A vasectomy reversal is performed in an outpatient surgery center under general anesthesia. Following induction of the anesthesia, the patient is properly positioned and the scrotum and the area around it are prepped with an antiseptic solution. Two small incisions are made in the scrotum over the area of the vas deferens. These are the tubes, one on each side, that were cut to perform the vasectomy. While the incisions for the vasectomy reversal are larger than those for the initial procedure, they are still small, usually an inch or less in length. A microscope will be used to magnify the area.
The surgeon locates the part of the vas deferens closest to the testicles, where the sperm are produced. Withdrawing fluid from this proximal tube, the surgeon looks through a microscope to see if motile sperm are present. If sperm are present in the vas deferens closest to the testicle, the vasectomy reverse will involve sewing the two vas deferens tubes that were cut back together. If no sperm are present, a more complex procedure, a vasoepididymostomy, must be preformed.
To perform the vasovasotomy, sewing the two severed ends of the vas deferens together, the scar tissue from each end is removed. A microscope is used due to the delicate nature of the surgery. The lumen of the vas deferens, the suture material, and the needles are all tiny. Two layers of sutures are required to form a water tight seal, allowing sperm to move through the tubes and into the ejaculate.
If no sperm is found in the proximal vas deferens, the distal tube will be sewn to the epididymis, where the sperm arrive from production in the testes. The vasoepididymostomy is more difficult to perform since a new hole in the epididymis must be made and matched to the vas deferens. Again, these structure are so small, a microscope is required to put them together.
Since this process must be done on both sides, a period of about three hours is required to complete the procedure. Dissolvable sutures are used to close the scrotum. Just as with the vasectomy procedure, an athletic support is used to place pressure on the areas while ice packs are applied for twenty four to forty eight hours. Once the patient is awake from the anesthesia, he is allowed to drink liquids, walk, empty his bladder, and dress before being discharged home.
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