Microscopic Vasectomy Reversal

Microscopic Vasectomy Reversal

The surgeons at Melbourne Urology Centre are experts in treating patients who require reversal of vasectomy (vaso-vasotomy). The surgical team comprises an expert Urologist and a specialist reconstructive Micro-surgeon with the use of a high powered surgical microscope. This enables the synergy of each surgeon’s unique skill set to maximise success. Dr Shekib Shahbaz and Dr Tony de Sousa offer this service in Melbourne for patients from all over Australia

• Vasectomy reversal involves the reconnection of each vas deferens in patients who wish to undo a vasectomy
• After a successful vasectomy reversal sperm will again be present in the semen allowing for possible subsequent pregnancy
• Successful pregnancy rates after vasectomy reversal vary from 30 percent to over 70 percent depending on a number of factors including: time since vasectomy, female partner’s age, surgeon experience/technique as well as any other pre-existing fertility issues
• Men seek vasectomy reversal for various reasons after an initial decision to have a permanent form of contraception. In some patients it may be an option to treat chronic testicular pain following vasectomy
• Vasectomy reversal is generally more successful if performed by experienced surgeons who use a high powered surgical microscope. These surgeons should be prepared and able to perform more complex procedures such as vaso-epididymostomy if necessary

Comparing vasectomy reversal to Assisted Reproductive Techniques ART/IVF?

Advantages of microscopic vasectomy reversal:

• Minimally invasive
• Able to have multiple conceptions if successful and desired
• More cost-effective than ART
• Allows natural conception
• Ease of sperm retrieval for Assisted Reproductive Technology (ART) in future if necessary

Disadvantages:

• Successful pregnancy dependent on quality of sperm
• Chances of successful conception decline with increasing age of female partner
• Need for ART (or repeat surgery) if the initial reversal is unsuccessful
• Unable to have control over timing of pregnancy and chromosomal testing

How is microscopic vasectomy reversal performed?

• Detailed pre-operative consultation to evaluate patient suitability for the procedure
• This procedure is performed under general anaesthesia
• Most patients will have day-case surgery although some will require overnight stay
• Strenuous activity and sex should be avoided for 4 weeks. Scrotal support with firm-fitting underwear is recommended for two weeks
• After a successful vasectomy reversal, sperm will again be present in the semen allowing for possible subsequent pregnancy
• A small incision is made in the scrotum and the vas deferens is identified on each side and delicately separated from surrounding tissue
• Depending on intra-operative findings a decision is made whether to perform vaso-vasotomy or vaso-epididymostomy. The latter is a more complex procedure, performed if no semen back-flow is identified when the vas deferens is cut close to the testicular end.  A high powered microscope with up to 40 times magnification is used
• The wound is infiltrated with local anaesthetic and absorbable sutures are used to close the skin
• Protective spray and supportive dressing is applied

Post-operative care

• During the first 48 hours, supportive underwear and dressings should be left intact. This can then come off and the sutures do not need to be removed but may take a few weeks to dissolve
• As the local anaesthetic wears off, the pain may increase over the first 24 hours but this subsides after a few days. Patients can return to light duties at work after a week
• Any activity that may pull on testes/scrotum should be avoided for six weeks; this includes sports/running and any other strenuous activity
• Sexual activity should be avoided for four weeks

Procedure Outcomes / Risks

• Viable sperm may take up to a year to appear. It may still not lead to successful pregnancy due to sperm antibodies, poor quality sperm and female partner sub-fertility
• Scrotal bleeding / haematoma
• Chronic testicular pain is uncommon but can happen after any scrotal surgery
• Infection and wound complications are rare

Are you suitable for this procedure?

Melbourne Urology Centre offers Microscopic Vasectomy reversal treatment in Melbourne to local and interstate patients.  Your case will be thoroughly evaluated including discussion of other appropriate management options.  We also have close affiliation with fertility clinics for those patients that are better suited to Assisted Reproductive Techniques/IVF.