Category Archives: Georgia vasectomy reversal.

Overview of a Vasectomy Reversal

Adobe Voice Video of Beginning the Vasectomy Reversal Process

The first step is making the decision to have one and the next is scheduling a free consultation to learn all about the procedure and how factors specific to you affect the success rates.

770-535-0001 ext. 113 and Kathy will guide you through the process.

After a vasectomy reversal…What type of scrotal support?

index

Well you might think this is an odd question. Well…it is probably the most commonly asked and the first question in the post-op area asked by the wife. Tighty whities or  boxer briefs are the most common “supports” mentioned as potentially being suitable for the post-reversal male.

The problem with the traditional “jock strap” and the above mentioned supports is that they just don’t add the compression and lack of movement of the testicles necessary to facilitate immobilizing the newly repaired vas deferens.

Nothing fits the bill better than a pair of athletic compression shorts as seen above. The male can begin wearing the day after the procedure and throughout the 3-4 week post-operative non sexual activity period necessary to allow the vasectomy reversal to heal appropriately.

Okay…you think this was an odd thing to spend a post on, but just wait…it will be on your mind as the first question after the surgery…that is after, ” When can we have sex?”

As a side note-this type of compression shorts are excellent for the post-vasectomy patient as well.

Vasectomy reversal-check for sperm at home!

vasectomy

A common question for the couple having had a microscopic vasectomy reversal is, “When should we check for the presence of sperm?” (As discussed elsewhere this will tell you two things: one that the testicles are now producing sperm and that the vas deferens is open i.e. the repair was successful.)

Although is a patient who had a vasectomy a relatively short time before the reversal may have sperm on the first ejaculate, the most fruitful time to check for sperm is in the three to four month range. In some it may take longer than that. The time frame depends on the time between the vasectomy and the reversal with the longer time interval resulting in a longer time for sperm to return.

Because most of our patients are from out of town, we often get calls as to how they check for the presence of sperm without having to come back to Gainesville. The two options would be to submit a specimen to the local hospital lab to be examined under a microscope which can quickly and easily be done but at some expense or a couple could use the kit provided by spermcheck.com. This kit has become a nice alternative to the post vasectomy patient who wants to assure sterility but would prefer not to have to give a specimen and then take it to the doctors office to be examined.

Even though the kit is to check for successful vasectomy, the presence of sperm for the post reversal patient would indicate things are on the right path to pregnancy. It would not indicate a specific number just presence or absence of sperm. A formal semen analysis would be required for the sperm parameters of count and motility. The minimum number of sperm to achieve pregnancy is usually 20 million with at least 40% having good forward motility.

 

What does sperm look like under a microscope after vasectomy reversal?

Sperm-egg

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.

 

Can a vasectomy reversal be done under local anesthesia?

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.

Most common reason for a vasectomy reversal?

Obviously there are a lot of reasons for a man choosing to reverse a vasectomy. The two most common reasons are:

  • The male is divorced, has had children and a vasectomy. He then remarries a younger woman who has not had children and wants to have children. Often times the discussion regarding the male undergoing the inconvenience and expense of a reversal  and his willingness to have it done, occurs before the couple is married.
  • A couple with several children decide after vasectomy they’d like to have more children. Interesting enough, in my practice, this reason for having a reversal is increasing.

Regardless of the reason we at Northeast Georgia Urological Associates look forward to helping you with a new addition to your family.

As a side note, the other day a patient told us that another doctor could tell him what he’d charge for a reversal but could not tell him what the hospital would be charging. In fact, the doctor told the patient to call the hospital to find out the costs. Because we own our Surgery Center we will be able to tell you exactly what the total cost will be and because we don’t use a hospital our costs are lower than most reversal centers.

 

Post vasectomy pain syndrome-Myth?

This real phenomenon in my experience happens rarely, but it happens. There are reports that show that doing a reversal has been dramatically beneficial.

The reversal surgeon however cannot assure that there will be resolution of symptoms if a reversal is done. This should weigh heavily in the decision making process of the patient wanting to pursue this.

I will mention that I performed a reversal on a man who wanted children but also felt he had PVPS. He wrote me after the procedure stating that he had had complete resolution of his pain and was very pleased.

Here are several links on the discussion of this:

Wikipedia

PubMed Article

CMRM Article

Review of literature-Note those patients that did not improve with reversal.