Types of reversal surgery
There are two different surgeries that may be required to restore sperm to the ejaculate. One involves simply suturing the two ends of the vas together again, called a vasovasostomy. This is the easier of the two surgeries and is performed roughly 75% of the time. This surgery is chosen when good sperm quality is present from the testicular end of the vas.
The second type of surgery, called vasoepididymostomy, is required when there is poor or absent sperm in the testicular vasal fluid. In roughly 20-25% of patients, the initial vasectomy causes a blockage to occur in a gland behind the testicle called the epididymis. In this situation, the more challenging and delicate vasoepididymostomy is required, a connection between the obstructed gland and the abdominal end of the vas. It is essential that the microsurgeon has the ability to perform this surgery. Some surgeons do not perform this surgery at all, and if there is a secondary blockage present, the surgery will fail. In fact, many of the failed vasectomy reversals that are then referred to our center have failed because the vasoepididymostomy was not performed the first time.