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Vasovasostomy (literally connection of the vas deferens to the vas) is a surgery by which Vasectomy are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.
Return of sperm to the ejaculate depends greatly on the length of time from the vasectomy and the skill of the surgeon. Generally, the shorter the interval, the higher the chance of success. The likelihood of pregnancy can depend on female partner factors.
Over half of men who have undergone a vasectomy develop anti-sperm antibodies. The effects of anti-sperm antibodies continue to be debated in the medical literature, but there is agreement that antibodies may reduce sperm motility.
Vasovasostomy is typically an out-patient procedure (patient goes home the same day).
The procedure is typically performed by urology. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia.
If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient's semen only transiently after the reversal, microsurgical vasovasostomy may be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections. The failure of a competently performed microsurgical vasovasostomy following the absence of any sperm in the contents of each vas usually is due to “blowouts” in the epididymides. Under these circumstances an operation should be performed only by a micro-surgeon with proven vasoepididymostomy expertise, bypassing the blowouts.
The presence of improves the likelihood of restoring sperm to the semen with a vasovasotomy. A local urologist can easily determine whether a patient has 0, 1, or 2 sperm granuloma by a painless examination of each vasectomy site. If the interval since the vasectomy is less than fifteen years, the prognosis will be 70% or better and this local examination is probably not needed. A sperm granuloma develops from post-vasectomy sperm leakage and somehow it behaves like a safety valve preventing internal pressure build up and ruptures of the delicate epididymis tubules with subsequent obstructive scarring.
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