Vasectomy Reversal - The Operation

What should I expect before the vasectomy reversal procedure?

You will require a consultation and assessment with Mr Rees before finally deciding to proceed with a vasectomy reversal. Factors in your history and scrotal examination findings will be taken into account, and a full discussion of the risks, success rates specific to your circumstances, and alternative options will be held. It may be necessary to establish that your partner is ovulating before vasectomy reversal is undertaken.

You will usually be admitted to hospital on the same day as your surgery. You will normally receive an appointment for a “pre-assessment” with the nurses prior to the days of surgery to assess your general fitness, to screen you for MRSA and to do some baseline investigations.

You may shave the area on the morning of the operation, but no sooner – as this may increase infection risk. Take care not to cut the skin. If you prefer, this can be done in the operating theatre at the start of the operation.

On the day of admission, you will be seen by Mr Rees, an anaesthetist, your named ward nurse, and possibly the resident medical officer at the hospital. You will be asked to sign a consent form and have a further opportunity to ask any further questions you may have.
You will be asked not to eat and drink for at least six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication.

What happens during the procedure?

You will be given a full general anaesthetic (where you will be asleep).

Mr Rees will make a small incision in the front of the scrotum. Occasionally it is necessary to make two separate incisions – one on either side. The ends of the tubes are then identified, and re- joined with fine stitches using an operating microscope. The whole operation can take up to 2 hours. 
 

Very occasionally it is not possible to connect the tubes, particularly if the gap between the two patent ends is too long. It may only be possible to connect one side.

Sometimes it may be possible to join the upper ends to the sperm-carrying mechanism (epididymis).
Dissolving sutures (stiches) are put in the skin, but they can take up to 2 weeks or occasionally longer to dissolve. A loose dressing will also be applied to the scrotal area.

What happens immediately after the procedure?

After waking up in the recovery area, you will be taken back to your room on the ward where your nurse will look after you, checking your pulse, blood pressure etc. He/she can let you know how the procedure went. You will then find out if the procedure went as planned, and the findings at operation.

In addition to the pain-killers given in theatre, you will also be offered additional pain relief by mouth if required. 
 

You may then want some refreshments, and it is expected that you will be able to get out of bed a few hours after waking up from the surgery. The dressing is then checked, and if all well then it is usually possible to go home on the same day (ie a daycase procedure).

The dressing can be removed the next day.

Do’s and Don’ts after surgery

Please wear supportive (but not tight or loose) underwear while recovering form the operation.

If all goes well, then you should be able to return to desk work after one week and not do anything too physical during that period – ie no long walks, running, gym, lifting etc. The tiny ‘joins’ in the vasa need minimal disturbance in order to heal properly and for the procedure to be a success. ‘Pottering’ or desk work is fine. If your job is more manual then you should be off work for two weeks.  

You should avoid a bath for the first week, to avoid dissolving the sutures too soon. Showers are fine, but avoid direct rubbing on the site of the wound – pat dry with a towel.

You should not drive for 48 hours after the general anaesthetic, and it is not advisable to drive any long distances for at least a week after the surgery. There will be discomfort in the scrotal area that may impair braking / clutch control etc. You do not normally need to tell the DVLA that you have had surgery, unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving.

Avoid sexual activity for a month. You may have some involuntary night-time ejaculation during this period which is unavoidable, and there may be some blood in the first few ejaculates. This is normal following this operation.

In case there are any complications, it is inadvisable to arrange any foreign travel for the month following surgery.

What are the potential complications?

Common (10% or greater)

• Scrotal bruising.
• Anti-sperm antibodies – even though there may be plenty of sperm, antibodies may be present which reduce the chances of pregnancy. However pregnancy is possible even with 100% antibodies.
• Blood in the semen for the first few ejaculations.

Rarer complications: (less than 5%)

• Sperm granuloma (painful nodule at the operation site).
• A small percentage of vasectomy reversals can block off in the years following the procedure.
• Rarely, inflammation or infection of the testes or epididymis requiring antibiotics.
• Inability to perform the procedure on one or both sides. 

Follow-Up and Results

You will be given an appointment to come back for a follow-up visit with Mr Rees in the outpatient clinic approximately 6 weeks after the operation. This is a check-up to ensure the wound and scrotum have healed, and an opportunity for any questions.

At this visit you will also be given a specimen pot and a form to do a sperm count 6 weeks later (i.e 12 weeks after the operation). This is because it takes approximately 3 months to make new mature sperm. 
 

Instructions on how and where to take the specimen will be on the form. You should refrain from ejaculation for at least 3 days before doing the test.

You will then be informed of the result by letter or telephone call from Mr Rees.

However you may start trying for baby during this period, and it is therefore possible to fall pregnant any time after the operation. However as mentioned above, you should avoid sexual activity for the first 4 weeks after the operation.