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By Mayo Clinic staff
Vasectomy reversal is a technically challenging operation that requires specialized skills and expertise. The surgery is more difficult than is the original vasectomy. The tube that carries sperm from each testicle to your semen (vas deferens) must be sewn back together or attached to the epididymis. The epididymis is the coiled tube on the back of each testicle where sperm matures. The surgery usually is done on an outpatient basis — without an overnight stay at the surgery center or hospital. Doctors can perform this surgery in one of two ways:
- Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure, the surgeon sews the severed ends of the tube that carries sperm (vas deferens) back together. However, sometimes this isn't possible and a more complex surgery is needed to restore the flow of sperm.
- Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the epididymis. This surgery is used when sperm flow is blocked and a vasovasostomy won't work.
You probably won't know ahead of time which technique is needed. In most cases, the surgeon makes the decision during the operation. You may need a combination of the two surgical techniques — a vasovasostomy on one side and a vasoepididymostomy on the other.
During the procedure
You may receive general anesthetics to make you unconscious during the surgery. Or, your surgeon may use an epidural, spinal or local anesthetic. In any case, your anesthesia will need to keep you completely still because the surgery is so delicate. It's done using a microscope that magnifies the surgery area.
The surgeon will make a cut on the underside of your scrotum, expose the testicle and release it from surrounding tissues. Next, he or she will cut open the vas deferens and examine the fluid inside.
Fluid assessment
Once the vas deferens has been opened, the surgeon will inspect the fluid that comes out. This is an important part of the operation because it helps your doctor determine what type of surgery you need to restore the flow of sperm. If the fluid contains sperm and plenty of clear fluid, surgery to re-connect the ends of the vas deferens — a vasovasostomy — is likely to work. Fluid below the vasectomy site that is thick or pasty, or that contains no sperm or partial sperm, can be a sign that there is scar tissue blocking the flow of sperm. In this case, attaching the vas deferens directly to the epididymis — a vasoepididymostomy — may be the best option.
Freezing sperm
If your doctor finds sperm during the surgery, you may choose to have some frozen in case your vasectomy reversal doesn't work. If after vasectomy reversal you're not able to father a child through sexual intercourse, your frozen sperm may be injected directly into an egg. This is a type of in vitro fertilization called intracytoplasmic sperm injection (ICSI).
After surgery
Immediately after surgery, your doctor may cover the incisions with bandages. You'll put on your jockstrap to hold any bandages in place and apply pressure to reduce swelling and movement. You'll need to rest with an ice pack placed on your scrotum to reduce swelling. As the anesthetic wears off, you may have some pain and cramping that can be relieved with a painkiller, such as acetaminophen. For most men, the pain isn't severe and gets better after a few days to a week.
After you return home, take it easy. You may be sore for several days, which you can treat with acetaminophen or, if your doctor prescribes it, acetaminophen plus codeine. You may also have bruising, but the discoloration should lighten and disappear after about two weeks. Any stitches should dissolve in seven to 10 days.
- For the first two days after surgery, avoid bathing and swimming.
- Refrain from sports and heavy lifting for at least three weeks.
- If you have a desk job, you'll probably be able to return to work three days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's appropriate to resume working.
- You shouldn't have sexual intercourse or ejaculate for about four weeks. At that point, you may resume sexual activity.
- You'll need to wear a jockstrap for several weeks at all times, except when showering. After several weeks, you'll need to continue to wear a jockstrap during exercise.
- Lipshultz LI, et al. Surgical management of male infertility. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/113319552-2/0/1445/23.html#4-u1.0-B978-0-7216-0798-6..50022-4--cesec30. Accessed Dec. 10, 2008.
- Boorjian S, et al. The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal. The Journal of Urology. 2004;171:304.
- Vasectomy reversal. UrologyHealth.Org. http://www.urologyhealth.org/adult/index.cfm?cat=11&topic=154. Accessed Nov. 13, 2008.
