What does a vasovasostomy consist of?
In restoring the patency of the vas deferens.
When is it performed?
When there is an obstruction of the vas deferens either through vasectomy or through any other cause (inguinoscrotal surgery, inflammation, trauma, etc).
What are the effects of a vasectomy on the testicle and the seminal duct?
A vasectomy does not stop the testicle from producing sperm. The sperm is eliminated by the immune system through certain antibodies.
When a vasectomy has totally occluded the extremity coming from the testicle, over time the seminal duct consisting of the epididymis and the initial segment of the vas deferens starts to dilate. The epididymis consists of a tube of 300 microns diameter and a length of between 5 and
If this tube starts dilating due to the effect of the pressure exercised by the sperm and a certain amount of liquid produced in the testicle and the epididymis, it can rupture over time, leading to a new area of obstruction. In these cases there will be two obstructive levels: the site of the vasectomy and the epididymis.
Reconstructive surgery in these patients must be undertaken between the epididymary tube and the vas deferens below the obstruction level where the vasectomy was performed.
What type of anaesthetic is used?
When less than 10 years have passed since the vasectomy was performed and the desire to recover fertility, reconstructive surgery of the vas deferens (vasovasostomy) can be performed under local anaesthetic. When more time has passed or when the epididymis feels very dilated upon palpation, leading one to suspect a potential secondary obstruction at this level, it is best to proceed under general anaesthetic or epidural for the purposes of performing an epididymovasostomy (joining the epididymary tube and the vas deferens), if necessary. This surgery is more difficult and requires longer time.
How is a vasovasostomy performed?
Through a minimal incision in the base of the scrotum (testicular sac), the vas deferens is liberated and exposed. The area obstructed by the vasectomy is removed and the patency of the vas deferens is checked in the direction of the urethra via the injection of saline solution through the lumen. Fluid emanates from the end of the vas deferens originating from the testicle and this is immediately analysed to confirm the presence of sperm.
The two lumen of the vas deferens are brought together and, under the surgical microscope, some 6 stitches are inserted between them. Subsequently, the join is completed with various stitches between the muscular layers that surround the lumen of the vas deferens.
1. Confirmation of presence of sperm
2. Confirmation of patency direction urethra
3. Anterior joining of lumen
4. Posterior joining of lumen
5. Joining of the muscle layer
 |
 |
How is an epididymovasostomy performed?
Once the segment of vas deferens where the vasectomy was performed has been removed and patency in the direction of the urethra has been confirmed, the epididymary tube is opened. The presence of sperm is confirmed in the emanating fluid and it is brought together with the vas deferens. Under the surgical microscope, various stitches are inserted between the lumen of the epididymary tube and the vas deferens.
How long does the surgery take?
The approximate duration of the vasovasostomy is 1.5 to 2 hours and that of the epididymovastostomy between 2 and 3 hours.
Do these surgeries have any complications?
As in all testicular surgeries, there may exceptionally be a hematoma (bruising) or inflammation of differing intensity which is resolved within a short period of time.
What is the post-operative aftercare?
- Disinfection of wounds for 5 days.
- Application of cold compress on the wounds for 2 days
- Antibiotic treatment and anti-inflammatory prophylaxis
- Jock strap (so that the testicles are not suspended by their own weight) for 10 days.
- Abstinence from sexual activity for 20-30 days.
When is the presence of sperm in the semen confirmed?
Approximately one month after surgery the first semen analysis is undertaken.