There are two specific options when it comes to vasectomy reversal. These are the vasovasostomy and the vasoepididymostomy. Of the two, the latter is considered as the more difficult to perform and technically demanding. This is often suggested if there is no sperm present or there is obstruction in the vas deferens of the patient. This will require anastomosis of the vas deferens of the person to the epididymis thus bypassing the obstruction made by the epididymal.
Just like the regular vasovasostomy, vasoepididymostomy does not require a confinement of the patient in the hospital. The procedure takes around 4 hours to perform, and usually epidural block or general anesthesias are used on the patient. Just to complete the preparation of the patient for the procedure, a number of antibiotics are usually administered to the patient 30 minutes before the actual procedure.
Causes of epididymal obstruction
1. If the patient shows some congenital abnormalities. Some of these abnormalities include the absence of a part of the cauda with the absence of the deferens;
2. Obstruction can be linked to Young's Syndrome;
3. If there is an infection or inflammation or;
4. If there is a latrogenic injury or injury from previous surgeries or procedures.
Overview of the surgical preparation
The procedure usually starts with the attending physical making a scrotal incision, often larger than the incision made on the vasovasostomy procedure. The intent of the incision is to allow for the delivery of the person's testis, the epididymis and the vas deferens. The vas deferens is then isolated on the spermatic cord. This is then transected and tunneled to the spermatic cord structure. From here, the attending physician will examine the epididymis for possible obstruction. If no obstruction is noted, the tunica albuginea of the epididymal tail is then incised and then pressure is applied to squeeze out the tubule. The fluid that comes out of the tube is examined for the presence of sperm. If no sperm is identified, the process is repeated until a sperm is found.
This is a complicated way of reversing the effects of vasectomy, but still many men consider having this kind of procedure. Also, in-vitro fertilization can prove to be a good alternative to procreation, still the popularity of the surgery never waned. The reasons can be traced to the advantages offered by vasoepididymostomy.
1. At least with this procedure, men can still be a father and experience the natural way of sexual intercourse;
2. Also, the reversal procedure through the use of vasoepididymostomy allows for a more natural way of conceiving and no ethical issues come into question;
3. The typical IVF costs more;
4. The sperm rate and pregnancy rates are comparable with what IVF offers. The return of sperm rates range from 52 percent to 92 percent. And the pregnancy rates range from 11 to 56 percent;
5. If the patient works with an expert in the field, then the higher the chance for a higher success rate (in terms of pregnancy rate);
6. Some costs can be covered by the insurance when it comes to an epydidymal obstruction and;
7. The good thing about this procedure is that sperm can be collected and can be frozen for future use. For example, couples can make use of the frozen sperm if the reversal didn't work and IVF is tried.
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