General Versus Local Anesthesia in Vasectomy Reversal

Patients commonly inquire about pain during vasectomy reversal and the risks of general anesthesia as opposed to local anesthesia. Pain is not just a common concern; it’s a legitimate concern. To put your mind at ease and to simplify the process, ask your physician about anesthesia during your initial consultation so that you can move forward with the right information from the very beginning.

Well performed local anesthesia is plenty effective in keeping a patient comfortable during the vasectomy reversal procedure. I also know that anesthesia does not impact patency rates (rate at which sperm returns to semen). There are other benefits to local anesthesia:

• Less expensive medical costs
• Fewer side effects
• Quicker recovery time

When I started this practice nearly five years ago, my opinion about local anesthesia for vasectomy reversal was based on what I saw in the scientific studies in the field. Most importantly, research showed that the type of anesthesia used did not affect results of the vasectomy reversal.

This was proven by the acclaimed Vasovasostomy Study Group*. In this study, most first time vasectomy reversals (515 patients) were done with local anesthesia. General anesthesia was used in 454 patients. Patients with sperm in their semen were 86% for local anesthesia and 85% for general anesthesia. The percentage of patients achieving pregnancy was also 1% higher for patients who had local rather than general anesthesia.

This study should silence the worn-out argument about patients not being able to hold still enough for precision surgery unless they have general anesthesia. It should also mute concerns about pain during vasectomy reversal.

It is likely you will feel the initial pinching that goes along with the numbing injection. However, after that point you should feel very little and be quite comfortable.

The other thing I saw in the surgical studies was the safe, comfortable and effective use of local anesthesia in all types of scrotal surgery including vasectomy, vasovasostomy (vasectomy reversal), excision of epididymal cyst, orchidectomy (removal of testicles for prostate cancer), hydrocelectomy, and excision of spermatocele.

My opinion of local anesthesia for vasectomy reversal is founded on these studies, and also my own experience of having over 1,200 satisfied patients.

We have hundreds of patients who can attest to the effectiveness of local anesthesia. We can even connect new patients to those who have completed a vasectomy reversal with local anesthesia. Just contact us for the referral list.

* Belker AM, Thomas AJ, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991 Mar,145(3):505-11.

How Much Does Vasectomy Reversal Cost?

Unlike vasectomies, the vasectomy reversal surgery is usually not covered by insurance, and several factors can drive up the cost for the procedure.

The investment required can vary among doctors, regions and states, as well as the type and complexity of procedure involved. The vasectomy reversal surgery generally is performed on an outpatient basis and does not require a costly hospital stay.

Many professionals charge $6,000 to $15,000 for vasectomy reversal surgeries, though the simpler methods can carry a much lower cost.

There are two types of reversal surgeries: The less common and more complex procedure is known as “vasoepididymostomy” and typically carries a much higher cost. It is rarely needed if the time from vasectomy is less than nine years. The most common — and more affordable – method is known as “vasovasostomy.”

I only perform vasovasostomy and recommend to patients that they should seek help elsewhere if they are nine years or more from vasectomy. I don’t incur the costs that go along with performing the more complex procedure, so if you are less than nine years out, you pay only for what you need.

Patients should ask their physicians for their success rates in performing either or both methods. Some surgeons, including myself, offer guarantees, so it is important to ask about these policies before the vasectomy reversal surgery.

The cost of vasovasostomies, the simpler method, can vary wildly as well. Whether a physician uses general or local anesthetic can affect the total investment, as well as the question of where the procedure is performed. Some physicians perform the vasectomy reversal procedure in their offices under local anesthesia as I do, which often helps control the overall cost.

Vasectomy Reversal Surgery 101

Vasectomy reversals, also known as vasovasostomies, provide millions of men with the opportunity to have children again.

It is an outpatient procedure, usually performed at a doctor’s office, clinic or hospital. Generally, it is performed by urologists, general surgeons, or other physicians trained in vasectomy reversal.

An estimated 10% of men, after vasectomy, later decide to get the procedure following divorce, death of a child or spouse, or a change in convictions or circumstances. The procedure usually takes 2 hours to complete. A local anesthesia and mild sedatives are used. Pain is mild. Most patients can resume vigorous activities in less than one month after surgery. Most men can return to a desk job in three days.

The Vasectomy Reversal Surgery Procedure

Vasectomy reversal surgery most commonly reattaches the vas deferens – the two ducts that carry sperm from the testicles to the prostate. The surgeon cuts the scrotum skin and through the one inch surgery site, reconnects the vas deferens, allowing the release of sperm when a man ejaculates.

There are two surgeries that may be used to perform a vasectomy reversal. The most common and successful method involves the surgeon suturing the cut ends of the vas tubes back together (vasovasostomy). This can be done equally successfully with either a formal two layer technique or with the modified technique equally successfully.

The less common surgery (less than 5-10% of all reversal patients) reconnects the cut vas to the epididymis, the tube resting on the testicle itself. This procedure is called vasoepididymostomy or “bypass” for short. It is less successful in resuming sperm flow and is more commonly used in patients over 9 years from vasectomy. I do not perform this procedure in my practice, but advise patients to seek help elsewhere if they are 9 years or more from vasectomy.

How Effective Is Vasectomy Reversal Surgery?

Overall, a reverse vasectomy is more effective the quicker it follows the original procedure. Sperm returns in my practice for patients less than three years after a vasectomy in 97% of patients; 91% in three to eight years; and 72% more than 9 years after the vasectomy.

In my practice, vasectomy reversals produce a pregnancy rate of 81% for patients less than 3 years from vasectomy, 74% in patients from 3-8 years out, and 42% greater than 9 years. These figures are for couples followed for 2 years who have no female fertility is

Defining Vasectomy Reversal Terms

As you begin to prepare for a vasectomy reversal or while you are researching to understand your options in vasectomy reversal, you will undoubtedly come across medical terms that are new to you and a bit unclear. Below is a list of terms my patients ask about. If there is another word you would like to understand better that you don’t see here, simply ask in the comments section of this post or contact me directly.

AntiSperm Antibodies – Proteins formed in response to sperm much like other proteins formed by the body’s immune system to protect itself from something harmful (i.e., allergy, injury). ASA have possible significance in less than 5% of vasectomy reversal patients. No need for preoperative testing.

Epididymis – A sac that lies on the testicle containing very thin walled tubes where sperm mature and are stored prior to ejaculation.

Fertility Expert – Either an Ob/Gyn physician who specializes in female reproduction or an Andrologist who specializes in male reproduction.

Local Anesthesia – Placement of numbing medication with tiny needles in the vas region to allow painless surgery on the vas deferens.

Microsurgery – Surgery using optical magnification by use of a microscope.

Microsuture – Tiny material (thread) used during vasectomy reversal microsurgery to reconnect the two ends of the vas deferens.

Patency – Rate at which sperm returns to semen following a vasectomy reversal.

Pregnancy Rate – Rate of pregnancy for couples following a vasectomy reversal. Usually defined as a two year rate (two years after reversal) for couples who have no female fertility issues.

Prostate Gland – Gland, located below the bladder in which the ejaculatory ducts, the two vas deferens and the urethra join.

Scrotum – The sac that contains the vas deferens, epididymis, and testicles

Semen or Seminal Fluid – Fluid containing sperm and glandular fluid released by the urethra with ejaculation

Sperm Count – Number of sperm per volume, also less commonly described as the number of sperm in a sampling of semen (better described as total sperm count).

Testes or Testicles – Two male reproductive glands located in the scrotum which produce sperm

Total Motile Count – Figured by multiplying the total sperm count by the percentage of sperm with motility (movement). Normal Total Motile Count is 20 million.

Urethra – Tube that runs from the bladder to the penis that carries urine or semen

Vas Deferens – The tube where sperm are transported between the epididymis and the prostate. There are two tubes, one on each side of the scrotum.

Vasectomy – A surgery that causes infertility in men. Specifically, part of the vas deferens is removed or divided.

Vasectomy Reversal – A surgery that aims to bring fertility back to a man. Specifically, the vas deferens are reconnected. Also loosely used to describe a more complicated surgery to connect the vas to the epididymis.

Vasoepididymostomy – A complicated vasectomy reversal performed in about 5% of all reversal surgeries, but more commonly in patients over 9 years from vasectomy. It connects the vas deferens to the epididymis in order to bypass a blockage in the epididymis. See vasectomy reversal definition above.

Vasovasostomy – Simple vasectomy reversal that reconnects vas deferens. It is by far the most common surgery for vasectomy reversal. See vasectomy reversal definition above.

Microsurgical Vasectomy Reversal – An Olympic Event?

You know the old saying “truth is stranger than fiction”? Well that came to mind a few days ago as I watched the Winter Olympic Games.

The same day the games began in Vancouver, I was doing the last operation of the week for a very pleasant couple from Delaware. I was listening to a symphony play “Ave Maria” in the background, and was really enjoying the surgery.

At that moment I was performing the anastamosis, the hook up between the upper and lower portions of the vas tube to repair the vas deferens. I was peering through the microscope that makes the vas look as big as a barn. I held in my right hand the titanium microsurgical needle holder that grasped the 4/1000ths of an inch needle and my left hand fingers cradled the titanium forceps with a 0.2 millimeter tip.

After running the needle precisely through the wall of the two vas ends, I was tying the microsuture (less than one third the diameter of a hair). I rhythmically intertwined the tips of the two instruments in order to tie the surgical knots. The image of a couple on the ice at the Winter Olympics came to mind as I methodically but gracefully performed the maneuvers to complete the exact reconnect.

Surgery has often been likened to an athletic event, and I was certainly enjoying the movement and execution of the vasectomy reversal maneuvers to help this couple with their dream.

Fast forward a week and a half – I walked into the living room where my wife was watching the live TV broadcast of the Winter Games. Belbin and Agosto, the veteran U.S pair were taking to the ice. They beautifully skated to the same song I had heard in the surgery room: “Ave Maria.” After the competition they spoke of their long-term commitment to excellence and the satisfaction of having done the best they could do.

So the truth really does beat fiction. I’ll never be on the ice center stage, but after years of sacrifice and preparation I know the joy of a job well done.

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