What is it?
This involves re-joining the ends of the vas which have been disconnected. The vas is the tube which transports sperm in the scrotum.
How will I be assessed?
You will be seen by a Urologist who will take a history and then examine the scrotum. The procedure will be explained and discussed with you as well as alternative methods of conception.
What are the alternatives?
- ART (assisted reproductive techniques)
- Adoption
- Donor sperm
What determines success?
Patency means the operation was successful in terms of being able to re-join the disconnected ends. You would have sperm present in your ejaculate. However, this does not necessarily correspond to a successful natural pregnancy. The factors which affect successful patency and/or pregnancy are:
- Time since original vasectomy
- Less than 3 years: patency rate 97%, pregnancy rate 75%
- ≥20 years: patency 40%, pregnancy rate <10%
- Age of partner
- How the join is made: results better if the 2 vas ends are joined. This may not be possible, and join may need to be made with epididymis (tube attached to testicle).
- Number of children desired
- Any female fertility problems
What does surgery involve?
The procedure is performed under a general anaesthesia. An incision will be made in the scrotum on each side. The 2 ends of the vas will be identified and freshened up. We will attempt to aspirate semen from one of the vas ends to check for sperm under a microscope.
The 2 vas ends will then be stitched back together using an operating microscope. Occasionally, this may not be possible if the gap between the 2 vas ends is too large. If this occurs, the vas will be joined with the epididymis.
The testis are returned to the scrotum and the incision closed with dissolvable stitches.
How long will I be in hospital?
You will normally go home the same day.
What can I expect after discharge?
It is normal to experience swelling and pain within the scrotum. This usually settles but you may require simple pain killers. We would advise you to avoid heavy lifting and strenuous activities for at least 6 weeks. Supportive underwear may be helpful. The stitches will be dissolvable so will usually fall out by themselves over 4-6 weeks. The testicle may feel bulkier after the surgery.
When can I try for spontaneous pregnancy?
It may take 3-6 months before your sperm is of sufficient quality and quantity.
What are the possible complications?
- Swelling, bruising and discomfort around the scrotum
- Bleeding and collection of blood within the scrotum (haematoma)
- Infection needing antibiotics
- Pregnancy failure
- No sperm in ejaculate (either at any point after surgery or after a period where sperm was present initially)
- Chronic pain
- Blood in ejaculate especially first few times
- Failure to perform procedure on one or both sides
- Infection or inflammation of the testicle or testis tube called epididymis