A vasectomy is an operation to cut, seal or block the vas deferens (tubes that carry sperm) from your testicles to your penis. This means that you are no longer able to have children.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.
A vasectomy is an operation to cut, seal or block the vas deferens (tubes that carry sperm) from your testicles to your penis. This means that you are no longer able to have children.
A vasectomy should be considered a permanent operation. However, some men come to regret the operation and want it reversed.
[ The position of the vas deferens and surrounding structures ]
About vasectomy reversal
Vasectomy reversal is an operation to reconnect or unblock the vas deferens, so that they can carry the sperm from your testicles to your penis.
How successful is the reversal?
Vasectomy reversal is more successful if it's done fairly soon after the original vasectomy. About eight out of ten men are able to father children when their vasectomy is reversed within five years. The success rate falls as time goes on.
It's important to understand that success is not guaranteed. Even if the operation is technically successful, the presence of sperm in your semen doesn't guarantee that your partner will get pregnant. Other factors that can affect your result include:
the time since your vasectomy
the type of vasectomy being reversed
the type of technique used to do the reversal
a problem with another part of the reproductive system
the presence of sperm antibodies
your partner's age and her fertility
It may be possible to have a second reversal operation if the first has not restored your fertility, but it's even less likely to be successful.
What are the alternatives?
Sperm can be removed directly from your testicle and injected into your partner's egg using an intracytoplasmic sperm injection (ICSI). The fertilised egg is transferred to your partner's womb. ICSI requires your partner to have IVF (in vitro fertilisation) treatment. ICSI is also not as successful as a vasectomy reversal.
Preparing for your operation
Your surgeon will explain how to prepare for your operation. For example, if you smoke you may be asked to stop, as smoking increases your risk of getting a chest or wound infection and slows your recovery.
A vasectomy reversal is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. Alternatively you may prefer to have the surgery under local anaesthesia, in which case your scrotum is numb but you stay awake. A sedative may be given with a local anaesthetic to help you relax.
Your surgeon will advise which type of anaesthesia is most suitable for you.
If you are having a general anaesthetic you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However some anaesthetists allow occasional sips of water until two hours beforehand.
At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine. You will be asked to change into a hospital gown and you may be asked to shave your scrotum.
Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure, and have given your permission for it to go ahead.
About the operation
Vasectomy reversal usually takes about one hour. The operation can be done in two ways.
Standard vasectomy reversal
The technique most commonly used is called vasovasostomy.
Cuts are made into each side of your scrotum, usually in the same position as your vasectomy scars. Sometimes, only one cut is needed in the centre of the scrotum.
Scar tissue is removed from the vas deferens and the tubes are carefully pulled through the cuts. Your surgeon repairs each tube using dissolvable stitches. The tubes are placed back inside the scrotum. The skin cuts are closed using dissolvable stitches or surgical clips.
Sometimes it isn't possible to rejoin the vas deferens tubes in both testicles and only one is rejoined.
How a vasectomy reversal is carried out ?
Vasoepididymostomy
Vasoepididymostomy is a complicated procedure that involves joining the vas deferens directly to the epididymis (this is where the sperm are stored in each testicle). This technique can bypass any blockages in the vas deferens that may have arisen from a previous vasectomy or reversal operation.
What to expect afterwards ?
You will need to rest until the effects of the general anaesthetic have passed. Your scrotum will feel sore as the anaesthetic wears off and you may need painkillers.
You will be wearing supportive underwear to help relieve any discomfort.
Occasionally, fine plastic tubes are left in the scrotum for up to 24 hours. These allow blood and fluids to drain into a bag. You will need to stay in hospital overnight. If the tubes are not used you will be able to go home after you have passed urine.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Your nurse will give you advice about caring for the healing wound, hygiene and bathing before you go home.
Dissolvable stitches will disappear on their own in seven to ten days. Surgical clips are removed after two weeks.
Recovering from vasectomy reversal
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.
General anaesthesia can temporarily affect your co-ordination and reasoning skills, so you shouldn't drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.
Follow your surgeon's advice about driving. You shouldn't drive until you are confident that you could perform an emergency stop without discomfort.
Continue to wear close-fitting underwear day and night for a few weeks. This will help ease any discomfort and swelling.
You can bathe and shower but you should dry the area gently and thoroughly afterwards.
Don't do any heavy lifting or vigorous exercise for the first four weeks.
You can have sex as soon as you feel comfortable. But, you won't know if you are producing sperm when you ejaculate until your doctor has checked a sample of semen. This is usually done three months after vasectomy reversal.
What are the risks?
Vasectomy reversal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
Side-effects
These are the unwanted, but mostly temporary effects of a successful procedure, for example feeling sick as a result of the general anaesthetic.
Your scrotum will feel sore, and you will have some bruising and swelling for a few days.
Complications
This is when problems occur during or after the operation. Most men are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding, infection or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Infection is usually treated with antibiotics.
Specific complications of vasectomy reversal are uncommon, but can include : -
Bleeding inside your scrotum (haematoma) : -this may need surgery to stop the bleeding and drain the area
fluid building up in your scrotum (hydrocele) : - this may need treatment to drain the area
damage to blood vessels : - this can cause permanent damage to one or both testicles (testicular atrophy)
long-term testicular pain : - this is caused by pinched nerves or scarring and may need surgery
It's possible the vasectomy reversal may not restore your fertility and you may need further fertility treatments to have a baby.
The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.
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