Vasovasostomy Health Article

Definition

A vasovasostomy is a surgical procedure in which the effects of a vasectomy (male sterilization) are reversed. During a vasectomy, the vasa deferentia, which are ducts that carry sperm from the testicles to the seminal vesicles, are cut, tied, cauterized (burned or seared), or otherwise interrupted. A vasovasostomy creates an opening between the separated ends of each vas deferens so that the sperm may enter the semen before ejaculation.

Purpose

The purpose of a vasovasostomy is to restore a man's fertility, whereas a vasectomy, or male sterilization, is performed to provide reliable contraception (birth control). Research indicates that the level of effectiveness in preventing pregnancy is 99.6%. Vasectomy is the most reliable method of contraception and has less risk of complications and a faster recovery time than female sterilization methods.

In many cases, a vasectomy can be reversed. Vasectomy reversal does not, however, guarantee a successful pregnancy. The longer the time elapsed since a man has had a vasectomy, the more difficult the reversal and the lower the success rate. The rate of sperm return if a vasovasostomy is performed within three years of a vasectomy is 97%; this number decreases to 88% three to eight years after vasectomy, 79% by nine to 14 years, and 71% after 15 years. In addition, other factors affect the success rate of vasectomy reversal, including the age of the female partner, her fertility potential, the method of reversal used, and the experience of the surgeon performing the procedure.

Vasovasostomies are also performed in men who are sterile because of genital tract obstructions rather than prior vasectomies. A vasovasostomy may also be performed on occasion to relieve pain associated with post-vasectomy pain syndrome.

Demographics

An estimated 5% of men who have had a vasectomy later decide that they would like to have children. Some reasons for wanting a vasectomy reversal include death of a child, death of a spouse, divorce, or experiencing a change in circumstances so that having more children is possible. One study found that divorce was the most commonly reported reason for a vasovasostomy and that the average age of men requesting a vasovasostomy is approximately 40 years.

About 7.4% of infertile men have primary genital tract obstructions caused by trauma, gonorrhea or other venereal infections, or congenital malformations of the vasa deferentia. Many of these men are good candidates for surgical treatment of their infertility.

Description

Most surgeons prefer to have the patient given either a continuous anesthetic block or general anesthesia because of the length of time required for the operation. A vasovasostomy generally takes two to three hours to perform, depending on the complexity of the surgery and the experience of the operating physician. More complex surgeries may take as long as five hours. The advantage of general anesthesia is that the patient remains unconscious for the duration of the surgery, which ensures that he remains comfortable. Regional anesthesia, such as a spinal block, allows the patient to remain awake during the procedure while blocking pain in the area of the surgery.

After an adequate level of anesthesia has been reached, the surgeon will make an incision from the top of one side of the scrotum, sometimes moving upward as far as several inches (centimeters) into the abdominal area. A similar incision will then be made on the other side of the scrotum. The vasa deferentia will be identified and isolated from surrounding tissue. Fluid will be removed from the testicular end of each vas deferens and analyzed for presence of sperm. If sperm are found, then a simpler procedure to connect the cut ends of the vasa deferentia will be performed. If no sperm are found, a more complex procedure called a vasoepididymostomy or epididymovasostomy (in which the vas deferens is attached to the epididymis, a structure in which the sperm mature and are stored) may be more successful in restoring sperm flow.

There are two techniques that may be used to reconnect the cut ends of the vasa deferentia. A single-layer closure involves stitching the outer layer of each cut end of the tube together with a very fine suture thread. This procedure takes less time but is often less successful in restoring sperm flow. A double-layer closure, however, involves stitching the inner layer of each cut end of the tube first, and then stitching the outer layer. After reconnection is established, the vasa deferentia are returned to their anatomical place and the scrotal incisions closed.