Does the Vasectomy Technique or Complications Impact on Vas Reversal Success Rates?

Yes, sometimes the vasectomy technique used and some complications can make a vasectomy reversal more challenging and so potentiality lower vas reversal success rates.

This 2023 updated article, prepared by International authority and author Sheldon H.F. Marks, MD, addresses many of the issues with the vasectomy technique and possible complications that can influence vas reversal surgery, care and success rates.

To better understand what a vasectomy reversal involves, it is helpful to first understand the vasectomy and how the specifics of the technique and any complications can potentially impact on vas reversal success rates. Here at our full time, vas reversal only “Center of Excellence” we can offer a proven, published success rate up to 99.5% for vas-to-vas connections most patients (1).

Vasectomy. A vasectomy is a relatively simple, surgical sterilization procedure for men. An estimated 600,000 vasectomies are performed in the U.S. alone each year (2). The vasectomy is most often performed as a minor, quick outpatient procedure in the doctor’s office through one or two small mini-incisions. The procedure is usually well tolerated. Most men experience no problems or complications after the vasectomy.

The vas deferens is a long, spaghetti-like tube that transports the sperm from each of the testicles to mix with fluid from the seminal vesicles to produce the semen. Only about 10% of the semen is made up of sperm. During the vasectomy, a small segment (usually 1 to 2 cm) of the vas is damaged or removed and the open ends of the vas are then closed with stitches, cautery and/or metal clips or a combination.

Technique. The vasectomy procedure is always a variation on the same theme – to damage the vas and block the flow of sperm into the semen, though every doctor uses their own slightly different technique. It is rare that the vasectomy technique creates any challenges or issues.

There are some vasectomy techniques that can make the vas reversal more challenging, such as:
-removing or damaging very long segments of vas,
-using excessive electrocautery to damage the length of the vas and/or
-performing the vasectomy very low down near the testicles in the twisted, deep convoluted vas.

Complications of the vasectomy. Significant bleeding along the vas, a large blood clot (hematoma) or infection after a vasectomy can lead to thick, dense scarring around the vas and testicles. This can make the vas reversal much more challenging, which can potentially increase risks for complications, though rare (3). Other possible though rare complications of a vasectomy include the development of a fluid collection around the testicle (a hydrocele), significant pain called “post vasectomy pain syndrome” (PVPS) (4) or formation of a small leak of sperm at the vasectomy site with a dense, inflammatory reaction and nodule called a sperm granuloma, which can be quite tender and even very painful (5).

The good news is that whatever we find at the time of the surgery, because of our decades performing more than 7000 vasectomy reversals, almost any vasectomy can be reversed successfully here at ICVR.

Does the vasectomy impact on hormones, testosterone or erections? The vas deferens does not transport the male hormone testosterone, which is also made by the testicles but instead is delivered directly into the bloodstream. Thus, a vasectomy usually has no effect on a man’s testosterone, sex drive or erections. There are some men who are certain that their testosterone did drop after the vasectomy, though this is not common.

To answer more questions about a precision, personalized vasectomy reversal or to set up a no-cost consultation with one of the two microsurgeons, call us at 1-888-722-2929 to find out what makes ICVR the destination for so many from every state in the US and more than 85 countries around the world!

This page was reviewed, edited and updated January 1, 2023, by Sheldon Marks, MD.

References:
1.Crosnoe LE, Kim ED, Perkins AR, Marks MB, Burrows PJ, Marks SH. Angled vas cutter for vasovasostomy: technique and results. Fertility and Sterility.2014;101(3):636-639.
2.Dickey RM, Pastuszak AW, Hakky TS, Chandrashekar A, Ramasamy R, Lipshultz LI. The evolution of vasectomy reversal. Curr Urol Rep 2015;16(6):40.
3.Adams CE, Wald M. Risks and complications of vasectomy. Urol Clin North Am 2009; 36:331-6.
4.Leslie TA, Illing RO, Cranston DW, et al. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int 2007; 100:1330-3.
5.Schmidt SS. Spermatic granuloma: an often-painful lesion. Fertil Steril 1979 Feb;31(2):178-81.