Vasoepididymostomy(Epididymal Bypass)
When an obstruction occurs in the epididymis after vasectomy, it is necessary to bypass the blockage by connecting the vas, above the site of the vasectomy, to the epididymis above the highest point of obstruction. This procedure is extremely delicate, as the tubule within the epididymis are no more than 0.1 b 0.2 mm in diameter, and have a very thin, delicate wall.
The testicular anatomy is seen above. The epididymis is attached to the testes by the efferent ducts at its upper end, and sperm flows through the epididymis from the top downward.
The epididymis is a maze of delicate tubules covered by a thin, translucent layer of tissue. After vasectomy, these tubules become more prominent, and the appearance of the fluid within them can be seen under the microscope.
In order to be certain that we are above the obstruction, a small window is created in the thin outer layer of the epididymis, exposing the underlying tubules. One of these tubules is then opened, and the fluid is tested for the presence and quality of sperm. This process is repeated until intact sperm — ideally active, motile sperm — are identified.
When an obstruction is present in the epididymis, the appearance of the tubular fluid changes at that point, and a transition zone can be appreciated. It is not unusual for several such transition areas to be seen. There is often a change in the distension of the tubules above and below such a point, which is best appreciated by feel.
Once sperm are identified, a point is selected just above the window where sperm were identified. This is where the reconnection will take place. The vas from above the vasectomy site is next sutured to the outer layer of the epididymis at this location.
A tubule in close proximity to the vas lumen is then selected.
A fine suture is placed through the tubule before it is opened, and sutured to the opening of the vas. This will stabilize and support the tubule for the repair.
[More photos coming soon]
Have any questions? Contact us.
