Vasovasostomy:
union of the two ends of the vas deferens.
Microsurgical reconstruction
Microsurgical vasectomy reversal
Precision to restore the passage of sperm.
Assessment and indication
Every decision starts with understanding the case.
Vasectomy interrupts the channels that carry sperm from the testicles to the ejaculate. The reversal seeks to reconstruct this path so that sperm reappear in the semen and the couple can attempt pregnancy.
It is a surgery that requires specific experience in microsurgery. The canals are very thin, and it is not enough to join them back together: it is necessary to evaluate what is found during the operation, choose the appropriate reconstruction and execute it precisely under the microscope.
01
How do I evaluate
During the consultation, I talk about the vasectomy, the time that has passed since the procedure, previous surgeries and the patient's reproductive history. I perform a physical examination, including evaluation of the testicles, epididymis and vas deferens.
I also try to understand the partner's reproductive situation and the couple's goals. Restoring the passage of sperm and achieving pregnancy are different results. This distinction needs to be clear before surgery.
02
What is the surgery like?
Reversal is done through small incisions in the scrotum. I identify the ends of the ducts interrupted by the vasectomy and examine the fluid found during the operation. This finding helps to define which technique to use on each side:
Vasoepididymostomy:
connection of the vas deferens to the epididymis, necessary when there are signs of additional obstruction in this region.
Sometimes the techniques are different from one side to the other. Therefore, the final decision cannot be made only in consultation; it also depends on the findings of the surgery.
03
The role of the microscope
Connections are made with very fine wires, under operating microscope magnification. The microscope allows you to see. The surgeon's experience is what makes it possible to interpret the findings, choose the technique and perform the delicate sutures that this reconstruction requires.
04
How long does it last?
The operation usually takes around two to four hours, depending on the reconstruction required on each side. This time does not include preparation before surgery or recovery from anesthesia. In general, the patient is discharged on the same day.
05
What is recovery like?
In the first few days, there may be discomfort, swelling or purpleness of the scrotum. After the operation, I advise on care with the dressing and gradual resumption of the routine.
Light activities and office work usually resume within a few days. Physical work, intense exercise and heavy lifting require more time. The usual guidance is to avoid sexual activity for around two weeks, with release depending on healing and post-operative evaluation.
06
When do I take my first spermogram?
I usually request the first spermogram between two and three months after surgery. Depending on the reconstruction performed, sperm may take longer to appear. Therefore, I monitor developments with new exams when necessary.
The return of sperm to the ejaculate is called patency. It shows that the passage has been reestablished, but does not in itself guarantee a pregnancy. I continue monitoring considering the results of the exams and the couple's reproductive status.
Consultation and planning
The indication is defined for each patient.
During the consultation, I evaluate the diagnosis, explain the alternatives and organize treatment and follow-up according to the needs of the case.