Tag Archives: john mchugh md

Vasectomy reversal-Loupes vs. Microscope?

Cardiac_surgeon_wearing_loupes

Atlanta—If you’re going to perform a vasectomy reversal, use a microscope. Despite the additional time and cost involved, microsurgical vasovasostomy is superior to the loupe-assisted macroscopic technique, findings from a recent study from Korea confirm.
In the retrospective study from Bundang CHA Hospital in Sungnam, researchers found a 24% higher patency rate in patients who underwent microsurgical vasovasostomy using 9-0 nylon compared with those who underwent a loupe-assisted technique using 8-0 nylon. However, the improved patency rate of the microsurgical technique did come at the expense of a significantly longer operation time than that of the loupe-assisted approach. Read More…

Dr. McHugh uses a Zeiss operating microscope in our accredited ambulatory surgery center. Contact us for a free consultation.

Request an appointment 24/7-We’ll return your call the next business day.

sandras grandson.png

 

Vasectomy Reversal-Frequently Asked Questions.

image

From  The University of Iowa-

Vasectomies can be reversed even after very long periods of time, sometimes after more than 25 years. Sperm are constantly being produced in men and even after time, there should be viable sperm. However, the success of the reversal, in terms of achieving a pregnancy, is dependent upon the experience of the surgeon, the age and fertility status of the female partner, and the length of time since the vasectomy. Read More

Video of fluid from testicular end of vas at the time of vasectomy reversal.

dnews-files-2013-04-us-largest-exporter-sperm-660-jpg

This particular patient had his vasectomy 8 years before the reversal. When the area of the vasectomy site is excised fluid then emanates from the testicular side of the vas. The presence of fluid and the character of the fluid can determine the success of the reversal. In general-the shorter the time period from the vasectomy to the reversal the better the success rates are for pregnancy.

From Metrocentre Australia 

Microscopic Vasectomy Reversal-One vs Two Layer Method?

176194

From Vasectomy.com

Although vasectomy should be considered a permanent form of birth control, around 6 percent of men will eventually decide to undergo a vasectomy reversal. This procedure is done to restore a man’s fertility and allow him to father a child through natural means.

One method for reversing a vasectomy is a vasovasostomy. During this surgical procedure, the two cut ends of the vas deferens are sewn back together using very fine sutures viewed through a powerful surgical microscope. If successful, this procedure will enable sperm to flow from the testicles once again.

Several surgical techniques exist for rejoining the vas deferens. Some work better than others, but the best results are always obtained by doctors with training in microsurgical reconstruction. One of these methods is known as a two-layer vasovasostomy. Read More

First Vasectomy in America? 1897

warning-vasectomy

Click on Image to Visit Northeast Georgia’s Vasectomy Page

Interesting Facts about a Vasectomy and Vasectomy Reversals

The First Microscopic Vasectomy Reversal?

Technical advances in vasectomy reversal mirror those in microsurgery over the past 100 years. As a discipline, microsurgery was first performed by Carl Nylen in Sweden for middle ear surgery in 1910, but grew most rapidly as a discipline in the 20th century stimulated by its success in microvascular reconstruction of war-injured soldiers.

The first microsurgical vasectomy reversal was performed by Earl Owen in 1971.

Ga Vasectomy Reversal-Why is an operating microscope necessary for vas reversals?

Penny

To get some idea of the size of the structures repaired, take a look at a penny. The “o” in God is approximately the diameter of the inner layer of the vas deferens (0.2-0.3 mm); the epididymal tubule is about half this size — and far more delicate. Read More from Dr. Finnerty’s Reversal Website.

 

Ga Vasectomy Reversal-What is the most common complication after a reversal?

a testis vessels

  • Major complications associated with a microscopic vasectomy reversal are uncommon.
  • In many ways the complications that do occur are similar to that associated with a vasectomy.
  • As the picture above illustrates, there is a large and intricate complex of blood vessels associated with vas deferens.
  • One can see that is removing the inch or so segment of the post-vasectomy vas deferens involves severing numerous vessels including the vasal artery.
  • Surgeons fear veins more than arteries because a vein has a thin outer covering and it is not pulsatile.
  • The bleeding from a vein is more sneaky than an artery; the vein slowly oozes  but an artery by having a pulse is easy to detect when it is bleeding.

So the most common complication of a vasectomy and a vasectomy reversal is a hematoma or a collection of blood, which will accumulate until the space around it has enough pressure to make it stop. It is important for the surgeon to thoroughly inspect the reversal site before finishing the reversal to detect even the slightest amount of bleeding. Using the microscope for this purpose allows for detection of bleeding that might not be noted with the naked eye. 

If a hematoma occurs the usual treatment is conservative i.e. allow for it to resolve and be absorbed by the  body on its own. Hematoma occurrence can be minimized by the patient following the post-operative instructions of limited activity and the use of  compression underwear. It is important to stop any aspirin or ibuprofen well in advance of the procedure. 

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

vasectomy-reversal-success

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! 

 

Why do you wait 3-4 months to check for sperm atfter a vasectomy reversal?

135449-004-F2AB0A3F

  • The time from the vasectomy to the reversal is one of the most important factors in the reversal’s success.
  • The longer the interval the more effect of the vasectomy obstructing the natural course of things in the testicle has on sperm quality.
  • Determining how much negative effect has occurred as result of the vasectomy on the quality and quantity is variable and usually based on the time interval.
  • Assuming that because a vasectomy can potentially “shut down” production of normal sperm, the testicles, after a reversal, have to readjust and begin to produce sperm again.
  • The chart above shows the maturation of sperm in the testicle.
  • This process usually takes about three months.
  • So, if the testicles have stopped producing sperm and the obstruction of the vasectomy is corrected by the reversal, then it would take about three months for normal sperm to complete the maturation process and be seen in the ejaculate.
  • So this is why many reversal doctors tell their patients not to consider submitting a specimen for the presence of sperm after a reversal for at least 3-4 months.
  • It you submit a specimen at three months and there are no sperm, that is disappointing, but in many patients it may take up to a year for the testicles to resume their normal activity.
  • I have had patients with no sperm in the ejaculate at six months and achieved pregnancy at one year.