The vasectomy reversal procedure actually begins with the decision process. Even before Dr. Fenig makes a single surgical incision, he will sit with you to explain and evaluate your options and alternatives, and educate you about the procedure. He will also let you know what to expect pre-operatively, the day of surgery, and during your recovery so that you and your partner are fully aware and comfortable with your choice prior to the procedure.
Because vasectomy reversal is a highly specialized and technical procedure, choosing a fellowship-trained microsurgeon like Dr. Fenig is very important. But, it’s also good to know that Dr. Fenig understands not just the medical side of the surgical procedure – he truly cares about your wish to conceive a child naturally and his goal is to help you achieve your ultimate desire – a baby.
Vasectomy Reversal - How it Works
It’s important to understand how sperm production occurs and how the microsurgical vasectomy reversal procedure that Dr. Fenig performs, works. Sperm production occurs in the testicle. After passage through the efferent ducts, sperm are stored and undergo maturation in the epididymis. The epididymis is a continuous, tightly coiled tube approximately 15-18 feet in length, which leads into the vas deferens. Sperm that have not passed through the epididymis are generally not able to fertilize eggs under normal conditions. The vas deferens is responsible for directly propelling sperm into the urethra.
During a vasectomy, the vas deferens, the tube that carries sperm into the ejaculate, is cut. During the vasectomy reversal procedure, Dr. Fenig will utilize his finely honed microsurgical skills to re-establish a connection of the vas deferens in a procedure called a vasovasostomy (pictured left). The procedure involves making an incision in the scrotum just large enough to allow Dr. Fenig to locate the vas deferens, a muscular tube with a diameter of about 1/8 inch, through which a tiny channel serves as the sperm cells’ superhighway into seminal fluid, or ejaculate.
Less commonly, a procedure called an epididymovasostomy (or vasoepididymostomy) is required if a blockage in the epididymis is found during surgery. Unlike most general urologists, Dr. Fenig is fellowship trained and has received advanced training in this delicate, more technically demanding, surgery.
Sometimes after a vasectomy the vas deferens is not the only sperm pathway that is obstructed, and reconnecting its two ends will not remove all the roadblocks in the sperm transport system. Another area that can become blocked is called the epididymis, a delicate coiled tube lying against the testicle where sperm mature and are stored. Blockage of the epididymis occurs more often when a vasectomy has been performed many years before. In this case, the vas deferens must be connected to the epididymis, also known as an epididymovasostomy (pictured right).
This procedure is even more delicate than the vasovasostomy and must be performed by an experienced microsurgeon like Dr. Fenig who has the advantage of the VRCA’s dedicated microsurgical operating suite equipped with the most advanced microsurgical equipment and a Zeiss operating microscope and dedicated nurses with microsurgical training.
The Day of Your Surgery- What to Expect
On the day of surgery, you will arrive at The Vasectomy Reversal Center of America where Dr. Fenig will perform your procedure in the Center’s state-of-the-art microsurgical suite that includes the most advanced microsurgical technology and equipment. At this time, you will also be introduced to the microsurgical team, including your operating room and recovery room nurses.
Once the surgery is underway, Dr. Fenig will first identify the location of the previous vasectomy, or blockage, and remove any scar tissue, leaving two freshly cut ends of the vas deferens. He will then precisely align and carefully sew the ends of the tubes together to prevent leaks and excessive scar tissue from forming as you heal. Once sewn together using special microscopic sutures, the vas deferens is placed back into the scrotum and the incision is sewn closed.
Of note, in the January 2012 edition of the Journal of Urology, Dr. Fenig authored the first publication which allows preoperative prediction of the need for the more complicated epididymovasostomy based on certain factors, including time since previous vasectomy. This paper importantly concludes that more patients will required epididymovasostomy at the time of vasectomy reversal than may be thought by patients or urologists without advanced microsurgical training. This underlies the importance of having your vasectomy reversal performed by an experienced microsurgeon trained in this advanced technique.