The Vasectomy Reversal Procedure

An Overview

Typically, your contact (often an email with questions answered) is followed by the required scheduled phone preoperative discussion with the patient prior to booking a surgery date. A regular mail confirmation letter with preoperative instructions is sent once the deposit is received. My practice is limited to microscopic vasectomy reversal microsurgery. I perform two or three surgeries a day Monday through Friday, except I only do one procedure on Wednesday. I will meet with you before the procedure on the day of surgery. The microsurgery is performed in the office operation room under local anesthesia. Most patients stay at a local motel overnight prior to resuming travel back home the next day, although a two night stay is ideally recommended.

Fee

Your total cost for the procedure is $1,700. A $500 deposit is required in order to secure a scheduled surgery appointment. The deposit is refunded at your request if you reschedule or cancel at least 2 weeks before your appointment. (The deposit is forfeited if changes are made less than 2 weeks prior to the scheduled appointment.) The balance of $1,200 is to be paid by money order, cashier’s check or cash on the day of surgery. Credit or debit cards and personal checks are not accepted. If you do not bring an insurance prescription card, you will need approximately $35 for a prescription at the pharmacy on your day of surgery.

The Surgery

You will shave the scrotum before your appointment. You may have preoperative oral sedation if you desire. After physical examination, local anesthetic (numbing medication) prepared to be both quick acting and long in duration is placed in the skin and soft tissues of the scrotum using a very small, fine-tipped needle, less painful than a pinch. After a few small “pinches” to instill the local anesthetic, the procedure is painless for typical cases. It is not unusual for a patient to doze during the procedure.

The surgery is performed with a quality 3X to 23X magnification microscope. A single one inch incision is made in the skin for typical cases. The area of scar and the vas ends are dissected. The testicular end of the vas is divided at a level of healthy tissue identified by high power magnification to note the quality of the vas tissue and its blood supply. A sample of vasal fluid is examined under a side table microscope for presence of sperm. The findings are noted, but vas-vas reconnection is planned even if no sperm are seen, as this is the usual accepted practice. The abdominal (upper) end of the vas is divided at a level of normal appearing tissue above the scarred site and gently flushed with saline. Every effort is made to ensure a lack of tension on the anastamosis.

Quality titanium microsurgical instruments are used to repair the vas. This is done with a modified two layer technique as described in the microsurgical literature. The modified inner layer is performed using 9 zero nylon with a 100 micron (4/1000th inch) diameter needle. The outer layer is sutured with 8 zero nylon. An average of 14 total sutures are placed in each vas, depending on the size of the two ends. The sheath tissue around the vas is brought together with suture to aid in healing and blood supply.

A small rubber drain is placed and the layers below the skin are closed with sutures that absorb. The skin is also closed with fine absorbable sutures. There are no sutures on the outside, and no sutures to remove. For typical cases, 2 hours are needed to meticulously reverse what was done in just a few minutes at the time of the vasectomy.

Post Operative Period

It is best if you can avoid travel the day of the procedure. You will need to change dressings at the drain site. You can simply remove the drain or I may remove it the day following surgery. Swelling and bruising up to twice normal size is expected. The pain after surgery is the same as after vasectomy in half of the patients. In a fourth of the patients, the pain is less after reversal compared with after vasectomy, and in the remaining quarter of patients, the pain is worse after the reversal. Advil or another medication is sufficient for discomfort the first few days. Good scrotal support is key to help relieve any discomfort with standing.

Lifting over 30 pounds, running, sports, or vigorous exercise is discouraged for three weeks. Sexual abstinence is recommended for two weeks. A semen analysis is recommended at 4 months. I will give you an order so the lab can fax results to me so that I can interpret the findings and forward them on to you.