Now you know!!!
A common question asked is whether the reversal will be harder if clips were used or if the patient was told by the urologist “I took out a section and burned it.”
In the vast majority of cases this has no influence on the microscopic vasectomy procedure.
The procedure is harder if both sides of the vasectomy were done in the vas deferens closest to the testicle-the convoluted vas. This area is smaller in diameter and not straight (convoluted) and this makes the repair a little harder.
Whether clips or burned, there is not difference in how difficult the reversal will be. Having had clips makes the area of the vasectomy easier to locate.
The amount of vas tube removed is usually not an issue unless there is a very large segment removed and this is customarily not done.
Of note, if you have had two vasectomies done, this could be an issue. If you had a complication after the vasectomy, say a large hematoma or infection that had to resolve or be operated on, these may affect the repair. On all unusual issues, be sure to make the reversal doctor aware.
The question was- “What are the options for the no scalpel vasectomy?”
- In terms of anesthesia (Absolutely no discomfort): we offer conscious sedation by a board certified anesthesiologist on Thursday. In this scenario, you’ll have an I.V., monitored and will sleep through the procedure safely with absolutely no discomfort. The medicine used by the anesthesiologist goes to work quickly and goes away out of your system quickly, so it is ideally suited for this type of procedure.
- Local anesthesia with a pre-med (Usually Ativan/Norco by mouth, or a I.V. injection of similar medications) before the procedure and then local anesthesia with Lidocaine. This method is suited for the patient that has no fear of needles, no anxiety with medical procedures or passes out easily. This is a more streamlined method and is commonly done on Friday.
- In terms of payment options: Our office accepts most all insurances and we have relationships with them. This means that we accept what they allow. You may have a deductible and other particular specifics of your plan, but that is what we go by.
- If you are self pay: Our fee is $950.00 and this is all inclusive and can be done on a Thursday or a Friday.
- The Consultation: This can be with an in office visit which has the advantage of being able to perform an exam, or with a Telehealth visit. One only has to call the office to arrange.
The procedure itself: All no scalpel vasectomies across America use a small hemostat to spread the skin (i.e. no scalpel), however whether after dividing the vas deferens tube the urologist uses cautery, clips or suture the success rate of 1/2000 is about the same. It becomes about the preference of the urologist. Dr. McHugh uses electrocautery (fulgurate or heat). We have learned over the years that many patients prefer not having the foreign body of the clip left in the scrotum.
So the answer to the question is that there are several combinations of how the procedure is billed and options re: how it is performed. We do them all. We have done thousands of vasectomies over the years and perform hundreds a year.
“We know a thing or two about doing vasectomies, because we’ve done a vasectomy or two.”
Dr. McHugh is Georgia’s most experienced no scalpel vasectomy and microscopic vasectomy reversal urologist.
“The office staff was very nice and very informative to me and my wife. The doctor was very personable and made you feel comfortable. He explained everything he was doing and explained it before he did it. I would recommend him to anyone and you don’t find that in many doctors these days.” Z.S.
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Great Doctor. Completely helps you understand what issues you have and actually talks to you with great respect. – S.G.
Thank you very much. You are kind!- John McHugh
The best infertility treatment for vasectomized men: assisted reproduction or vasectomy reversal?
In men with prior vasectomy, microsurgical reconstruction of the reproductive tract is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.
A Microscopic Vasectomy Reversal Podcast by Dr. McHugh
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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!
I saw a patient recently on whom I performed a reversal around a year ago. He and his wife have not achieved pregnancy. He showed me the report of a semen analysis which showed around 50 million sperm with a motility of over 50%. Although 60-150 million sperm is considered normal, most urologists feel that any count above 20 million is suitable to achieve pregnancy. Motility should be over 45% (i.e. 45% of the sperm under the microscope are observed to be moving forward). Other parameters such as morphology (how the sperm look) are less important.
From the perspective of the surgeon who performed the procedure, any sperm in the ejaculate indicates that the reversal was successful and now it is up the the male to begin to produce the quality of sperm necessary to achieve pregnancy. As well, there is the added dynamics of the female ability to have a child. As a rule, when there is no pregnancy between a couple without the history of a vasectomy, the problem is about 50/50 male to female. The point is that even if the post reversal male has adequate sperm, pregnancy still requires other factors to be in place as well.
In the above scenario, the good sperm count and motility is a very good start and indicates a good reversal. And it makes the point about couples understanding the difference between patency (presence of sperm after a reversal) and pregnancy. There is usually a 10-15% differential between the two.
Pregnancy is a many splendored thing-Pregnancy after a reversal is a multi-factorial thing.
- The age of the male.
- The age of the female.
- The time since the vasectomy.
- The quality of the sperm from the testicular end of the transected vas at the time of the reversal procedure.
- The technical quality of the reversal procedure itself and the experience of surgeon.
- Some degree of luck for all of these factors to come together and result in pregnancy.
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.