After vasectomy reversal
A semen analyses should be obtained approximately 3 months post-operatively. Should the initial semen analysis not reveal sperm or the have virtual azoospermia (sperm only visible following centrifugation of the sample) then repeat analysis should be undertaken 3 months later. In men who do not achieve a pregnancy further monitoring of semen quality may identify the small number that develop late obstruction due to scar formation at the anastomotic site. The incidence of postoperative re-obstruction is approximately 1% after microsurgical vasovasostomy and as high as 35% following vasoepididymostomy. If sperm do not return to the semen by 6 months after vasovasostomy or by 18 months after vasoepididymostomy, the procedure should be considered to have failed. Most pregnancies that are achieved without further intervention occur within 24 months after surgery.
Possible risks and complications
Complications following microsurgical vasectomy reversal are uncommon. Haematoma is by far the most frequent varying between 0.5% and 3% with drainage of the operation site markedly reducing the risk. Infection either of the wound or underlying haematoma occurs in less than 1% of operations. Rarer still are wound problems and long lasting post-operative pain. Occasional patients may develop short-term urinary retention following surgery. Fournier’s gangrene has not been reported following vasectomy reversal. Provided that patients are well informed about the nature of the procedure, the potential post operative complications along with its success and failure rate, medico-legal action is rare.
Management of operative failures
Repeat operation may be offered to when an initial vasectomy reversal fails. While many men consider the prospect of successful repeat operation to be sufficient to contemplate most decline to undergo further surgery. Repeat procedures may be more difficult technically because the remaining viable segments of the vas will be shorter. In the largest published study sperm returned to the semen after surgery in 75% of men, and 43% of their partners subsequently conceived. Repeat attempt at vasectomy reversal should be considered particularly where the prior operation had been performed macro-surgically or by a surgeon performing small numbers of microsurgical procedures. After a failed vasoepididymostomy, a repeat procedure may or may not be possible, depending on the amount of scar that forms around the epididymis after the first operation.
Microsurgical methods are by far the most accurate and effective way of overcoming damage reproductive organs in both men and women to restore fertility.
EXPERIENCE AND EXPERTISE MATTER