How does the surgeon decide when to perform a vasovasostomy or a vasoepididymostomy?
A direct vas to vas reconnection (vasovasostomy) is the most reliable type of vasectomy reversal with the highest success rates. This is the surgeon’s procedure of choice. If sperm are identified in the cut end of the vas coming from the testicle and epididymus, this confirms that sperm are being produced and are able to swim to this point. A direct vas to vas reconnection (vasovasostomy) can be performed. If no sperm are seen within the fluid from the cut end of the testicular vas, this typically suggests a blockage at the level of the epididymus and a bypass re-connection or vasoepididymostomy should be performed. A word of caution – some surgeons who perform vasectomy reversals do not have adequate experience to perform a vasoepididymostomy. Either a vasovasostomy is inappropriately performed or the surgery is abandoned altogether. Choosing a surgeon who is experienced in microsurgical vasovasostomy and vasoepididymostomy is essential.
