Vasectomy Reversal Technique

When the vas deference is divided at the time of vasectomy, sperm continue to be produced in the testicles on each side. Most of this sperm is either reabsorbed by the body or accumulates in the epididymis, the small gland located behind each testicle where sperm normally mature and gain the ability to swim. The epididymis is a very fine, single tube that is prone to blockage when a long time interval has occurred between vasectomy and vasectomy reversal (long usually means greater than 10 – 15 years).

The decision to perform vasovasostomy versus epididymovasostomy is one that can only be definitively made at the time of surgery. There are, however, some factors that can help predict preoperatively which surgery will be necessary. The following factors would favor the ability to perform a vasovasostomy:

• Time from vasectomy < 10 years

• Vasectomy performed higher in the scrotum away from the epididymis

• The presence of a small, “pea-sized” lump at the vasectomy area. This is called a sperm granuloma and consists of a microscopic leakage of sperm from the vasectomy site into a walled-off area. This is not dangerous and the sperm are rapidly resorbed by the body. It does, however, act as a “pop-off” valve to prevent build-up of pressure in the epididymis which contributes to epididymal obstruction.

It should be noted that the findings at the time of surgery may not be the same on each side. Thus, it is possible that a vasovasostomy could be performed on one side while an epididymovasostomy could be performed on the other.