Rigi10™ Malleable Penile Prosthesis
Also Known As
Vasovasostomy, Vasoepididymostomy, VR
Definition
Vasectomy reversal is a microsurgical procedure performed to undo a previous vasectomy, thereby restoring the flow of sperm from the testicles into the semen. The surgery involves reconnecting the severed ends of the vas deferens, the tubes that carry sperm. After a successful vasectomy reversal, sperm are again present in the semen, which may allow a man to achieve pregnancy with his partner.1 The procedure is technically demanding and is typically performed by a urologist with specialized training in microsurgery.2 The success of the procedure in restoring fertility can vary based on several factors, including the time elapsed since the vasectomy, the specific surgical technique used (vasovasostomy or vasoepididymostomy), the surgeon’s experience, and the female partner’s age and fertility status.1,2
Clinical Context
Vasectomy reversal is considered for men who have previously had a vasectomy and wish to restore their fertility. Common reasons for seeking a reversal include a new marriage or partnership, the desire for more children within an existing marriage, the loss of a child, or, in some cases, to alleviate post-vasectomy pain syndrome (PVPS).1,2
Patient selection involves a thorough medical history, including pre-vasectomy fertility, time since vasectomy, and the partner’s fertility status. A physical examination is conducted to assess testicular size, the presence of a sperm granuloma, and the palpable vasal defect.2 While most men who have had a vasectomy are candidates, success rates can be influenced by the duration of obstruction; longer intervals since vasectomy may decrease the likelihood of success or necessitate a more complex repair (vasoepididymostomy).1,2
The surgical procedure is typically performed under general or regional anesthesia using an operating microscope. The surgeon makes a small incision in the scrotum to access the vas deferens. The type of repair depends on the presence of sperm in the vasal fluid proximal to the vasectomy site. If sperm are present, a vasovasostomy (direct reconnection of the vas deferens ends) is usually performed. If no sperm are found, indicating a blockage closer to the epididymis, a vasoepididymostomy (connection of the vas deferens to the epididymis) is necessary. The latter is a more complex procedure.2
Expected outcomes vary, with pregnancy rates reported from approximately 30% to over 90% following reversal, depending on factors such as the type of procedure, time since vasectomy, partner age, and surgeon experience.1 Recovery typically involves a few days of soreness and restricted activity. Stitches usually dissolve within 7-10 days. Semen analysis is performed a few months post-surgery to check for sperm count and motility.1