Vas and epididymis reconstruction
What are various reconstructive surgeries done to restore male infertility?
Vaso-vasostomy (vasectomy reversal) and vaso-epididymostomy are the surgical reconstructive procedures done to improve sperm parameters if there is blockage in vas deferens or epididymis.
Is vasectomy reversal possible?
Vasectomy is a simple day care procedure which takes less than 30 min of surgical time whereas Vasectomy reversal requires high level microsurgical skills and 3-4 hours of surgical time depending on the complexity of each case. Dr Pramod Krishnappa is exclusively trained in male reproductive tract microsurgeries. The previously divided cut ends of vas deferens tube will be identified and their edges trimmed to make them feasible for re-attachment. One can wait upto 3 months since vasectomy reversal to see if sperms appear in the semen. The success of the vasectomy reversal surgery depends on surgeon’s microscopic expertise, baseline semen analysis report (prior to vasectomy), healing of prior vasectomy wound, presence /absence of significant anti-sperm antibodies and time since the vasectomy was done.
In which conditions, Vaso-vasostomy and vaso-epididymostomy are done?
Short segment blockage in scrotal part of male reproductive tract (vas deferens and epididymis) may be corrected by microscopic reconstructive surgeries such as Vaso-vasostomy and vaso-epididymostomy. Very specialised sutures finer than a human hair are used to join the two ends. Success of vasovasostomy is around 90% and vasoepididymostomy is around 60% depending on many patient factors. The most common causes of correctable obstruction (blockage) in male reproductive tract are infection and previous surgeries (like inguinal hernia mesh repair, childhood difficult hydrocele surgery).
How long is the recovery time after Vaso-vasostomy and vaso-epididymostomy ?
The patient is usually discharged the same day if general anaesthesia or the next day if spinal anaesthesia is given. It is advised not to indulge in strenuous activities including sex, outdoor and indoor sports, but does not need any bedrest. He can resume his work-from-home (WFH) from the very next day after the surgery. If working outdoors and the job is physically very demanding, then better to apply leave for a week.
Who is the best doctor for reconstruction surgery in male infertility ?
Dr Pramod Krishnappa is the best andrologist dealing with Men’s’ Sexual Health and Male Fertility. He has been trained extensively in high volume Andrology centres in Madrid (Spain), Belgrade, Budapest, Chicago, and New York.
Dr Pramod Krishnappa has undergone microsurgical training and a dedicated male infertility fellowship under Prof Dr Craig Niederberger at the University of Illinois at Chicago (UIC), who was the Chief Editor of “Fertility Sterility” Journal, the official journal of the American Society of Reproductive Medicine (ASRM).
Frequently Asked Questions
A previous vasectomy does not automatically rule out reconstruction. The chances of successful reversal depend on factors including the time since vasectomy, the condition of the vas ends, previous semen findings, healing, and the presence of antisperm antibodies. Vasectomy reversal success therefore needs to be assessed individually.
The choice depends mainly on where the sperm-flow obstruction is located. If the vas deferens can be directly reconnected, vaso-vasostomy may be performed; when the blockage involves the epididymis, vaso-epididymostomy may be required. Vasectomy reversal surgery is therefore selected according to the location and nature of the obstruction.
Yes. Infection and previous operations, including inguinal hernia mesh repair and difficult childhood hydrocele surgery, can contribute to correctable obstruction in the male reproductive tract. Male reproductive tract obstruction can sometimes be treated with microsurgical reconstruction.
Not necessarily. Sperm may take up to three months to appear in the semen after vasectomy reversal. Follow-up semen analysis is therefore important before concluding that the reconstruction was unsuccessful. Sperm after vasectomy reversal should be monitored according to the surgeon's instructions.
In selected men with a surgically correctable obstruction, reconstructive surgery may restore the pathway through which sperm travel into the semen. This can potentially allow sperm to appear naturally in the ejaculate, although the outcome depends on individual factors. Reconstructive male infertility surgery may therefore provide an alternative to sperm retrieval in appropriate cases.
The procedure requires extremely precise joining of delicate reproductive structures using very fine sutures. Microsurgical expertise is important because the success of reconstruction depends partly on the surgeon's technical skill and experience. Microsurgical vasectomy reversal therefore requires specialized training and expertise.
Recovery depends on the type of work. Patients can generally resume work-from-home activities from the next day, while people with physically demanding outdoor jobs may need approximately a week away from work. Vasectomy reversal recovery should still follow the surgeon's individual instructions.
No. Complete bed rest is not required. However, strenuous activities, sex, and indoor or outdoor sports should be avoided during the advised recovery period. Recovery after vasectomy reversal should therefore focus on avoiding activities that could interfere with healing rather than remaining in bed continuously.
Yes. The purpose of vaso-vasostomy and vaso-epididymostomy is to restore sperm passage when an obstruction is surgically correctable. The reported success rates are around 90% for vasovasostomy and around 60% for vasoepididymostomy, although individual results vary according to several patient factors. Sperm recovery after reconstruction cannot be guaranteed for every patient.
Important considerations include the time since vasectomy, the reason for the original procedure, previous semen-analysis results, the condition of the vasectomy site, possible antisperm antibodies, and the surgeon's microsurgical experience. Discussing these factors helps determine whether vasectomy reversal treatment is a suitable option for the couple.
