Technical advances in vasectomy reversal mirror those in microsurgery over the past 100 years. As a discipline, microsurgery was first performed by Carl Nylen in Sweden for middle ear surgery in 1910, but grew most rapidly as a discipline in the 20th century stimulated by its success in microvascular reconstruction of war-injured soldiers.
The first microsurgical vasectomy reversal was performed by Earl Owen in 1971.
To get some idea of the size of the structures repaired, take a look at a penny. The “o” in God is approximately the diameter of the inner layer of the vas deferens (0.2-0.3 mm); the epididymal tubule is about half this size — and far more delicate.Read More from Dr. Finnerty’s Reversal Website.
Major complications associated with a microscopic vasectomy reversal are uncommon.
In many ways the complications that do occur are similar to that associated with a vasectomy.
As the picture above illustrates, there is a large and intricate complex of blood vessels associated with vas deferens.
One can see that is removing the inch or so segment of the post-vasectomy vas deferens involves severing numerous vessels including the vasal artery.
Surgeons fear veins more than arteries because a vein has a thin outer covering and it is not pulsatile.
The bleeding from a vein is more sneaky than an artery; the vein slowly oozes but an artery by having a pulse is easy to detect when it is bleeding.
So the most common complication of a vasectomy and a vasectomy reversal is a hematoma or a collection of blood, which will accumulate until the space around it has enough pressure to make it stop. It is important for the surgeon to thoroughly inspect the reversal site before finishing the reversal to detect even the slightest amount of bleeding. Using the microscope for this purpose allows for detection of bleeding that might not be noted with the naked eye.
If a hematoma occurs the usual treatment is conservative i.e. allow for it to resolve and be absorbed by the body on its own. Hematoma occurrence can be minimized by the patient following the post-operative instructions of limited activity and the use of compression underwear. It is important to stop any aspirin or ibuprofen well in advance of the procedure.
There two areas that have to heal after a vasectomy reversal procedure.
The subcutaneous tissues and the skin which have been incised to reach the vas tubes has to heal.
What the patient sees is the skin sutures. These sutures dissolve and go away in about two weeks.
Although the skin will appear healed on the surface, microscopically full healing occurs at approximately six weeks.
The scrotum is not like an abdominal incision where excessive straining prior to complete healing could cause extrusion bowel or create a hernia.
The skin of scrotum healing is independent of straining but excessive activity and motion could delay the healing process.
Sometimes the sutures dissolve prior to complete healing of the skin. Some areas of the suture line may open minimally and this is of no concern and will close over (epithelialize) within a week.
In regards to the skin healing process, a patient can shower in a few days with care for water not to hit the site directly, and one should place Neosporin ointment on the site daily.
The Reversal Site
The repair is done with 12-14 permanent sutures in a tension-free and water-tight fashion.
Compression shorts are recommended for approximately three weeks.
This allows for the inner and out layers of the repair to heal without the undue stress of the testicles and hence the vas deferens moving up and down and potentially delaying the healing process.
So though the two primary areas that need to heal before strenuous physical activity or sexual activity are different in character, the magic number of time is around three weeks-four weeks.
Anecdotally, I have had a patient present to my office the day after a reversal stating that he was having bleeding at the incision site. He confessed that he had had sex the night of the procedure. I reassured him the bleeding was from the skin edge and nothing to be concerned about.
This couple had a baby almost 9 months later to the day. Go figure!
The time from the vasectomy to the reversal is one of the most important factors in the reversal’s success.
The longer the interval the more effect of the vasectomy obstructing the natural course of things in the testicle has on sperm quality.
Determining how much negative effect has occurred as result of the vasectomy on the quality and quantity is variable and usually based on the time interval.
Assuming that because a vasectomy can potentially “shut down” production of normal sperm, the testicles, after a reversal, have to readjust and begin to produce sperm again.
The chart above shows the maturation of sperm in the testicle.
This process usually takes about three months.
So, if the testicles have stopped producing sperm and the obstruction of the vasectomy is corrected by the reversal, then it would take about three months for normal sperm to complete the maturation process and be seen in the ejaculate.
So this is why many reversal doctors tell their patients not to consider submitting a specimen for the presence of sperm after a reversal for at least 3-4 months.
It you submit a specimen at three months and there are no sperm, that is disappointing, but in many patients it may take up to a year for the testicles to resume their normal activity.
I have had patients with no sperm in the ejaculate at six months and achieved pregnancy at one year.
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.