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Georgia vasectomy reversal., john mchugh, microscopic vasectomy reversal atlanta

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

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Dr. McHugh holding Ga vasectomy reversal success baby

There are 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 although 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! 

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Should you consider a vasectomy permanent?

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Yes you should! The sperm doesn’t always score.

  • Yes if you have a vasectomy and decide to reverse it within 5 years you have a very good chance of having a successful pregnancy.
  • The longer the time between the vasectomy and the reversal the lower the rate of patency (the presence of sperm in the ejaculate) and the subsequent rate of pregnancy.
  • If you have doubts about a vasectomy, don’t have one.
  • Banking sperm before the vasectomy if you want fall back plan for the future is probably a better idea than depending on a reversal.
  • Remember that with a reversal you have to have a suitable number of sperm and you still have to overcome all the impediments to achieving pregnancy that any normal couple would have.

When considering a vasectomy you should take the “long view” before proceeding.

Georgia vasectomy reversal.

After a vasectomy reversal…What type of scrotal support?

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Well you might think this is an odd question. Well…it is probably the most commonly asked and the first question in the post-op area asked by the wife. Tighty whities or  boxer briefs are the most common “supports” mentioned as potentially being suitable for the post-reversal male.

The problem with the traditional “jock strap” and the above mentioned supports is that they just don’t add the compression and lack of movement of the testicles necessary to facilitate immobilizing the newly repaired vas deferens.

Nothing fits the bill better than a pair of athletic compression shorts as seen above. The male can begin wearing the day after the procedure and throughout the 3-4 week post-operative non sexual activity period necessary to allow the vasectomy reversal to heal appropriately.

Okay…you think this was an odd thing to spend a post on, but just wait…it will be on your mind as the first question after the surgery…that is after, ” When can we have sex?”

As a side note-this type of compression shorts are excellent for the post-vasectomy patient as well.

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Vasectomy reversal-check for sperm at home!

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A common question for the couple having had a microscopic vasectomy reversal is, “When should we check for the presence of sperm?” (As discussed elsewhere this will tell you two things: one that the testicles are now producing sperm and that the vas deferens is open i.e. the repair was successful.)

Although is a patient who had a vasectomy a relatively short time before the reversal may have sperm on the first ejaculate, the most fruitful time to check for sperm is in the three to four month range. In some it may take longer than that. The time frame depends on the time between the vasectomy and the reversal with the longer time interval resulting in a longer time for sperm to return.

Because most of our patients are from out of town, we often get calls as to how they check for the presence of sperm without having to come back to Gainesville. The two options would be to submit a specimen to the local hospital lab to be examined under a microscope which can quickly and easily be done but at some expense or a couple could use the kit provided by spermcheck.com. This kit has become a nice alternative to the post vasectomy patient who wants to assure sterility but would prefer not to have to give a specimen and then take it to the doctors office to be examined.

Even though the kit is to check for successful vasectomy, the presence of sperm for the post reversal patient would indicate things are on the right path to pregnancy. It would not indicate a specific number just presence or absence of sperm. A formal semen analysis would be required for the sperm parameters of count and motility. The minimum number of sperm to achieve pregnancy is usually 20 million with at least 40% having good forward motility.

 

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Can a vasectomy reversal be done under local anesthesia?

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Just because something can be done doesn’t mean that it is the way you’d want it done.

Yes. The scrotal skin and the nerves that innervate the testicles and vas deferens can be infiltrated with short and long acting anesthetics for very good control of pain. Oral medicines similar to what is used in “sedation dentistry” can be used as a sedative to further make non general anesthesia possible for a vasectomy reversal.

Why doesn’t everyone do it this way? Because the procedure usually lasts 2-3 hours some patients might not be comfortable lying still for that long. As well, because the operative microscope magnifies the operative field so much, small movements dramatically change the area seen and the focus settings. This in turn results in the surgeon having to readjust the microscope and in turn make procedure last longer. One might add that the occasional adjustments hamper the surgeon’s ability to do a quality repair of the vasectomy.

Another reason that a patient and the doctor might prefer local anesthesia with oral sedation is cost. Having general anesthesia must be done in a facility and that in it self adds an expense and then there is the anesthesiologist and the supplies necessary for general anesthesia.

The advantage to the patient with general anesthesia is that he is put to sleep and then wakes up and the procedure is done. For the surgeon he has had the advantage of not being concerned or dealing with a patient moving and having to readjust the microscope.

So in the end it becomes about patient and surgeon preference, and cost. At Northeast Georgia Urological Associates we believe we have the best of both worlds.

Because we own our center the added costs for a facility and anesthesia is minimized resulting in a very cost effective reversal without compromising safety and comfort by utilizing a  board certified anesthesiologist in an accredited surgery center.

Georgia vasectomy reversal.

Most common reason for a vasectomy reversal?

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Obviously there are a lot of reasons for a man choosing to reverse a vasectomy. The two most common reasons are:

  • The male is divorced, has had children and a vasectomy. He then remarries a younger woman who has not had children and wants to have children. Often times the discussion regarding the male undergoing the inconvenience and expense of a reversal  and his willingness to have it done, occurs before the couple is married.
  • A couple with several children decide after vasectomy they’d like to have more children. Interesting enough, in my practice, this reason for having a reversal is increasing.

Regardless of the reason we at Northeast Georgia Urological Associates look forward to helping you with a new addition to your family.

As a side note, the other day a patient told us that another doctor could tell him what he’d charge for a reversal but could not tell him what the hospital would be charging. In fact, the doctor told the patient to call the hospital to find out the costs. Because we own our Surgery Center we will be able to tell you exactly what the total cost will be and because we don’t use a hospital our costs are lower than most reversal centers.

 

Georgia vasectomy reversal.

Post vasectomy pain syndrome-Myth?

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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.