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Subtleties in Reversals


#1

I am overwhelmed by the shear amount of information on this webpage, and I am very much grateful for all the people contributing to it, and more so for the administrators trying to keep a good structure of all posts.
My question is probably not a new one, but I found it challenging to decipher the subtleties around the reversal surgery (vasovasostomy).
Can anyone summarize the main differences in the techniques out there? And if possible tell what is best practice, i.e. what gives better results in terms of pain relieve?


#2

I share your concerns and am considering a reversal myself. I suggest you go through and find the reversal threads and read them carefully.

Based on watching this forum for the last 7 months though, I can give you my current impression.

  1. You get the reversal in the first 3 years after the vasectomy
  2. Vas-to-vas (not vas-to-epi)
  3. You go to a micro-surgeon with plenty of experience, who can do a 2 layer surgery with 9-0 or 10-0 stiches under a microscope.
  4. Seems like guys here lean toward removing scar tissue rather than minimizing impact.
  5. Your surgeon is able to focus on just you. They don’t have students watching and helping. They don’t have any other significant responsibilities that day.
  6. Personally I would look for someone age 45-55. I hate to be ageist but that strikes me as the time a surgeon will be in their prime. Old enough to have experience and no young children to wear them out. Young enough to have the steadiest hands and a bit more recent education.
  7. Expect it to cost in the neighborhood of $10,000. Don’t look for a cheap surgeon.
  8. I prefer to speak with the surgeon for a while in person to get a sense for their personality and how they think about PVPS. I would also not want to get it done by someone who thinks that pain is someone a less legitimate reason to get a reversal compared with wanting to have more children.

You can expect to be in pain for 6-18 months following reversal, so don’t panic.


#3

I’m guessing you meant to say a three layer.


#4

I guess what I meant to say was ‘multi-layer’. I don’t know how many layers are the right number, but I do want a doctor who is skilled enough to do a multi-layer surgery.


#5

@Juno,

You don’t need to overthink this part.

If you are considering a reversal and are going out of pocket and choosing who to go to I would suggest using someone who does reversal all the time. If they do them exclusively that’s best.

I don’t recall your story but wanted to stress we recommend guys waiting or trying conservative measures as much as possible before getting reversed. It’s not a trivial surgery. For some guys it’s a walk in the park but my experience was the recovery was long, slow and painful. I think most guys have a much harder time with it than their original vasectomy.


#6

Thanks for all the replies here.

I found one surgeon who does reversals only, 3 layers. some 200 per year, with some PVPS victims.
So I think I am fine.

I still wonder about your experiences with “full clean up” (I guess that means removal of all scar tissue?) vs. “minimum impact” (I guess just reconnecting vas-to-vas?).

Is there any other distinguishing element during surgery??

What about the “follow up” protocols? What should that include? (semen analysis, what else???).

I am going to talk to him on the phone today and hopefully in person in a few weeks before I decide whether surgery is the way to go.


#7

Today I received some information from 2 reversal surgeons who admit on their homepages 20+ % of men suffering from PVPS. Wish I was living in that country and had read that before!

Anyways, 2 completely different replies to my case. One saying, it’s “microscope assisted” which is “recommended for patients who had vasectomy less than 7-10 years ago” or “for some cases of post vasectomy pain”. It “differs from the full microsurgical procedure in that 8 small stitches are used on each side rather than 16 (more chance of scar tissue causing a blockage with this procedure). During this procedure semen sampling is not carried out. This also means that the joins will always be between the vas and vas rather than vas to epididymis.”
Anyone has an opinion on that?

The 2nd surgeon from the same country, replied he would no recommend reversal within the first 2 years.


#8

Duncan Harriss mentioned that excessive stitching can promote scarring, and that he decides on the number of of stitches during reversal, depending on individual size of the lumen.


#9

Always using microscope @Juno, and ask how many reversals does the surgeon perform a year. You need someone who performs fair bit of them e.g. 100’s rather than someone who does 2-3 a year. Ideally you need soneome who does just reversals.

When did you have your vasectomy? If it is fairly recent up to 2 years, you most likely won’t need vaso epidydymectomy.


#11

DH is one of the 2, but the one advising to wait 24 months.


#12

It is a specialist only doing reversals, and claims to have done a fair amount in total.
One that has been mentioned on this forum numerous times, in the UK.
My vasectomy is only 3.25 months ago, but the pain is driving me crazy. I can’t work right now, it’s constant, 24/7, and I can’t control it with any medication it seems. Last thing I want to do is jump to conclusions, but I am really desperate right now.


#13

I had a reversal with DH 3 months ago, a number of guys on this forum went with him. Another surgeon you can check is Mike Henley.


#14

It’s these 2 that I contacted, thanks!
How’s your situation? How was your pain before the reversal, and how did it change?
How long did you wait with the reversal?


#15

I feel for you brother, it’s tough, but hang in there. You hit rock bottom, so the only way is up. If you read up my story, I had vasectomy 2 years ago, my issue was inflammation and congestion. Try to diagnose what kind of pains you have, congestion or nerve pains. Use papaya seeds and anti inflammatory medications for 3-5 months see where you are.


#16

Yes, I understand that all of the top tier pvps reversal surgeons world wide, etc have their own opinions far as what’s best.

I’ve never said what I think is best, yet I have said which direction I tend to lean towards. In another one of @Juno reversal threads I did make a point to say that giving opinions far as who’s the best in the world, country, etc, who does things the right way, etc, etc is asking for an argument, or a war to break out in forums like this one. Everyone is entitled to their opinions. You, me, the next guy, reversal surgeons, etc.

Everyone must do their own diligent homework for themselves. I do recommend talking with several pvps reversal surgeons, getting their input, opinion’s, etc, and decide for yourself what you think is in your best interests.

You do make a valid point that all men should be aware of, and yes, I was already aware of it @SomeGreyBIoke.

Nobody has to live with anyone’s surgical outcome but themselves.


#17

When you do your homework on this how many layers, sutures, etc stuff, outcomes, statistics, long term patency, etc, it’s truly hard to know who, or what to believe sometimes.

More stitches, more scarring, all that stuff sounds hypothetically plausible to us, but we aren’t the guys who’ve been doing this stuff for years, decades, a lifetime, etc. If anyone should know, it should be them, yet based on what I’ve seen over 8+ years, these people don’t seem to agree on a whole lot, especially far as what we are talking about specifically.

There’s some other pretty wild stuff some of these top tier pvps reversal surgeons are doing to that sound a bit wacked to some of us that have been reading about this stuff for nearly a decade. Is it wacked? Hard to say with any certainty.

Until we are able to see long term, unmolested, true data on all this stuff, it will always be hard to say much for absolute certain. I don’t see that day coming anytime soon.


#18

I’m talking about things such as a no clean up, infertile reversal, etc. Patency isn’t even part of the outcome, and its not supposed to be.

I’ve also seen, heard of, etc reversal surgeons that do a sutureless reversal with glue/s. I’ve never seen much data regarding outcomes, statistics, patency, etc with that methodology. At this point, I have no reason to be a fan of that methodology. People need to be aware that all of these methodologies exist though.


#19

Any good PVPS specialists in or around seattle? I am not able to locate a good urologist who can work with me holistically towards a better solution to this. The ones I am seeing are just decided on prostatitis or something else and just treating for it.i