Vasovasostomy can be performed in the convoluted or straight portion of the vas deferens.
Vasovasostomy is typically an out-patient procedure (patient goes home the same day).
The procedure is typically performed by urologists. Most urologists specializing in the field of male infertility perform vasovasostomies using an operative microscope for magnification, under general or regional anesthesia.
If sperm were seen in one or both vas contents at the time of surgery, or sperm reached the patient’s semen only transiently after the reversal, microsurgical vasovasostomy may be successful. Unfortunately, surgeons performing only an occasional vasectomy reversal often neglect examining the vas contents for presence or absence of sperm. A surgeon cannot determine sperm presence or absence by the naked eye. The most common cause for failed vasectomy reversals is the inappropriate non-microsurgical technique using sutures that are too large to achieve watertight reconnections. The failure of a competently performed microsurgical vasovasostomy following the absence of any sperm in the contents of each vas usually is due to “blowouts” in the epididymides. Under these circumstances an operation should be performed only by a micro-surgeon with proven vasoepididymostomy expertise, bypassing the blowouts.
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