This video is actually a nice primer to microscopic vasectomy reversal giving the patient an idea of what things look like during the procedure. Reminds me of listening to a Beatle interview back in the day.
Several times a month a patient, who has had a reversal, will drop off a specimen to see if there are any sperm present. This evaluation takes just a minute to do. If sperm is present it means that the reversal mechanically is open and has been successful. This evaluation however doesn’t count the sperm, that would require a full semen analysis which is done through the hospital lab and quantitates the actual number of sperm present. For the purposes of seeing if the reversal “worked or not” the in office check for sperm is sufficient. If there are no sperm and it has been three months post reversal this may either means that reversal is not open but probably more likely that the testicles have not “picked up the ball” and started producing sperm yet. It can take four to twelve months for the sperm to be produced in numbers sufficient for conception. The time to producing sperm by the testicles post vasectomy is large part dependent on the interval between the vasectomy and the reversal. It is always a “drum roll” moment when the specimen is dropped off for me to evaluate and always rewarding to see sperm moving about so excited to be set free and get to work.
The following is not a post reversal sample but it shows what you want to see in the ejaculate after a reversal. It is also interesting how the maker of the video created the project.
Just because something can be done doesn’t mean that it is the way you’d want it done.
Yes. The scrotal skin and the nerves that innervate the testicles and vas deferens can be infiltrated with short and long acting anesthetics for very good control of pain. Oral medicines similar to what is used in “sedation dentistry” can be used as a sedative to further make non general anesthesia possible for a vasectomy reversal.
Why doesn’t everyone do it this way? Because the procedure usually lasts 2-3 hours some patients might not be comfortable lying still for that long. As well, because the operative microscope magnifies the operative field so much, small movements dramatically change the area seen and the focus settings. This in turn results in the surgeon having to readjust the microscope and in turn make procedure last longer. One might add that the occasional adjustments hamper the surgeon’s ability to do a quality repair of the vasectomy.
Another reason that a patient and the doctor might prefer local anesthesia with oral sedation is cost. Having general anesthesia must be done in a facility and that in it self adds an expense and then there is the anesthesiologist and the supplies necessary for general anesthesia.
The advantage to the patient with general anesthesia is that he is put to sleep and then wakes up and the procedure is done. For the surgeon he has had the advantage of not being concerned or dealing with a patient moving and having to readjust the microscope.
So in the end it becomes about patient and surgeon preference, and cost. At Northeast Georgia Urological Associates we believe we have the best of both worlds.
Because we own our center the added costs for a facility and anesthesia is minimized resulting in a very cost effective reversal without compromising safety and comfort by utilizing a board certified anesthesiologist in an accredited surgery center.