Vasectomy Reversal Surgery
Vasectomy reversal surgery is a very effective form of microsurgery that restores an open vas deferens for the majority of patients. The success rates of vasectomy reversal surgery can be as high as 90%.
Vasectomy Reversal Surgery Steps
1. Patient anaesthetic and access
The procedure is performed under a general anaesthetic. Once the patient is asleep and the tissues have been anesthetized, we draw out the segment of damaged vas through a small incision in the front of the scrotum.
2. Preparation of the vas
The damaged area of vas where the previous vasectomy took place is removed or bypassed and the ends are trimmed to healthy tissue with an open vas tube.
3. Analyzing the fluid
We analyse fluid that comes out of the vas under a microscope and if sperm is visible, we know that that the system is now open, and we can perform a vas-to-vas connection.
4. 3 layer vas-to-vas connection
We perform a multi-layer reversal by using a surgical microscope or robot. The innermost layer on both sides is sewn together with 6 fine nylon microsutures, smaller than a human hair. After this, the outer layer is connected with 12 stronger sutures, each 1 mm apart around the vas. Finally, the next layer of the outer tissues is connected with several sutures to bring blood supply and secure the repair site with no tension so that it can heal.
5. Closing the wound
Further local anaesthic is placed to numb the tissues, and the repaired vas are returned to the scrotum through the initial inicision. The small wound is closed with absorbable sutures and a dressing is applied.
6. What happens if the fluid doesn’t have any sperm?
If there is no sperm present in the fluid, most often this means that there’s a deeper obstruction in the epididymis from a blowout. This is due to a buildup of pressure in the tubules over time, and is more common the longer it has been since your vasectomy. A vas-to-epididymal bypass will be required and perfomed at this time.
Vasectomy Reversal Recovery
A Relatively Pain Free Process
Most of our patients tell us they feel something that could be described as tightness or a pressure sensation with no real pain immediately after the surgery. Some low level pain in the scrotum is expected for around 2 weeks after the surgery and is controlled with oral pain killers.
48 – 72 Hours After the Reversal Surgery
We ask our patients to relax and stay off their feet at home for 48 - 72 hours after the reversal surgery, which allows the tissues to heal quickly and minimizes any pain, inflammation or swelling.
Avoid Extreme Activities
We recommend that our patients avoid any heavy lifting or exertion 4 - 6 weeks after their surgery. This is to protect the delicate repair site. Slowly, patients can then begin light exercise. We need to let the delicate tissues heal.
The First 14 Days
After the first 3 days have passed, we tell our patients that they can begin most normal light daily activities. However, the patient shouldn’t do anything strenuous for the first 14 days after surgery. Tight underwear for 6 weeks is essential to avoid any tugging on the repairs.
After 4 weeks, we perform the first semen analysis test. The results are reviewed and we can provide additional advice as needed. The test will be repeated at the 3 month mark, by which time we may see further improvement in sperm numbers and activity.
No Sex for 21 Days
Patients should refrain from any sexual activity for at least 21 days after their reversal surgery to allow for healing. Patients are then encouraged to try to ejaculate once every few days to allow fluid to flow through the new connection. Conception can be attempted with unprotected intercourse. There is no benefit in flushing out any old sperm, with the female reproductive tracts being able to filter out imperfect sperm.
Risks and Complications
The risks of complications after vasectomy reversal surgery are quite rare.
However, they do occur occasionally, and when they do, the following symptoms may occur:
Bleeding of the Scrotum
A degree of surface bleeding, bruising and swelling is normal and should improve over the first week post surgery. Problematic bleeding of the scrotum is rare and might lead to painful swelling, which can be avoided by closely following our advice before and after surgery.
There is always the possibility of acquiring an infection after any surgical procedure. Most often we treat infections that patients might have with antibiotics.
Persistent or Severe Pain
In the rare situation where patients experience persistent of severe pain, we ask that they contact us immediately.
Vasectomy Reversal Post Operation Instructions
The recovery process is relatively easy for most of our patients.
To help the process to be as easy and smooth as possible we have the following post-operation instructions for our patients after surgery.
Icing the Scrotal Area
Ice packs help patients reduce the swelling that can occur after surgery. Many of our patients find it helpful to make use of an ice pack around the scrotal area for the first 48 hours after the vasectomy reversal surgery. Make sure to never apply the ice directly to the skin, and to apply the pack in a '10 minutes on and 10 minuted off' fashion.
Supporting the Scrotal Area
Our patients should wear tight scrotal support for at least 14 days after their vasectomy reversal surgery. This will minimise any bruising, swelling or pain. We advise that scrotal support is maintained for up to 6 weeks to reduce any tension on the repairs.
Patients should avoid ejaculating for 2 - 4 weeks after their vasectomy reversal surgery. If a patient ejaculates too soon after their vasectomy reversal surgery, they may experience sperm leakage.
We prescribe our patients with pain medication to help them relieve any of the pain that might occur after their vasectomy reversal surgery. Non-prescription pain relievers such as paracetamol and ibuprofen should also be used by patients during this period to help them alleviate any discomfort they may experience after their surgery.
Following their vasectomy reversal surgery, patients can expect to experience a little amount of bleeding in the scrotal area. We recommend that patients add 2 - 3 gauze pads under the scrotal area until the bleeding has stopped.
We ask patients to refrain from lifting heavy items that weigh over 10kg for 2 - 4 weeks after their surgery. They can return to their normal everyday activities after a few days following the surgery. We recommend that patients avoid excessive walking and running 4-6 weeks after surgery.
If the patient experiences any pain in their lower abdomen or groin areas then this can be a sign of insufficient scrotal support or that they have done too much, too soon after their surgery. Wind it back!
Bruising, Swelling and Bleeding
Some bruising or swelling is be expected in your scrotal area after your vasectomy reversal surgery. the bruising can extend onto the base of the penis, as the tissue layers communicate. Some bleeding from the wound can also occur.
Contact us if you experience severe painful swelling, bleeding from the wound that is soaking through pads or fevers.