Under these circumstances an operation should be performed only by a micro-surgeon with proven vasoepididymostomy expertise, bypassing the blowouts.
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Vasovasostomy (literally connection of the vas to the vas) is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.
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A vasoepididymostomy involves a connection of the vas deferens to the epididymis. This is necessary when there is no sperm present in the vas deferens.
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Vasoepididymostomy or epididymovasostomy is a surgery by which vasectomies are reversed. It involves connection of the severed vas deferens to the epididymis and is more technically demanding than the vasovasostomy. For a vasectomy reversal that involves a vasoepididymostomy, there are two microsurgical approaches. The procedure involves a similar surgical incision as vasovasostomy; however, unlike with a vasovasostomy, the testis is usually delivered into the field for this more complex microsurgery.
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Silber S. "Reversal of vasectomy and the treatment of male infertility: role of microsurgery, vasoepididymostomy, and pressure- induced changes of vasectomy." Urologic Clinics of North America. 1981;8:53-62.
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After the findings from the vasal fluid are reviewed showing epididymal obstruction, the epididymis is exposed by opening the outer testis covering (tunica vaginalis). The epididymis is inspected and an individual tubule is selected to enter and connect to the vas deferens. From this point on, one of two epididymovasostomy techniques is taken. In the mucosa-to-mucosa, end to side method,Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am. 14: 527, 1987 an opened epididymal tubule is connected to the cut end of the vas deferens with 4 to 6 small (10-0) simple sutures placed around the circumference of each. This “inner” layer is supported with an “outer” layer of radially placed 9-0 sutures to strengthen the connection. Recently, an “invagination” vasoepididymostomy was described as an alternative to the mucosa-to-mucosa method.Berger RE. Triangulation end-to-side vasoepididymostomy.
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Vasovasostomy can be effective regardless of how long it's been since the original vasectomy. However, if more than 15 years have passed since the original vasectomy, one may have a lower chance of having enough healthy sperm in one's own semen to father a child. Also, the longer the obstructive interval, the more likely it is that a vasoepididymostomy will be required.
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Depending on when it occurs, it may be treated with anti-inflammatory medication or could necessitate repeat vasectomy reversal surgery. #If an epididymal blowout has occurred and is not discovered at the time of vasectomy reversal surgery, the vasectomy reversal will probably fail. In this case, a vasoepididymostomy would need to be performed. #When the vas deferens has been blocked for a long time, the epididymis is adversely affected by elevated pressure.
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In most cases the vas deferens can be reattached but, in many cases, fertility is not achieved. There are several reasons for this, including blockages in the vas deferens, and the presence of autoantibodies which disrupt normal sperm activity. If blockage at the level of the epididymis is suspected, a vasoepididymostomy can be performed. Return of sperm to the ejaculate depends greatly on the length of time from the vasectomy and the skill of the surgeon.
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Vasectomy reversal is a term used for surgical procedures that reconnect the male reproductive tract after interruption by a vasectomy. Two procedures are possible at the time of vasectomy reversal: vasovasostomy (vas deferens to vas deferens connection) and vasoepididymostomy (epididymis to vas deferens connection). Although vasectomy is considered a permanent form of contraception, advances in microsurgery have improved the success of vasectomy reversal procedures. The procedures remain technically demanding and expensive, and may not restore the pre-vasectomy condition.
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J. Urol. 159: 1951, 1998 With this technique, one, two or three “vest” sutures of 10-0 suture should be placed near the opening of the epididymal tubule to allow the epididymal tubule to “invaginate” into the vas deferens, theoretically creating a connection, that, based on studies in animal models, has an improved watertight seal and possibly a higher chance for success. Once the vas- deferens-epididymis connection is completed, the covering around the testis is replaced. Vasoepididymostomy is often considered one of the most technically challenging operations in the field of urology.
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