Category Archives: john mchugh

Question: The patient has had a vasectomy and has only one testicle. Can you achieve pregnancy with only one testicle?

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The question on vasectomy.com is about IVF however a microscopic reversal is also a reasonable option in this scenario.

It takes two to tango but only one testicle to conceive!

How long does it take for a vasectomy reversal to heal?

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There two areas that have to heal after a vasectomy reversal procedure.

The Skin

  • 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 major factors in a successful vasectomy reversal. John McHugh M.D.

  

  1. The age of the male.
  2. The age of the female.
  3. The time since the vasectomy.
  4. The quality of the sperm from the testicular end of the transected vas at the time of the reversal procedure.
  5. The technical quality of the reversal procedure itself and the experience of surgeon.
  6. Some degree of luck for all of these factors to come together and result in pregnancy.

Post Vasectomy Pain Syndrome: Reason for Vasectomy Reversal?

I have done over a thousand vasectomies and to my knowledge have not seen this syndrome in my practice.

Having said that, I do believe this malady does exist. But here is the thing, when a patient has a vasectomy reversal to alleviate the pain, it may not be the reversal per se that makes the pain go away.

I recently did a vasectomy reversal on a patient that wanted the procedure to have another child. He did, however, mention that he was told that clips were used for his vasectomy and that he had had pain in the right testicle since the procedure. At the time of the reversal on the right side I found a sperm granuloma (an inflammatory mass in the area of the vasectomy as a result of the body’s attempt to correct the trauma of the surgery and response to sperm which the body views as a foreign body)  and marked surrounding inflammatory changes.  There were clips noted and dissecting the granuloma out, cleaning the two ends of the vas and removing the “inflammatory glob” was more difficult than the usual dissection.  So at the end of the reversal on the right side the patient had the granuloma removed and pristine ends of the vas reconnected with microscopic suture.

It is too early to say if the reversal in terms of pregnancy and patency was successful. But what if his right testicular pain goes away? Maybe it is the removal of the sperm granuloma and not reconstituting the vas. In other words a vasectomy reversal done of post vasectomy pain syndrome that is successful, might have been because of removing the scar tissue and not the reversal.

I had a reversal patient several months ago tell me as he was leaving our surgery center that the primary reason for having the reversal was for pain and not children. He failed to tell me that preoperatively and if he had I would have discouraged having a reversal for that purpose alone. (Surgeon’s rule number one: Don’t operate on folks for pain.)  As it turned out, he wrote me a note complimenting my staff at our surgery center and that he was very pleased with the results, i.e. no more pain not that there was a pregnancy.

In summary, there may be something to having a reversal to alleviate chronic post vasectomy pain but it may have more to do with removing the sperm granuloma and inflammatory tissue than restoring the flow of sperm.

Free accommodations for out of town vasectomy reversal patients.

As most of our microscopic reversal patients are from out of town, we offer free accommodations at Gainesville’s Holiday Inn-Lanier Centre. This hotel is less than two miles from our surgery center and depending on the travel needs of the patient, we can reserve a room the night before or after the procedure.

Considering the time, expense and emotions involved with having any surgical procedure, we are happy to offer this small convenience to our out of town patients. At scheduling,  Kathy (ext. 113) will happily arrange for you.

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Birth defects after microscopic vasectomy reversal?

Just like the Marines…only the strongest, the fastest, the finest “get through.” And this is natures way of assuring the best sperm for the job.

“Cracking the egg” is very competitive!

A link between vasectomy reversals and birth defects has not been convincingly demonstrated.

Considering a vasectomy reversal? Consultation is free.

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If you are considering a vasectomy reversal, even if you are unsure who you will choose to perform it, it is a good idea to have a preoperative consultation. You can ask the pressing questions that concern you, you can get a concept of the procedure, the time it will take, the cost, and as a result of the exam of the previous vasectomy site-you will know if there are any contraindications for the procedure pertinent to you. It is also an opportunity to get to know the physician that may be doing the procedure.

The reason it is not unusual for a consultation to be free for reversals is that the visit and the subsequent procedure is usually not covered by insurance. The free consultation is beneficial to both parties and by being at no cost encourages the  couple to take that”first step” to the journey of having another baby.

Northeast Georgia Urological Surgery Center Reaches 100 Vasectomy Reversals Milestone

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Earlier this year Dr. McHugh performed his hundredth microscopic vasectomy reversal in the Northeast Georgia Urological Surgery Center. Thanks to all the patients and the dedicated staff that helped make this possible. Here’s to the next one hundred!

Does it matter what type of vasectomy you had if you are considering a vas reversal?

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No. All vasectomies involve removing a segment and then closing both ends of the vas defens tube. Whether the vasectomy was no needle, no scalpel, or whether the ends were closed with suture, electrocautery, or staples it doesn’t matter.  What is seen at the time of the reversal is a scarred area of vas between the testicle and body side of the tube. This segment is removed, the ends resected to clean and pristine tissue and then prepared for the rejoining process. The operative microscope is useful in examining the “freshened” ends of the vas tubes as success rates depend on no residual scar at the point of the repair.

Can a vasectomy be reversed?

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Yes a vasectomy  can be reversed…but that really isn’t the issue. The real question is if a vasectomy is reversed what are the chances that it will be successful?

The answer is multifactorial and dependent on the age of the male and female, how long ago was the vasectomy done, the reproductive health of the female, the surgical reconnection of the vas deferens staying open after they are rejoined, and finally the quality of the semen produced after the reversal. All of these factors explain why the patency of the procedure (presence of sperm) and the pregnancy (it worked) of the procedure differ.

Yes you can send a boy to college but you can’t make him think

and yes you can lead a horse to water but you can’t make him drink.

Yes you can reverse a vasectomy but that don’t guarantee no baby

It’s about if it will result in success and that my friend is a big maybe!

Reversal Rates Based on the Time Since Vasectomy

Less than 3 years  Patency 97% Pregnancy 76%

3-8 years             Patency 88% Pregnancy 53%

9-14 years           Patency 79% Pregancy 44%

Greater than 15 years Patency 71% Pregancy 30%

Belker AM, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. Journal of Urology 1991; 145(3):505-11.