A vasectomy reversal which fails is an extremely disappointing — not to mention a very expensive — experience. Patients are of course anxious to know why the surgery didn’t work — and what to do to prevent such failures, either on their first reversal, or especially when considering a redo after failed reversal.
Microsurgical vasectomy reversal is one of the most challenging operations in all of surgery, because of the extremely small size and delicacy of the structures being reconstructed. This is particularly true when the epididymis needs repair, where the wall of the epididymal tubule is only about 1/4 the diameter of a human hair.
Every surgeon who performs vasectomy reversal has some failures — if you find a surgeon who “guarantees” success, it is best to look elsewhere, as he or she is not being honest. Highly experienced reversal surgeons will, as expected, have the lowest failure rates — but it is important to determine the nature of even a good surgeon’s skills — in particular, their experience and success with epididymal reconstruction (VE), which is far more challenging than uncomplicated vas-to-vas (VV) repairs.
Most well-trained and reasonably experienced reversal surgeons should achieve 90% or better success rates (that is, postoperative sperm counts in the normal range) in uncomplicated vas (VV) repairs. With current techniques, the success rate of epididymal reconstructions should approach 60% — but success rates like these require a great deal of experience with this very difficult repair. Less experienced microsurgical surgeons are generally more likely to achieve only 30% success, or less, on such repairs.
Some surgeons unfortunately seem to blame the patient when the reversal fails, telling them that they formed “scar tissue” which blocked the reconnection. While this is occasionally true, it is much more likely that surgical technique, or failure to perform the correct surgery, are the cause of most reversal failures. Some surgeons promote the use of anti-inflammatory medications and even steroids (such as Prednisone) after surgery, to prevent such “scarring” — despite the fact that there is no medical evidence for their benefit in reducing the failure rate of reversal surgery, and drugs such as Prednisone impair healing and increase the risk of infection, among other complications.
So why do reversal surgeries fail? In Dr. Finnerty’s experience of nearly 40 years of performing microsurgical reversal, they fail for one of the following reasons: