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Category Archives: microscopic vasectomy reversal atlanta

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.

Vasectomy Reversal-Northeast Georgia Urological Associates

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.

Reversal Success Story

“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.

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.

 

How long after microscopic vasectomy reversal can a couple have sex?

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Answer: One month is the usual recommendation however, I have had couples tell me (I am not making this up) that they had sex the evening of the procedure and that the reversal resulted in a baby.

The microscopic reversal is watertight from the microscopic sutures (meaning conceivably that tube is patent from the get go and that sperm can traverse the reversal without leakage) however there are other areas of the procedure that need to heal as well. So the one month of waiting is for everything to heal properly- from the skin incision, to the vessels that surround the vas deferens and the repair itself.

 

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.

Microscopic Vasectomy Reversal-How big is a micron?

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So why is an operating microscope necessary for reversing a vasectomy?

Well…

The thickness of a strand of hair is 100 microns.

The outside thickness of the vas deferens is about 2 mm and the lumen of the vas (the part of the vas that is connected with the reversal procedure and the tube that sperm travels) averages about .56 mm.

The suture used used for the procedure is 70 -100 microns, i.e. the suture is about the diameter of the human hair.

So…12 or so sutures the size of hair is used to join a tube that is that is less than a millimeter in diameter.

1000 microns equals a millimeter.

Of note: The suture that is usually be used to close an incision after an abdominal procedure would be bigger than the tube in which sperm travels in the vas deferens.

Very small sutures must be used to connect very small openings if there is going to be enough room after connecting the tubes for sperm to travel in their quest to achieve pregnancy.

And now…you know the rest of the story-and why…size does matter.

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.

Helping couples achieve the new addition to their lives with microscopic vasectomy reversal.

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