Vasovasostomy (Vasectomy Reversal)
Vasovasostomy involves a surgical reversal of a previous vasectomy with the goal of producing sperm in the ejaculate. The procedure is ordinarily performed in an effort to produce sperm which are sufficient to achieve pregnancy. However, other reasons for doing the procedure include chronic pain following the vasectomy, as well as fears regarding change in cardiac status or possible malignancy associated with vasectomy. The procedure involves identification of the vas deferens, usually done through a single, midline scrotal incision under general or local anesthesia. The procedure involves transection of the sperm duct (or vas deferens) on the testicular ends of the vas deferens and prostatic ends of the vas deferens and dilation of the internal opening or the center of the vas deferens, on the prostate side. Ordinarily, the testicular ends of the vas deferens are dilated sufficiently so that no special procedures are necessary on this end. The ends are sutured using microscopic enhancement, usually in two layers involving the mucus membrane or mucosal lining of the vas deferens. The second layer involves the outer covering or serosa and the muscular layers of the vas deferens. The sutures used for the procedure are usually of a permanent variety such as Proline with the size range from 7.0 to 9.0. Proline is a very small suture and has to be handled with microsurgical instruments. After placement of the sutures, the wound is closed and the individual sent home.
We request that support underwear be worn in the postoperative phase, ice bags be maintained for at least forty-eight hours, and that the individual essentially remain at home rest for at least four days. We recommend early attempts at ejaculation beginning on about the fourth day and, if possible, unprotected intercourse at that time. We usually have the individual take an antibiotic for five days postoperatively and recommend use of Nolvadex on a twice a day basis for at least three months in an effort to stimulate sperm production.
If the individual has had an uncomplicated vasectomy and if that vasectomy was performed within six years of the time of vasectomy reversal, an approximate 90% sperm productive rate is achieved. If the vasectomy is once again uneventful and if the reversal takes place at ten years post vasectomy, the sperm productive rate is approximately 50%. At fifteen years, under similar circumstances, the sperm productive rate drops to 2%. Pregnancy rates are not related to sperm production. Often a new partner is involved in the equation and a pregnancy may not have been achieved at any point in that individuals life. On the other hand, sperm present in the ejaculate may appear perfectly healthy, and there is no change in the marital relationship but pregnancy may not occur – which makes it difficult to give pregnancy rates. Although, overall, if sperm are present, the pregnancy rate is about 55%. It is equally difficult to construct a time frame for pregnancy to occur, as we have seen this occur very early following vasectomy reversal, and in other cases we have had couples go two to three years before pregnancy occurs.
Vasovasostomy, when done at Michigan Urological Clinic by either of our two physicians, costs $4,700.00. This fee includes the procedure, a local anesthesia, and operating room. Our doctors perform approximately fifty such procedures a year. If this procedure was to be done under general anesthesia in a hospital outpatient setting, the costs involving operating room use, equipment use, and anesthesia costs would be billed separately.
A $500 deposit is required at the time the procedure is scheduled. Patients that cancel the week of or do not show up to their appointment will forfeit their deposit. Patients that reschedule at the time of cancelation will apply the deposit to the new date of service.