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.
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.
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.
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.
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.
Gainesville Urologist Provides Unique Niche for Microscopic Vasectomy Reversal Surgery in Northeast Georgia.
Northeast Georgia Urologist John McHugh M.D. is one of a small number of urologists in Georgia who performs the Microscopic Vasectomy Reversal routinely.
“Naomi Aria Polk was born 12 months after having my surgery, & we couldn’t be happier with our newest addition!” Reginald Polk
Only a small percentage of urologists both perform this procedure at an acceptable cost and have the experience to assure optimal results.
Gainesville, Georgia (PRWEB)
Community urologist John McHugh routinely performs a procedure that most urologists don’t do at all. Although the concept of a vasectomy reversal (removing the vasectomy site scar and reattaching the vas tubes) is simple, the actual performance of the procedure is not. Two issues make a vasectomy reversal unique compared to other procedures that the urologist performs: one the number of couples who desire a reversal is only six percent of those who have had a vasectomy and as a result the number of potential reversals for the average practicing urologist is small, two the procedure involves microscopic suture and use of the operating microscope and as a result there is a steep learning curve. These two factors contribute to the fact that very few urologists perform vasectomy reversals and fewer yet perform it frequently to do it well. Although pregnancy after a reversal is multifactorial it all begins with the quality of the joining of the two ends of the vas deferens in a tension free and watertight fashion and this in turn highlights the importance of an experienced surgeon.
“Although I have done reversals for over twenty-five years, the opening our Urological Ambulatory Surgery Center in 2009 has added the dimension of making the procedure more cost effective and efficient for the patient. We have the same suture, operating microscope, microscopic instrumentation and staff without the expense of the hospital,” says Dr. McHugh.
Dr. McHugh performs the procedure using a modified two layer anastomosis using microscopic suture, a Zeiss operating microscope with anesthesia provided by a Board Certified Anesthesiologist. His surgery center is accredited adding safety of the patient to the benefits the reversal he performs.
“Few urologists perform microscopic vasectomy reversals routinely because the number of patients who desire it is small. If you add to this the cost of having it performed in a hospital and the fact that the procedure is not covered by insurance, you can see how the patients become very selective. In addition, the patient must undergo the expense and inconvenience of this procedure and rightfully wants the best chance of pregnancy. Few urologists meet the criteria of providing both acceptable cost and the experience to assure optimal results,” adds Dr. McHugh.
Dr. McHugh uses a technique in which the tube inside each vas deferens is joined by using six 9-0 microscopic sutures, which are smaller than a hair in diameter, making the use of a microscope a necessity. The outer layer is then joined with additional sutures assuring a watertight connection.
The procedure involves two small upper scrotal incisions and takes between two and half and three hours to perform. Success of the procedure is affected by the length of time between the procedure and when the vasectomy was done. Historical data regarding success rates depending on when the vasectomy was performed is on the reversal page of his practice website-ngurology.com.
Dr. McHugh offers a free consultation to couples considering having a vasectomy reversal and complimentary hotel accommodations for out of town patients who desire it.
“The microscopic vasectomy reversal has become for me the most enjoyable and rewarding procedure I perform as a urologist.” – Dr. John McHugh
Dr. McHugh has written several books available on Amazon and has practiced urology in Gainesville, Georgia for twenty nine years. His interests include history, writing, dogs, water and fishing.