Microsurgical Vasectomy Reversals

The location of an epididymal repair (distal, mid or proximal) is determined by specific findings at surgery. The standard approach Dr. Finnerty has used in the past has been to leave as much epididymis as possible, to maximize both storage capacity and length for sperm maturation. But his experience has been that this often leads […]

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Dr. Finnerty uses state-of-the-art operating microscopes by Zeiss and Leica - the foremost manufacturers of these precision instruments in the world. These scopes have optical magnification up to 40x power, superb optical characteristics, and precision power focus and zoom capabilities.

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All vasectomy reversals are performed using a two-layer technique, using extremely delicate monofilament nylon microsutures (9-0 and 10-0). The “microdot” technique places small ink dots around the inner opening, and was developed to help inexperienced surgeons place the sutures evenly and accurately. These ink dots are unnecessary when the reversal is performed by experienced microsurgeons, […]

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Conscious sedation is a technique where a local anesthetic is used to numb the surgical area, while drugs are given intravenously to make you relaxed and sleepy. Dr. Finnerty has extensive experience with this approach, but no longer uses it. The sedation can have unusual and unpleasant effects on a small percentage of patients, leading […]

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The answer is, it depends on the situation and the anatomy found at surgery. This question first arose when some surgeons using low-power optical loops began claiming they were doing “microsurgery.” The use of only a few larger sutures was the tip-off, as microsurgery uses finer and more numerous sutures.

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Although each patient is different, most patients find recovery from vasectomy reversal surgery to be similar to their recovery from their vasectomy (assuming, of course, you had no complications from your vasectomy). The principle risk in the first 24-48 hours is bleeding inside the scrotum. While this is rare, and does not usually cause problems […]

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There are a few important things to keep in mind when getting ready for your surgery, to help ensure a safe and uneventful procedure:

Avoid aspirin or aspirin-containing products for at least 10 days prior to surgery. Aspirin inhibits the clotting cells (platelets) and can increase your risk for bleeding during and after surgery.
Avoid non-steroidal anti-inflammatory […]

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At the time of reversal surgery, the vasectomy site is removed, which allows fluid to be expressed from the testicular side of the vas. In the past, the presence of any sperm or sperm parts was thought to indicate that no obstruction was present. Even men with no sperm — if the fluid appearance […]

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While it is true that the incidence of epididymal obstruction increases with time after vasectomy, partial or total epididymal blockage is actually very common, even in men only a few years after vasectomy. Failure to address this at the time of surgery will result in higher failure rates, and even those who have sperm after […]

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The first portion of the sperm duct is known as the epididymis. The epididymis is about 1.5 inches long, is attached to the testes, and contains about 20 feet of coiled, microscopic sperm ducts. Sperm become mature and active (acquiring motility) in the epididymis after they leave the testes.

After vasectomy, some men will develop a leak of sperm from one of these delicate tubes, which results in scar tissue formation and a second blockage point in the epididymis. The chances of this occurring increase with the number of years after vasectomy, although it can occur at any time after vasectomy.

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Very rarely. Most health insurance policies specifically exclude coverage for infertility or reversal of vasectomy. If a man has chronic testicular discomfort after vasectomy which has failed to respond to medical treatment, and the medical treatment is well-documented, insurance companies will sometimes cover the procedure on this medical basis.

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The major alternative to vasectomy reversal is a technique called sperm aspiration. Sperm aspiration is generally performed by one of two means: percutaneous aspiration or open surgical aspiration. In percutaneous aspiration, a fine needle is inserted into the testes or the epididymis under local anesthesia. Since only a tiny amount of sperm can be retrieved, […]

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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 […]

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Some surgeons use a micro-laser to assist in the reconnection of the vas. Early in his reversal experience, Dr. Finnerty performed some reversals using this technique. In the laser technique, several sutures are placed to approximate the ends of the vas. A laser is then used to “spot-weld” the vas together, sealing only the outer […]

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Sperm in the testes and duct system are normally isolated from the body’s immune system. When a vasectomy is performed, the sperm are exposed to the immune system, and the body responds as if the sperm were a foreign protein. The immune system produces substances called antibodies against the sperm.
These antibodies may be found in […]

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In most cases, no. Almost all vasectomy techniques involve removing a short piece of the vas, and sealing off the cut ends using sutures, metal clips, cautery, or a combination of these. All of the scarring from the vasectomy — regardless of technique — is removed at the time of reversal. The length of vas […]

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Most definitely. The large majority of men, even after 20 or more years, can have their vasectomy successfully reversed. Although fertility tends to decrease with longer time after vasectomy, Dr. Finnerty has seen many couples achieve pregnancy in this time frame. He has even performed a reversal on a man over 30 years after vasectomy […]

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While several older studies suggested an increased risk of prostate cancer in men after vasectomy, more recent studies have shown no evidence for increased risk. Other potential health problems, including heart and vascular disease, arthritis, and autoimmune disorders, have also been suspected in a few studies in the past. To date there is no conclusive […]

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There is much disinformation about the success of vasectomy reversal, due to the poor success rates typical when reversals were done without microsurgery, and many doctors as well as patients remain confused about this subject. It is also common, when doctors perform vasectomy, to emphasize its permanent nature in order to avoid hasty decisions about […]

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