Tag Archives: vas reversal cost

Post vasectomy pain syndrome-Myth?

This real phenomenon in my experience happens rarely, but it happens. There are reports that show that doing a reversal has been dramatically beneficial.

The reversal surgeon however cannot assure that there will be resolution of symptoms if a reversal is done. This should weigh heavily in the decision making process of the patient wanting to pursue this.

I will mention that I performed a reversal on a man who wanted children but also felt he had PVPS. He wrote me after the procedure stating that he had had complete resolution of his pain and was very pleased.

Here are several links on the discussion of this:

Wikipedia

PubMed Article

CMRM Article

Review of literature-Note those patients that did not improve with reversal.

 

Are vasectomies reversible?

Yes…but that doesn’t mean it will work!

This is a common question by the person wanting a vasectomy. I often explain that yes they are reversible but that is not the entire issue. As explained elsewhere, there are many factors involved in a “successful” reversal to include the health of the couple, who does the reversal and the time between the reversal and the vasectomy.

Urologists always tell the vasectomy couple that they should consider the procedure permanent. We mention that it can be reversed but the success rates vary and that they should not depend on that.

If there is any doubt  about wanting another child you probably are not ready to nor should you have a vasectomy.

A good option for some is to bank sperm. The fee for this varies but is around $300 a year.

A funny memory for me… awaiting our third child my wife informed me that she did not want anymore children and that she had arranged for her tubes to be tied after the delivery. I asked, “What if you change your mind and we do want another one in a few years.” (I was one of five boys and had always wanted a large family.)

“John we can adopt. My body is done with having babies.”

Well…there you go. Having three children now all over the age of thirty I understand the wisdom of her decision.

How wonderful is this?

Thank you Dr. McHugh! After our 3rd child was born my husband and I thought we were done having children and opted to have a vasectomy. Well, about a year later we both realized that we were not done having children and wanted to try for one more. I researched urologists in the area that performed vasectomy reversals and Dr. McHugh really stuck out to me. My husband had his consultation and agreed that he was a great doctor and felt really comfortable with him. My husband had his VR done October 30, 2014 and I was pregnant 4 months later. We couldn’t believe it and we were so ecstatic! Our perfect little girl, Layla Anne Kapish was born November 3, 2015 at 8lbs 6oz. Now with two girls and two boys she really completes our family and we couldn’t imagine life without her. If you are considering a vasectomy reversal, Dr. McHugh is the one you should see. We HIGHLY recommend him! Thank you so much again to him and all of his staff. INCREDIBLE!
Sincerely,
Marly and Robert Kapish

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Why doesn’t the average urologist do vasectomy reversals?

Most urologists do a vasectomy once or twice a week. They can be done in the office and usually take fifteen minutes or so to do. We call that in the business a “bread and butter” procedure. In other words, a vasectomy is something that most urologists do often and well. (I might add that some urologists do a better job than others in this procedure-that is true for most surgical specialties.)

Since only about 1 in 6 men who have had a vasectomy will, at some point due to a change in his circumstances consider a reversal, several factors come into play that dissuades the urologist from agreeing to perform the procedure.

  • Fewer numbers of available men wanting the procedure for the average urologist to become proficient in performing it.
  • The procedure takes around 2-3 hours to perform and done looking through a microscope throughout the procedure.
  • It is not covered by insurance-some patients want a reversal but can’t afford it.
  • There is a steep learning curve in doing the procedure well and in a timely fashion.
  • There are expected results by the patient who will be inconvenienced, undergo a surgical procedure and at an expense not covered by his insurance. (When a general surgeon removes the gallbladder, well he removes it…it is not like some function will be expected beyond that. The reversal couple rightfully expect and hope that there will be sperm in the ejaculate after the reversal. This is a lot for the average urologist who would much rather just send the patient desirous of a reversal to someone “Who does them all the time.” Let him or her deal with all the expectations and potential of having put someone through all this and then no sperm in the ejaculate.)
  • The procedure requires special instruments, an operating microscope, and special suture. The local hospital may or may not have all this and if they do, then the patient has the added expense of the hospital fees making the patient pay at a premium for the “set up” and by a urologist who does the procedure infrequently.
  • Not all physicians are comfortable or have the skills to use microscopic suture and to sew and tie suture under the microscope. Without this skill set, the 2-3 hour procedure can last much longer with less acceptable results.
  • So…that the average urologist doesn’t do this procedure is a good thing and how it should be. If they aren’t comfortable with the procedure and logistics of it they shouldn’t be doing it.

It is a fair question for the patient to ask their doctor, “Do you do this procedure commonly?” “How many have you done?”

At Northeast Georgia Urological Associates we have an accredited surgery center appropriately equipped for this procedure, we are approaching 130 reversals done and our patency rates compares favorably with studies in the medical literature.

On top of that-we enjoy performing the procedure, the hopeful couples, and the happy results.

We look forward to working with  you!

The major factors in a successful vasectomy reversal. John McHugh M.D.

  

  1. The age of the male.
  2. The age of the female.
  3. The time since the vasectomy.
  4. The quality of the sperm from the testicular end of the transected vas at the time of the reversal procedure.
  5. The technical quality of the reversal procedure itself and the experience of surgeon.
  6. Some degree of luck for all of these factors to come together and result in pregnancy.

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.

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.

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.

 

Is the No Scalpel Vasectomy a gimmick? Yes and No.

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The very first vasectomy ever performed probably isolated the vas deferens, cut out a section and then destroyed the cut ends. This has the effect of a double whammy to assure sterility. How the ends are destroyed or closed is myriad-clips, suture, fulguration, folding the vas on itself and tying- doesn’t really matter in terms of the long-term success rates.

When I learned to do a vasectomy as a resident in the 1980’s, we made a fourth of an inch midline scrotal incision and brought the vas to the surface with a instrument called a towel clip. It had two fine pointed ends and was used to hold towels in place to isolate the surgical field. This instrument was adapted to many functions in surgery and in urology was the device of choice for a vasectomy.

The China Method or the No scalpel method introduced two instruments. One is the fine pointed hemostat which is used to spread the skin for the vasectomy opening. (So there is still an opening but you did not use a scalpel to make it-whoopee do.)

The fine pointed hemostat is also used to open the vas sheathing without having to incise it with a knife once the vas has been isolated and brought to the skin.

This is where the grasper is used. The opening is smaller-a grain of rice in length- and the grasper allows for the urologist to easily grasp and bring the vas to the skin to perform the procedure.

The story line goes that the procedure has a smaller opening, that the opening heals better because the skin has been spread and not cut, the procedure can be done quicker  because of these instruments, and that the patients do better with less heal time and fewer complications.

So is it a gimmick? Well it is a better procedure now because of these instruments, but we still identify, cut and destroy. You can decide if all this fuss in nomenclature warrants “spreading” is better than “cutting” an opening that is less than a centimeter in length.

No Scalpel does have a ring to it I must admit. The No Needle vasectomy is another story; I’ll do that at another time.

Of note, these same two instruments are also very useful in preparing the post vasectomy vas for the microscopic vasectomy reversal.