Because of the extremely small size of the sperm duct, even a perfect repair using microsurgical techniques can sometimes fail to remain open. In uncomplicated reversals where sperm is present at the time of surgery, this occurs at most about 3-4% of the time (about 1 in 25 men). In complex repairs involving the epididymis on both sides (the most difficult type of repair), failure is seen in about 15-20% of men.
Non-microsurgical reversals fail far more frequently than this.
A reversal which fails to produce sperm is very disappointing. Fortunately, in most cases repeat reversal can be done with good success rates. The chances for success depend on the reason for failure of the original surgery, and the type of reversal surgery originally performed.
Reversals generally fail for two reasons: scarring at the site of reconnection (the most common cause for failure after non-microsurgical reversals), and failure to recognize or deal successfully with epididymal blockage at the time of first surgery. If the cause of failure is scarring at the reconnection site after an uncomplicated vasovasostomy, success rates for repeat reversal are nearly identical to first time surgery. If there is an epididymal blockage, or if there has been previous surgery on the epididymis, then the success rate for repeat surgery is somewhat lower, but still very good in most cases. Repeat surgery in this situation is also quite long and may be very difficult.
Dr. Finnerty has extensive experience in complicated reversal surgery, including prior failed reversals, or difficult anatomic problems, such as vasectomy performed in the groin at the time of inguinal hernia repair.
Other references:
