Category Archives: Microscopic Vasectomy Reversal

Vasectomy on your New Year’s Resolution list?

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Great Doctor. Completely helps you understand what issues you have and actually talks to you with great respect. – S.G.
Georgia Vasectomy/ Vasectomy Reversal -John Clay McHugh M.D.
Thank you very much. You are kind!- John McHugh

Will the Vasectomy Reversal procedure be like my Vasectomy?

A vasectomy takes about 15 minutes and I do them through a single “size of a grain of rice” opening.

A reversal, in my hands, takes about two hours and more commonly uses two incisions (3/4 inch on each side of the upper scrotum over the course of the vas deferens) and requires an operating microscope and microscopic suture.

I tell patients that it is a minor procedure, minimal blood loss or other complications, but it does take two hours to do. Bruising and some scrotal swelling is more common and there is a longer recovery period.

So…to the question…same structure (the vas deferens) different procedure.

Vasectomy? On this day in history Caesar was surprised. Don’t you be!

Rome-History-Julius-Caesar

As sole Roman ruler, Caesar launched ambitious programs of reform within the empire.

The most lasting of these was his establishment of the Julian calendar, which, with the exception of a slight modification and adjustment in the 16th century, remains in use today.

He also planned new imperial expansions in central Europe and to the east. In the midst of these vast designs, he was assassinated on March 15, 44 B.C., by a group of conspirators who believed that his death would lead to the restoration of the Roman Republic. However, the result of the “Ides of March” was to plunge Rome into a fresh round of civil wars, out of which Octavian, Caesar’s grand-nephew, would emerge as Augustus, the first Roman emperor, destroying the republic forever.

Click for free eBook on vasectomies by Dr. McHugh

What is the ideal number children to have?

From  The Atlantic

A handful of studies have tried to pinpoint a number of children that maximizes parents’ happiness. One study from the mid-2000s indicated that a second child or a third didn’t make parents happier. “If you want to maximize your subjective well-being, you should stop at one child,” the study’s author told Psychology Today. A more recent study, from Europe, found that two was the magic number; having more children didn’t bring parents more joy.

In the United States, nearly half of adults consider two to be the ideal number of children, according to Gallup polls, with three as the next most popular option, preferred by 26 percent. Two is the favorite across Europe, too.

Ashley Larsen Gibby, a Ph.D. student in sociology and demography at Penn State, notes that these numbers come with some disclaimers. “While a lot of [the] evidence points to two children being optimal, I would be hesitant to make that claim or generalize it past Western populations,” she wrote to me in an email. “Having the ‘normative’ number of children is likely met with more support both socially and institutionally. Therefore, perhaps two is optimal in places where two is considered the norm. However, if the norm changed, I think the answer to your question would change as well.”

Did you know this about vasectomies?

About 500,000 vasectomies are performed each year in the U.S. Although the procedure is cheaper, faster, safer, and more reliable than female sterilization (1 pregnancy in 100), only 9% of sexually active men in the United States get vasectomies, while 27% of women get tubal ligations.

Predictive factors in sperm appearance after vasectomy reversal.

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Patient’s often ask, “What is your success rate?” The successful reversal is heavily influenced by the quality of the fluid at the testicular end at the time of the reversal and the time interval since the vasectomy. JM

Time to Sperm Appearance Can Be Predicted After Vasectomy Reversal

Urology – November 30, 2007 – Vol. 23 – No. 08

After vasectomy reversal, motile sperm observed intraoperatively at the testicular vas, undergoing vasovasostomy, and an obstructive interval of <=8 years predict shorter time to appearance of sperm in the ejaculate.

Article Reviewed: The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal. Yang G, Walsh TJ, et al: J Urol; 2007; 177 (June): 2272-2276.

The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal.

Yang G, Walsh TJ, et al:
J Urol; 2007; 177 (June): 2272-2276

Objective: To study the time to appearance of sperm in the ejaculate for men undergoing vasectomy reversal. Design: Retrospective chart review of men who had undergone bilateral vasovasostomy, bilateral epididymovasostomy, or a combination of vasovasostomy on 1 side and epididymovasostomy on the other. Participants/Methods: 150 men whose records included intraoperative findings with type of reversal performed, record of sperm presence or absence, and associated fluid findings from each testicular vas deferens.

Results: Presence of motile sperm in vasa was associated with a shorter time to postoperative presence of sperm observed in the ejaculate: 95% of men with motile sperm in the intraoperative vasal specimen were observed to have sperm in the ejaculate by 6 months after vasectomy reversal compared to 76% of men without motile sperm in the intraoperative specimen (P =0.04). Features correlated with a shorter onset to the observation of sperm in the ejaculate within the first 3 months after vasectomy reversal included an obstructive interval of <=8 years and vasovasostomy rather than epididymovasostomy. Patient age did not affect time to the observation of sperm in the ejaculate after vasectomy reversal.

Conclusions: Motile sperm observed intraoperatively at the testicular vas, undergoing vasovasostomy, and an obstructive interval of <=8 years predict shorter time to the appearance of sperm in the ejaculate after vasectomy reversal. Reviewer’s Comments: The similarity with previous studies by other investigators of time to sperm seen in the ejaculate, with an average of 3.2 months for vasovasostomy and 6.3 months for epididymovasostomy, provides excellent counseling information for couples considering vasectomy reversal. (Reviewer–Craig S. Niederberger, MD).

 

Reversal: Does it matter which type of vasectomy was done?

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In the big scheme of things nope! However the picture shown above the vasectomy was done with clips. For the reversal surgeon this type of vasectomy is the easiest to find and usually is associated with a smaller segment to remove.

When the vasectomy has been done with fulguration alone (burning the inside of the severed vas) it be hard to find the actual site of the vasectomy. The defect is sometimes so small that the entire vas tube appears as if nothing has been done.

If a sperm granuloma has formed this is very easy to find and is a positive thing as the fluid is much better in this case.

Finally, a vasectomy should only be done if the couple is wanting “permanent” birth control. So a urologist doing a vasectomy in a way to make a reversal easier in my opinion is not the right attitude for either the patient or the doctor.

Vasectomy Reversal Success Depends on Three Big Things…Read On!

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The three things…The surgeon, the quality of fluid at the time of the procedure, and the years since the vasectomy…and a little luck.

Time to Sperm Appearance Can Be Predicted After Vasectomy Reversal

Urology – November 30, 2007 – Vol. 23 – No. 08

After vasectomy reversal, motile sperm observed intraoperatively at the testicular vas, undergoing vasovasostomy, and an obstructive interval of <=8 years predict shorter time to appearance of sperm in the ejaculate.

Article Reviewed: The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal. Yang G, Walsh TJ, et al: J Urol; 2007; 177 (June): 2272-2276.

The Kinetics of the Return of Motile Sperm to the Ejaculate After Vasectomy Reversal.

Yang G, Walsh TJ, et al:
J Urol; 2007; 177 (June): 2272-2276

Objective: To study the time to appearance of sperm in the ejaculate for men undergoing vasectomy reversal. Design: Retrospective chart review of men who had undergone bilateral vasovasostomy, bilateral epididymovasostomy, or a combination of vasovasostomy on 1 side and epididymovasostomy on the other. Participants/Methods: 150 men whose records included intraoperative findings with type of reversal performed, record of sperm presence or absence, and associated fluid findings from each testicular vas deferens. Results: Presence of motile sperm in vasa was associated with a shorter time to postoperative presence of sperm observed in the ejaculate: 95% of men with motile sperm in the intraoperative vasal specimen were observed to have sperm in the ejaculate by 6 months after vasectomy reversal compared to 76% of men without motile sperm in the intraoperative specimen (P =0.04). Features correlated with a shorter onset to the observation of sperm in the ejaculate within the first 3 months after vasectomy reversal included an obstructive interval of <=8 years and vasovasostomy rather than epididymovasostomy. Patient age did not affect time to the observation of sperm in the ejaculate after vasectomy reversal.

Conclusions: Motile sperm observed intraoperatively at the testicular vas, undergoing vasovasostomy, and an obstructive interval of <=8 years predict shorter time to the appearance of sperm in the ejaculate after vasectomy reversal.

Reviewer’s Comments: The similarity with previous studies by other investigators of time to sperm seen in the ejaculate, with an average of 3.2 months for vasovasostomy and 6.3 months for epididymovasostomy, provides excellent counseling information for couples considering vasectomy reversal. (Reviewer–Craig S. Niederberger, MD).

 

Success rates for vasectomy reversal? What’s important.

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