Vasectomy is a minor surgical procedure wherein the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering the seminal stream (ejaculate).

During the vasectomy operation, the vas deferens (the tube through which sperm passes into the seminal fluid during ejaculation), was cut, a piece from the middle of each tube removed and the 2 ends sealed so that no sperm can pass. The sperm that is still produced by the testis is harmlessly reabsorbed by the body.

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Fertility could be regained if those 2 ends could be rejoined such that sperm can once again pass through the vas unhindered. However, many factors dictate whether or not this actually happens including the distance between the 2 ends of the vas, the stitches used to seal up the ends of the vas and infections and scar tissue formation after the original vasectomy operation. The success rate is therefore low.

The actual operation is usually done as a day case but under general anesthesia. Incisions are made to pull out the ends of the vas deferens, the stitches removed, the 2 ends prepared and then stitched together. The skin wounds are then stitched.

Here’s what to expect Treatment in India

The typical vasectomy reversal procedure is called a “Vasovasostomy.” It is performed with a microsurgical technique to reconnect the previously cut ends of the vas deferens, in order to open the vas channel to restore fertility.

Occasionally, the original vasectomy may cause an increase in pressure at the epididymis, a special tube upstream from the blocked end of the vas deferens, resulting in a “blow-out” or blockage. This should be bypassed. The surgeon does this by reconnecting the vas end to the epididymis even further upstream from the blockage. This more complicated reversal procedure is known as a “Vasoepididymostomy.

What a Vasectomy Reversal Procedure Is: –

  • The vasectomy reversal procedure is generally painless and safe
  • A general or epidural (spinal) anesthesia is usually used, and the procedure can be performed in an outpatient surgical center with the patient returning home the same day.
  • Vasectomy reversal microsurgery is a delicate procedure that attempts to reconnect the cut ends of the vas and reestablish an open channel, thus restoring fertility in the man.
  • It is not uncommon; approximately 5 percent of the half million men who opt for vasectomy each year later elect to have the vasectomy reversed.
  • Success rates are typically higher for men whose vasectomy occurred more recently, and they tend to decline as the time interval since vasectomy lengthens. The most significant decline seems to occur at an interval of 15 years or more. Nonetheless, successful reversals can still occur more than 30 years following a vasectomy.

How is Vasectomy Reversal Performed?

With the patient under anesthesia, a 1-2 inch incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are found and freed from the surrounding scar tissue. A drop of fluid from the testicular end of the vas is placed on a glass slide and examined using a light microscope. This is a crucial part of the operation because the information obtained is used to decide what type of microsurgical reconstruction needs to be performed. Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm.

There are 3 possible scenarios that may be encountered when examining the vasal fluid. The first and best scenario is that the vast fluid contains whole sperm. The second possible finding is that the fluid is thin and copious and contains only sperm parts or no sperm. The third is that the fluid is thick, pasty and contains no sperm. This last scenario usually means that a “blow out” or rupture has occurred in the epididymis. Sperm leaks out if the pressure in the tubule becomes greater than the resistance in the wall of the tubule, similar to the way a pipe breaks in the basement when the water pressure gets too high. The body tries to heal this tubule and scar forms. This causes a second blockage in the epididymis, which needs to be bypassed to allow the sperm to get out into the vas. If this second blockage is present and is not recognized then the operation is doomed to failure.

Side effects

After a vasectomy, the testes remain in the scrotum where Leydig cells continue to produce testosterone and other male hormones that continue to be secreted into the bloodstream. Some studies find that sexual desire is unaffected in over 90% of vasectomized men, whereas other studies find higher rates of diminished sexual desire, for example nearly 20%. The sperm-filled fluid from the testes contributes about 10% to the volume of an ejaculation (in men who are not vasectomized) and does not significantly affect the appearance, taste, texture, or smell of the ejaculate.

When the vasectomy is complete, sperm cannot exit the body through the penis. Sperm is still produced by the testicles, but they are broken down and absorbed by the body. Much fluid content is absorbed by membranes in the epididymis, and much solid content is broken down by the responding macrophages and re-absorbed via the bloodstream. Sperm is matured in the epididymis for about a month once it leaves the testicles. Approximately 50% of the sperm produced never make it to the orgasmic stage in a non-vasectomized man. After a vasectomy, the membranes increase in size to absorb and store more fluid; this triggering of the immune system causes more macrophages to be recruited to break down and re-absorb more of the solid content. Within one year after a vasectomy, sixty to seventy percent of vasectomized men develop antisperm antibodies. In some cases, vasitis nodosa, a benign proliferation of the ductular epithelium, can also result.

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