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Vasovasostomy and Vasoepididymostomy: Microsurgical Vasectomy Reversal Surgery

Vasectomy Reversal Surgery Preparation

The patient is put under general anesthesia for a vasectomy reversal. If desired, the procedure can be performed under local anesthesia like epidural or spinal anesthesia instead. Total time of the procedure is approximately 2 to 3 hours. Dr. Bastuba always takes time without rushing through a surgery.

Vasectomy reversal is a surgical procedure restoring the flow of sperm through the vas deferens. There are two types of vasectomy reversal techniques.

1. Vasovasostomy

Vasovasostomy is the standard procedure and most commonly performed vasectomy reversal surgery. During vasovasostomy, the separated ends of the vas deferens are reconnected. This is done after the examination of the vas fluid. The vas fluid is examined under the microscope and considered good if it has a clear non-opaque consistency and contains completely formed, healthy sperm. Motile sperm is even better. See Dr. Bastuba perform a vasovasostomy.

Microsurgical Multi-layer Microdot Technique

Dr. Bastuba uses a high-powered surgical microscope for vasovasostomy. Via a 1-inch incision on the original vasectomy site, six sutures of 10-0 or 11-0 (finer than a human hair) using the formal multi-layer Microdot technique are used to reconnect the inner lumen (tubes) and the outer layer separately. Multi-layer Microdot vasectomy reversal technique has lead to Dr. Bastuba’s high success rates, low risk of scarring and minimal recovery time for his patients.

2. Vasoepididymostomy

In about 30% of Dr. Bastuba’s vasectomy reversal cases, no vas fluid or low quality vas fluid is found during the procedure, which requires a vas-to-epididymis (vasoepididymostomy or VE). During the procedure, Dr Bastuba expresses fluid from the vas deferens coming from the testicle. If there is no sperm in this fluid, we must conclude that there is a blockage upstream closer to the testicle. This blockage will not allow sperm to pass through to the vas deferens. Therefore simply connecting vas deferens to vas deferens and performing a vasovasostomy does not make sense. Blockage in the epididymis upstream following vasectomy may have been caused by inflammation, too much pressure in the epididymis or scarring at the time of the vasectomy. See Dr. Bastuba perform a vasoepididymostomy.

Microsurgical Two-suture Longitudinal Intussusception Technique ( Microsurgical Longitudinal Intussusception Vasoepididymostomy (LIVE)

Dr. Bastuba currently employs the state-of-the-art vasoepididymostomy technique. This technique is sometimes referred to as the two-suture longitudinal intussusception technique and requires two 10-0 or 11-0 sutures. The technique allows a larger opening between the extremely small epididymal tubule and the larger vasal tubule. The technical aspects of this technique have simplified it which is one of the reasons for higher success rates. It is utilizing this technique that Dr. Bastuba has achieved the 87% patency rate in his vasoepididymostomy patients. A three stitch, triangulation intussusception technique was first described by Dr. Richard Berger and then further improved by Dr. Mark Goldstein into the two suture longitudinal intussusception technique (short: LIVE).

During vasoepididymostomy, the vas deferens is connected directly to the epididymal tubule in the epididymis to bypass the blockage. This is one of the most complex and demanding procedures in microsurgery and only physicians who perform vasoepididymostomies on a regular basis should attempt the surgery. For Dr. Bastuba, this demanding procedure is routine and performed at no extra cost. His success rates for vasoepididymostomy are indistinguishable from those of the world’s foremost male fertility microsurgeons.

Other Techniques for Vasectomy Reversals

Laser Vasectomy Reversal

This is a technique, which was popular around 1990. Laser surgery works very well for select blood vessel surgery in cardiovascular microsurgical procedures. However, for vasectomy reversal, research showed that the laser vasectomy reversal success rates are not satisfactory. In fact, laser vasectomy reversal may cause more complications and damage to the vasectomy reversal site. Dr. Bastuba does not perform this method of reversal.

Multilayer Microdot Technique:
M. Goldstein, eds. Surgery of Male Infertility. W.B. Saunders Co., Philadelpia, pp.46-60, 1995.(M. Goldstein, P.S. Li, G.J. Matthews, Microsurgical vasovasostomy: The microdot technique of precision suture placement. Journal of Urology 159:188-190, 1998.

Three Stitch Triangulation Technique:
Richard E. Berger, Triangulation End-to-Side Vasoepididymostomy. Journal of Urology 159:1951-1953, 1998.

Two Suture Longitudinal Intussusception Technique:
Marc Goldstein, Peter Chan, Outcomes of Microsurgical Longitudinal Intussusception Vasoepididymostomy (LIVE): A Prospective Analysis. Abstract presented at Annual Conference AUA 2004