Preoperative considerations for vasectomy reversal surgery

Several preoperative factors influence the success of vasectomy reversal.

These factors can be assessed by a preoperative consultation with the operating urologist. This consultation includes taking the patient's history and physical examination.

Patient history

Length of time since the vasectomy is one of the most important factors influencing the success of vasectomy reversal. Success rate is higher in men with a relatively recent vasectomy. If the vasectomy has been done many years ago, there is a greater chance of pressure damage or blockage in the epididymis. If there is an obstruction in the epididymis, vasoepididymostomy may have to be done for vasectomy reversal.

These are the statistics from the largest research study on vasectomy reversal. The rates for 1,247 men studied who underwent vasovasostomy are shown below:

Years between vasectomy and reversal
Sperm return in semen
Pregnancy rate
<3
97%
76%
4-8
88%
53%
9-14
79%
44%
>15
71%
30%

The patient history is taken regarding any trauma, infection or disease involving the scrotum, penis, prostate gland or pelvic organs. History of complications if any, following the original vasectomy such as bleeding into the scrotum (hematoma) or infection of the epididymis (epididymitis) is also noted.

The physician will review the medical records of the patient in order to determine how the vasectomy was performed and if large lengths of vas deferens was removed during the surgery.

Examination

Examination of the scrotum is done during preoperative assessment. The scrotum is palpated to determine the size and firmness of the testes. Small, soft testes may indicate impaired sperm production and the chances of restoring fertility after vasectomy reversal is low. Swollen and irregular epididymis may indicate obstruction in the epididymis which may require vasoepididymostomy reversal.

The urologist will also try to determine the length of the vas deferens left behind after the initial vasectomy. The longer the length of the vas remnant, better are the chances of vasectomy reversal by vasovasostomy. Shorter vas remnant may require vasoepididymostomy.

vasectomy

Finding a sperm granuloma at the testicular end of the vas deferens is a good prognostic sign. A sperm granuloma is formed when sperms leak out of the vas deferens at the site of vasectomy. An inflammatory reaction occurs in response to this leaked sperm and a lump is formed which can be palpated through the scrotum. This sperm granuloma relieves the pressure on epididymis and protects it from damage.

The scrotum is examined for the presence of other conditions such as a varicocele which may reduce the chances of successful vasectomy reversal.

Glossary of terms used in this page:

Epididymis: Epididymis is a tube-like structure which connects the testis and the vas deferens. The sperms are stored and matured in the epididymis.

Inflammation: Inflammation is the reaction of the body to injury, disease or irritation. The classic features of inflammation are heat, redness, pain and swelling.

Sperms: Sperms are male reproductive cells. They are produced in the testes. They are carried in fluid called semen. Sperms are capable of fertilising an egg cell to form a zygote.

Testes: Testes (singular=testis) are the male gonads. They are situated in the scrotum. They produce sperms and the male hormone, testosterone.

Varicocele: Varicocele is the swelling of veins that carry blood out of the scrotum. Varicocele may cause infertility in some men.

Vas deferens: Vasa deferentia are thin tubes which carry sperms from the testes to the urethra. Vas deferens is also known as sperm duct. Each vas deferens is about 45 cms long.

Vasovasostomy: Vasovasostomy is a method of vasectomy reversal surgery where the two cut ends of the vas deferens are reconnected.

Vasoepididymostomy: Vasoepididymostomy is a method of vasectomy reversal surgery where the vas deferens is connected to the epididymis.

Next Preoperative laboratory tests for vasectomy reversal