to perform a vasovasostomy versus a vasoepididymostomy depends on whether sperm are seen when fluid from the vas deferens is analyzed at the time of surgery.

Immediately after surgery, the incisions will be covered with bandages. The outside layer has been closed with a medical superglue known as Dermabond. The wound is closed in 4 separate layers. You will wear tight-fitting undergarments, such as an athletic supporter, and apply ice to reduce swelling. You may be sore for several days. Dissolvable stitches are used and they generally are absorbed 7 to 10 days after surgery by themselves.

At home, you should relax and try to limit any activities that might cause the testicles to move around excessively. As the anesthetic wears off, there may be some pain and swelling in the testicles. For most men, the pain isn't severe and improves after a few days to a week. There are medications such as EXPAREL which can be provided and will further control for pain for up to 3 days.

What can I expect after a vasectomy reversal in terms of recovery and pain?

Activity Information

  1. Bed rest on the day of the procedure and most of the next day.
  2. Deep breath 10 times per day for the first 5 days as well as ankle presses (press on and of a gas pedal).
  3. You may resume light daily activities the day after surgery.
  4. Do not drive a car or operate machinery, power tools or appliances for at least 24 hours.
  5. Do not drink alcoholic beverages or make critical decisions for a minimum of 24 hours following the procedure.
  6. No ejaculation for 28 days.
  7. Your wound has been sealed with Dermabond sterile medical superglue). The Dermabond will start to peel off at the edges about post-op day 7 to 10.

Medication Information

  1. Take your pain medication as prescribed by Dr. Bastuba. Constipation is a side effect of this medication.
  2. Your pain should be relieved by the medication prescribed by Dr. Bastuba. Additional medications such as EXPAREL can be provided to shut down the pain receptors for 72 hours.
  3. Take your antibiotics until they are completed per the prescription.

Post Operative Care

  1. Keep ice on the surgical site for at least 48 hours’ post op (20 minutes on and 20 minutes off or longer). Many patients notice increase scrotum pain and swelling as activity increases. It is recommended to use ice on and off for up to two weeks post operatively.
  2. Remove ½ of the dressings in your athletic supporter the day after surgery or as directed by Dr. Bastuba. You may continue wearing the athletic supporter for one-week post-op to reduce swelling.
  3. You may shower 24-hours after your procedure. DO NOT scrub but let the water run over the wound site. The soap may sting.
  4. If you are hungry try clear liquids first. If you tolerate the clear liquids advance slowly into a regular diet as tolerated.
  5. NO ejaculation or intercourse for 28 days’ post-surgery. You do not want to tear any of the tiny sutures.
  6. You will start a second medication called Prednisone a steroid which should be taken for 3 – 4 months to reduce inflammation and the chance of the open reversal closing again.

How will I know if a vasectomy reversal has been successful?

You will be asked to set up a post operative follow up visit with our 20 year urology experienced physician assistant (Michael Schumacher, PA-C). He will be review the healing, pain and wound closure.

You will also be asked to set up 2 month and 4 month comprehensive sperm analysis (CSA). As you know, from the time sperm is created until it becomes available in the ejaculated can be 70 – 90 days. Therefore sperm may not appear for up to 3 months. The 2 month CSA will begin to tell the story of success and the 4 month analysis will clarify how things are going.

After each CSA a lab technician will help walk you through the meaning of each CSA and our patient navigator will work with you and Dr. Bastuba to help ensure success.

Can vasectomy reversals fail?

Vasectomy reversals sometimes fail if there is an underlying issue with the testicle, which cannot be recognized during surgery, or if a blockage develops sometime after surgery. Up to 10% of patients can scar down following a successful vasectomy reversal4 (Sharlip et al. 2015. AUA).

Dr. Bastuba encourages all patients to recover sperm at the time of the vasectomy reversal, which can be frozen and used as a back if there is failure.

Some men have a second-attempt vasectomy reversal surgery if the procedure doesn't work the first time. Many insurance carriers recognize Dr. Bastuba for his outstanding work and send him their client’s failures for 2nd opinions.


References

  1. Craft I, Bennet V, Nicholson N. 1993. Fertilizing ability of testicular spermatozoa. The Lancet. Volume 342(8875):864. https://www.thelancet.com/journals/lancet/article/PII0140-6736(93)92722-6/fulltext
  2. Goldstein M, Shihua P, Matthews G. 1998. Microsurgical vasovasostomy: the microdot technique of precision suture placement. Journal of Urology. Volume 159(1):188-190. https://www.auajournals.org/doi/abs/10.1016/S0022-5347%2801%2964053-9
  3. Berger RE. 1998. Triangulation end-to-side vasoepididymostomy. Journal of Urology. Volume 159(6):1951-3. https://www.ncbi.nlm.nih.gov/pubmed/9598495?dopt=Abstract
  4. Sharlip I, Belker A, Honig S, Labrecque M, Marmar J, Ross L, Sandlow J, Sokal D. 2015. Vasectomy Guideline. American Urological Association. https://www.auanet.org/guidelines/vasectomy-guideline