Treatment / Vasectomy and Reversal

MALE STERILISATION AND REVERSAL
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How is this done?

This is an operation that involves disconnection of these tubes (vas) at the level of the upper part of the scrotum. This is usually done under local anaesthetic and can also be done under general anaesthetic. Local anaesthetic means injection of a medication in the scrotum which will numb that area and the urologist or a trained doctor can do this operation. Two small cuts are usually made or a sharp (knifeless) instrument can be introduced through the skin to hook up the tubes by locating them by finger palpation at the start of the procedure.

Vasectomy

Once the tubes are brought outside the skin, they are tied and cut. This will permanently block the transport of sperm from the testicles to outside.

What are the implications of vasectomy?

This is a permanent procedure. At a later stage if you wanted to revert this procedure it can be surgically possible and that will involve a much longer, time consuming operation and it will be more expensive. Reversal of vasectomy is not available on the NHS in the United Kingdom and you would have to pay for this service. 6% of men who undergo vasectomy do regret the decision about having gone through the procedure. Therefore you are to be absolutely sure before considering this method of contraception.

Is vasectomy a completely reliable method of contraception?

Vasectomy is the most reliable form of contraception but this could fail. The initial success of the vasectomy will be confirmed by absence of sperms in your semen which you would check at three months and four months after the procedure. Even after the initial success the cut ends of the vas could join together at a later stage and the tubes may transfer the sperm outside and you may find yourself fathering a child. This is in the order of about 1 in 2000 men undergoing vasectomy. Therefore it is not a common problem and vasectomy is the most reliable method of contraception but again it cannot be considered 100% reliable for ever.

When can I stop using other methods of birth control?

You should continue your current birth control measures until your doctor or your urologist writes to you following the results of the semen tests you would undertake at three months and four months after the procedure. Until then you should continue your current methods of birth control measures. The sperms which are produced in the testicle can stay alive on the tubes for up to 90 days and therefore 90 days should elapse before you submit your first semen test. It is advisable that you ejaculate at least few times during this period to clear the sperms from the tubes.

What are complications of vasectomy?

The complications include the common complications of any surgery as well as those specific to vasectomy.

  • Bleeding
  • Haematoma formation (accumulation of blood) in the scrotum which may need further surgical evacuation.
  • Wound infection
  • Injury to other organs (blood vessels to the testes causing shrinking of testes)
  • About 5-15% of men who undergo vasectomy can develop longstanding testicular pain due to swelling and inflammation of the tubes coming from the testicles. These are supposedly caused by the irritation of the sperms that accumulate in these tubes. Such patients may require further treatment options using pain killers and in some cases even to undergo further surgery to remove the thickened tubes that come from the testicle (epididymectomy) or in extreme cases to resort to removal of testicles.

How long should I take time off work?

You may return to work after a few days unless you have any complications or if you work involves very heavy manual work and personal body contacts with lifting of heavy objects. Generally you can return back to work within a week.

Vasectomy Reversal

 

What is Vasectomy Reversal ?

Vasectomy reversal (Snip Reversals or Reversal of Male Sterilisation) is the operation to identify the cut ends of the vas (with minute diameter of 0.2 – 0.4 mm)  that carrries sperms from Testis to the penis and reconnect  them to give the chance to become fertile again.

The main principles of this operation inlcude the following

  1. Achieve the best possible alignment of the minute openings (lumens) of both cut ends that could be of different diameters
  2. Connect them in a leak proof manner as leakage can cause blockage of the connection
  3. Preserve the blood supply to the vas  throughout the procedure as careless handling may  cause scarring & blockage.

If these principles are not adhered to, the operation is likely to fail due to blockage at the connection.

What are the types of Reversal Operations & How the procedure is chosen at the time of the operation?

Two types of procedures are available to deal with the intntional  blockage caused by the vasectomy. If your surgeon or the clinic does not have the skills and resources to do both type of procedures, the reversal will be incomplete in a proportion of men who had late consequences of vasectomy such as blow-out or blockage upstream at the level of epidydimis.

Vaso-vasostomy:  This means connecting the cut ends (segments) of the vas.  This is the most common reversal procedure needed.

Vaso-Epididymostomy: If there is blockage upstream at the level of epididymis due to damage by back pressure called Blow-out, simply connecting the cut ends will not be helpful. The vas will need to be connected directly to the even more minute tube, epididymis.This is called Vaso-epididymostomy. Not many surgeons in the UK take steps to diagnose the blow out and do vaso-epididymostomy. You need to check that with the surgeon. The risk of blow-out goes up with every passing year since vasectomy.

How are Vasectomy Reversals performed in the UK?

Unfortunately there is no standardised way of doing the vasectomy reversal in the UK.The reversal operations are done in the following ways.The type of procedures is chosen mostly due to limitations in  surgeon’s experience, resources, need to limit the operation time and the need to offer the procedure in a cost effective way. Therefore it may not necesssarily be at the only interest of the patient. So you need to make your research and choose the clinic and surgeon diligently.

Reversal without Microscope and using larger stitches with bigger needles

Surgeons use magnifying loupes that give atmost 2-3 times magnification and 6-0 stitches that contain needle that is as thick as the half of the lumen of the vas. This is a very basic way of doing this procedure. The tube ends are joined with 6 stiches on a single layer. It may take 60 to 90 minutes to do this procedure.This is a no-go area if you want to have a predictable result.

Reversal using Operating Microscope but larger needles and stitches

Surgeons use similar material as above but with the help of an operating microscope. Here the  operating microscope provides bit more magnification. But its power of magnification is not put to full use as surgeons choose the easy and less demanding way of using larger sutures (with larger needles) and  conventional instruments. The operation is done in one layer of 6 – 8 stiches and will take just about 90 minutes. This technique is widely used in the UK to manage the costs by limiting the expensive operating theatre and surgeon time while claiming it as microsurgery (arguably incorrect in our opinion). This procedure will work if the quality and dimension of the tubes are relatively straitforward. But the patient or the surgeon cannot assure that until at the time of the operation. Please see in the picture below, the thicker 6-0 stitches (bluish coloured) seen in one of our redo-reversals and compare the size of the balck suture and the finished product of redo procedure at the right side.

               

 Reversal using operating Microscope and Advanced Multilayer  Microsurgery

The best possible alignment of the tubes can be only  achived by multilayer microsurgery reversal using very minute 10-0 or 9-0 stitches. It is so important to connect the inner layers (mucosal layer) of the vas separately to keep the connection site (anaestamosis) open or patent. In real life, during the operation the inner layer can look very collapsed with diameter of the opening varying from 0.2-0.4mm. Thats is the reason the multilayer surgery carries distinct advantage. This method using two layers was initially described by two different surgeons (Silber and Owen) in 1977. They described two layer technique which raised the successful outcomes from over 40% to more than 90%. Further development brought by Professor Goldstein at New York’s Cornell University was called Microdot Multilayer Microsurgical Vasovasostomy (MMMV) which is the world’s gold standard procedure. This involves using three or more layers to reconnect the tubes. This helps to realign the tubes of varying diameters even in the mist of challenging situations such as extremely thin tubes.

Also see our Blog  “Does the technique and the type of sutures matter in vasectomy reversals?”

What do we offer in Tees-Urology at Best Life Clinic?

We offer the same advanced Microdot Multilayer Microsurgical Vasovasostomy (MMMV). This service is unique in the UK.  We are very cost effective and may be even less expensive than those clinics offering basic procedures. You can very easily identify from how long the actual operation takes and what size stiches the surgeons are using. We have not come across any other surgeon in the UK fully transparent that they do this multilayered procedure though this is the standard of care in most male-infertility centres in the United States. This operation usually takes four hours using expensive purpose made sutures. The full magnification power of the operating microscope will have to be used during the difficult and minute steps of the procedure.

We also perform Vaso-Epididymostomy in the event of Blow-out that is disgnosed at the time of the operation. So there is hope even if there is a blow-out. At the time of the procedure, we check the fluid from the testicular end of the vas multiple times. This is to ensure that the procedure we are doing carries the highest possible chances of success.

Which procedure should you choose?

Please do your research and read through the materials on our website. Based on that, it is upto you to make your informed choice. The surgeons using basic techniques may claim that their techniques are working. It is true the nature’s healing mechanism is so wonderful,  there is even a chance of spontaneous natural reversal in one out of 2400 men undergoing vasectomy. So all procedures will work to some extent, but do you want to settle for some thing less than the current best-standard. If the surgeon can do only one type of basic reversal procedure, the outcome is left to the mercy of the chance of you being the right patient for that surgeon. But it should be other way round. The surgeon should have skills and resources to make the procedure right for you as per the needs arising at the time of the operation. The needs can be very challenging such as loss or damage to long segment of vas, extremely thin vas, varying diameters of the cut-ends of the vas, vas being cut very close to the epidydimis and blow outs. 

We can assure that we are capable and resourced to deal with all of these Challenging situations because of our unique factors and resources

  • Ability to offer Advanced Multilayer reversal
  • Allocation of four operating hours
  • Resources & skills to do vaso-epidydimostomy at the same sitting.

 

We are here to help with the assurance that Tees Urology at Best Life Clinic always offers the current Best standard of service and try our Best to make the procedure right for you. 

Call us today on:

Tees Urology
Tel: 01642 699066
Text 07305 916901

or

Vasectomy Reversal dedicated contacts
Tel: 01642 939 798
Text 07305 916901
www.vasectomyreversals.co.uk