Vasovasostomy vs Vasoepididymostomy
These two terms are generalizations that break down the type of surgery in basically two forms. Vasovasostomy is a reconnection of the vas to the vas, but this can be done in different locations and with different techniques. A vasoepididymostomy, ofter referred to as a bypass procedure, is the connection of the vas directly to the epididymis. A vasoepididymostomy can be performed many ways, from a simple incision with a couple of sutures attaching the vas to the side of the epididymis, to a more complex union with a tuble from the epididymis.
How the Surgeon Determines Which Procedure You Need: The type procedure that you might need cannot be determined before the procedure. How the vasectomy was performed, how the semen appears both in appearance and microscopically, and whether or not sperm are present must all be taken into consideration. It is not uncommon for the semen to allow for a vasoepididymostomy but the severity of the vasectomy to demand a bypass procedure.
Why Microsurgical Technique Matters in Vasectomy Reversal: The microsurgical technique used is critical to your success, and is a skill acquired over time, not with one or two times being coached. There is an inside opening in the vas which is very small and very delicate. Sutures that are improperly placed can actually serve to obstruct the tube while attempting to reconnect it.
Can a Vasectomy Be Reversed Twice? Most of the time, the answer is yes. Failure is common with less experienced surgeons as scarring can occur where the tubes are sewn together. If there was sperm present at the time of the initial reversal that went away at a later date, a scar has formed. If there was no sperm present at the time of the initial reversal, then there might be another reason for the failure. A vasectomy destroys some amount of the vas and a reversal will damage a bit more. At some point, we can run out of suitable vas to work with, but for most individuals, a second reversal is very possible, but having it done right the first time is certainly a better option.
