What Is Vasovasostomy?

What to expect when undergoing this test

surgeons working

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A vasovasostomy is a micro-surgery and one of two ways to reverse a vasectomy. During a vasectomy, the vas deferens—tubes that carry sperm from the testicles to the point of ejaculation—are cut. So, a vasovasostomy involves reconnecting the two ends of the cut vas deferens.

Men who have undergone a vasectomy use vasovasostomies to regain their fertility. A vasovasostomy is performed by a urologist. Learn more about the uses, side effects, procedure, and results of a vasovasostomy.

Purpose

This procedure is done to restore fertility to a man that has previously undergone a vasectomy. It is also done to help relieve men who suffer from pain after they have a vasectomy done. This pain is often referred to as post-vasectomy pain.

When vasovasostomies are done via microsurgery, they have a success rate of about 85 percent in terms of the sperm returning, and about 53 percent in terms of resulting in a pregnancy.

Vasovasostomy should not be confused with vasoepididymostomy, which is the second type of surgery used to reverse vasectomies.

Vasoepididymostomy is a more technical surgery than vasovasostomy, and it is done when there is a blockage in the epididymis (where sperm is stored) and other cases where a vasovasostomy would not be successful. There is no way to know which of the two procedures you'll undergo until the surgery itself begins and your surgeon has the chance to examine the quality of your vasal fluid. 

Risks and Contraindications

There aren't many risks with vasovasostomies. However, it is possible that after the procedure you could experience:

  • chronic pain
  • infection (which is a risk with almost any surgery)
  • bleeding in the scrotum which can then lead to blood pooling and causing the area to swell (hematoma); this can be avoided by following your doctors post-surgery care instructions properly
  • strictures and blockage (it is possible that the vas will become obstructed or strictured)

It is important to report any of these effects such as chronic pain and bleeding to your doctor immediately.

Before the Test

Your doctor will ask you about your medical history to make sure you are a good candidate for the surgery, and he or she will also perform a physical examination on you.

You should inform your doctor if you or your family have a history of hypogonadism which is characterized by low testosterone levels in men.

You should also find out accurate information on the date you had your vasectomy done as well as how much time has passed since then.

Let your doctor know if you’ve had any previous scrotal or penile surgery. Your doctor will request your reproductive history as well—that is, if you have or have ever had any children or pregnancies, at what age, and the ages of your current and/or previous partners.

If your purpose for doing the vasovasostomy is to have children, your doctor may recommend that your partner undergo testing to see if she is still producing any eggs. If you were infertile before you underwent a vasectomy, your doctor may recommend that a testicular biopsy (where a bit of tissue is removed from your testicles and taken for testing) be carried out.

The biopsy may be on a day before your vasovasostomy or it may be done at the beginning of your vasovasostomy.

Timing

A vasovasostomy can take anywhere from two to four hours, although it is possible for it to extend even beyond that time-frame if the surgery is complicated. The time it takes also depends a bit on the expertise of the surgeon performing the procedure. You can also expect to spend some time filling out consent forms.

Location

The vasovasostomy will either take place in the hospital or at a surgical center. A vasovasostomy is an outpatient procedure, meaning that you can go home that same day.

What to Wear

You'll be required to change into a hospital surgical gown for the procedure, so you can wear your regular clothes to the hospital. It is, however, advisable that you wear clothes that aren't too tight around the crotch area. This is because after the procedure, you experience some pain in your testicles and any clothing pressing hard against that area may make it worse.

Food and Drink

A vasovasostomy most often takes place under general anesthesia so you may be asked not to drink or eat anything the night before the surgery. This is to reduce the chances of any complications with the anesthesia arising.

What to Bring

If it's possible, you should ask a family member or friend to come to drive you home when the procedure is done.

During the Test

Pre-Test

Your urologist and anesthesiologist will discuss your anesthesia options with you beforehand. Vasovasostomies are usually performed under general anesthesia, but in a few cases, local anesthesia is used. However, you should note that medical literature considers using local anesthetics as not optimal.

This is because general anesthesia lets the urologist do his or her work better and more precisely, especially if it turns out the surgery will be more complicated than anticipated or if it turns out that it’s actually a vasoepididymostomy that needs to be performed.

Throughout the Test

After the anesthetic is administered, you will be placed flat on your back on the surgical table. The urologist will mark the area he will make an incision in the scrotum (the skin covering your testicles). Using a highly advanced operating microscope, your doctor will magnify the view of your vas deferens. This is mainly why vasovasostomy is called microsurgery because the strong microscope enables the urologist to see very clearly and make really tiny, precise cuts, and stitches.

The doctor will trim open the ends of the vas that were cut and sealed during the vasectomy. Vasal fluid will be taken from the vas deferens end that is closest to your testicles The vasal fluid will be tested for sperm. If sperm is found, the urologist will go on to perform the vasovasostomy. 

If there’s no sperm present, the doctor will consider some other factors and may decide to switch to a vasoepididymostomy. The urologist will use very tiny stitches to join the ends of the vas deferens together. This may take anywhere from two to four hours, or in certain cases, even more.

Post-Test

Your urologist may use bandages to cover the site of the surgery. As the anesthesia wears off, you may experience some pain, soreness, and swelling. However, it shouldn’t be severe. If it is, report it immediately to the urologist.

You'll likely be given some painkillers to help with the pain. Your urologist may give you or instruct you to buy scrotal support garments like a jock strap that you wear for some weeks.

After the Test

You’ll be asked to rest for two to three days, after which you can resume light activity. If your job requires heavy or strenuous work, you should ask your doctor when you can resume.

You should also ask the doctor when you should take off the bandages and stop wearing the scrotal support. It is likely your doctor will ask you to abstain from sex for a couple of weeks.

Managing Side Effects

As with almost any surgery, you can expect to feel some mild pain, which should go away after some days or a few weeks, tops. You’ll be given some painkillers to help you deal with that.

You may experience some swelling which is normal and should go down after a week or two. If your pain is severe, and/or the swelling is persistent after weeks, you should report it to your doctor.

Interpreting Results

Follow-Up

It may take several months or even up to a year (or even more) for sperm to return to your sperm, and for your partner to get pregnant. You will be asked to come in for an appointment two to three months after the procedure where your semen will be collected for analyses.

Another follow-up appointment may be scheduled for four to six months after the procedure for another semen analyses. If your sperm hasn't appeared yet or your sperm count isn't regular yet, you may be asked to come in for further testing every two to three months.

A Word From Verywell

A vasovasostomy is a very technical surgery and its success somewhat depends on the microsurgical skills of the urologist. As such, it is highly advisable that you find one that has a lot of experience performing this kind of surgery. If possible, go the extra mile to find a urologist with experience performing vasoepididymostomies, too, in case this ends up being the required route. Ask any questions you have or do your own research on the urologist's background, skill, and experience before committing to the procedure.

While vasovasostomies have high rates of success, you should always have realistic expectations. It is possible that the vasovasostomy may not be successful, and even it is, it’s possible that it may not result in a pregnancy (if that’s your aim, of course). If the vasovasostomy fails, you can consider finding another urologist for a repeat vasovasostomy, which, depending on the urologist's medical opinion, may have a good chance of success.

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Article Sources

  • What is Vasectomy Reversal? - Urology Care Foundation. Urologyhealth.org.

  • Herrel L, Hsiao W. Microsurgical vasovasostomy. Asian J Androl. 2012;15(1):44-48. doi:10.1038/aja.2012.79

  • What You Should Know About Vasectomy Reversals. Hopkinsmedicine.org.