Vasectomy
Reversal
After
vasectomy, the vas ends can be surgically reconnected and sperm restored
to the semen. While the intent of a vasectomy is to produce a permanent
condition of male sterility, there are two microsurgical procedures
that have been successful at restoring the flow of sperm through the
vas deferens.
The
most common, called vasovasostomy, involves
stitching the disconnected ends of the vas deferens back together with
ultra-fine sutures.
The
other reversal procedure, called vaso-epididymostomy,
is performed when inflammation or scarring from the original vasectomy
blocks the epididymis - the tubular structure connecting the testes
to the vas deferens. In this microsurgical procedure, the blockage is
bypassed by surgically connecting the vas deferens directly to the epididymis
in a new location.
The
inner tube (lumen) diameter of vas deferens is approximately 0.2 mm
requiring extreme delicacy in placement of stitches. The lumen of epididymis
is 10 times smaller and more fragile. Although most urologists are trained
to do these procedures during their residency training but very few
actually continue to engage in these demanding microsurgical procedure.
Regular experience with large number of cases using magnification with
operating microscope results in the best chances of success.
Over
the years many techniques have been tried to reverse vasectomy including
insertion stents, use of protein glue, and laser
guided stitching but the scientific data has proved that the
gold standard procedure is an accurate microsurgical
connection of the two cut end of vas.
Lasers
were used initially in 1980's as a tissue welding
technique with the hope to replace difficult microsurgery by
melting the tissue together. The existing data has convincingly confirmed
that there is on advantage of using laser in place of or in addition
to accurately placed microsurgical stitches with a watertight tension-free
anastomosis (connection).
