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Micro-surgical Vasectomy Reversal

 

This operation is requested by people who had vasectomy some time ago, and there has been a change of circumstances, e.g.: remarriage, new relationship. It is technically more difficult and takes longer time to perform and recover. Success of the operation depends on various factors:

  • Time since vasectomy
    Best results are within 3 years after vasectomy (76% pregnancy rate)
    3-8 years: 53%
    9-14 years: 44%
    >15 years: 30%
  • Length of sperm tube (Vas) that has been removed at the original operation
  • Closeness of vasectomy site to testis- the vas is much thinner and convoluted

Presence of anti-sperm antibodies: Anti-sperm antibodies are proteins that can inhibit the movement and function of sperm. Some research indicates that anti-sperm antibodies may decrease the chances for pregnancy after reversal surgery; however, studies have found little correlation between preoperative testing for anti-sperm antibodies and pregnancy. The difficulty in testing for anti-sperm antibodies before reversal surgery is that only serum (blood) antibodies can be tested, which do not accurately predict the antibodies that may be found in the semen after the operation. Because of these difficulties, most surgeons do not find anti-sperm antibody testing to be useful.

What preparation is needed?

I usually recommend you to shave scrotum and have a shower prior to arrival at the centre.

What type of Anaesthesia is used?

The operation can be performed under general anaesthesia or under local anaesthesia supplemented by sedo-analgesia given by the anaesthetist.

Will you be using Micro-surgical technique?

Yes. Use of operating microscope has revolutionized this operation, enabling 2 layered micro surgical technique.

What does the operation involve?

The scarred ends of vas are divided and patency confirmed by semen coming out of the testicular end and saline flush for the abdominal end. 9/O or 10/O nylon suture is used to join the freshened ends, usually in 2 layers. If there is no fluid from the testicular end one has to resort to vaso-epididymostomy (joining the vas to the epididymis).

Post Operative instructions:

A scrotal support with padding is recommended for the first 2 weeks. Avoid physical exertion for this duration. Pain killers and antibiotics are routinely prescribed to help with pain and prevent infection. Normal activities can be resumed in 48-72 hours, and intercourse in 10-14 days. Semen samples should be submitted in approximately 10 and 12 weeks.

Are there any complications?

 

 

 

 

 

 

 

 

 

Bruising: It is not unusual for the scrotum to look red, swollen and bruised for the first few days. It may occasionally bleed and require further surgery

 

Pain: Mild to moderate - controlled by tablets

 

Infection: As with any wound, there is a small risk of infection. If the wound looks red, feels hot and start oozing smelly fluid or you feel feverish, you will need medical attention. Rarely inflammation of testis or epididymis requiring antibiotics

 

Chronic testicular pain 5% or sperm granuloma- lumpy feel

 

No Guarantee that sperm will return to semen. Sperm may return but pregnancy not always achieved .


Outcomes of our last 100 cases is as follows:



 


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