Post Vasectomy Pain Forum

Reversal date set

It’ll be done on March 8th by Dr. Sevann Helo at the Mayo Clinic.
https://www.mayoclinic.org/biographies/helo-sevann-m-d/bio-20471435

We spent about two hours going back and forth trying to figure out pain distribution and chances of success. She’s hopeful that the congestion issue will be resolved, but isn’t selling me 100%. Makes sense. I’m a chronic pain patient already (should have been a clue I shouldn’t have had a vas done in the first place) so unfortunately the back pressure is just exacerbating my issues.

It’ll be done in the OR under anesthesia. She’s also doing this as a micro surgery done under microscope. My vasectomy was done on Aug 25th, 2020 and the pain, as of today, is debilitating. I’m looking forward to a chance of resolution.

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I have read countless positive testimonials from men that had a reversal with someone that gets little to no recognition on websites like this one. A reversal surgeon doesn’t have to be famous to get a fair shake.

It sounds like your consultation went well. I can only hope that you asked her all the right questions, and she had all the right answers.

Did you happen to ask or did she mention how often she comes across a patient like yourself?

Good luck @ope

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Very true. It’d be interesting to see the distribution of reversal patients on this site. I actually think it’s pretty widespread. I’ve probably observed 5-6 different reversal surgeons cited at least once just here i Ohio over time.

I bombarded her with questions. Plenty of them.two of my biggest concerns is the reversal surgery plugging up. Or having a blowout and having the reversal be not effective.

based on my age and the amount of time that has passed since the vasectomy, she feels the chances of having the epi be plugged are slim. She’ll still test for motile sperm after opening the testicle end of the vasectomy.

I did not ask the question how often she comes across a patient like me, but she has noted that I’m not the first. she was very thorough with her questions and very thorough with her answer is, so I’m feeling much more at ease knowing that she’s on my case.

one thing she wanted to warn me about is the recovery time for a patient like myself. Just to be prepared that it’s probably going to be rough.

She does not seem like other urologists that I have seen who are very short with their answers. My appointment with her took 2 hours, and most of it was her asking questions.

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The posts are correct in that in our practice more than 90 to 95% of the men will either describe total resolution of the pain or such dramatic resolution that they don’t really notice or care anymore after a reversal. These are as an insider not only as a vasectomy reversal surgeon where we perform about 300 a year but also as a Mayo trained doctor . A couple of thoughts to add to the discussion. Many of the top reversal doctors are at academic teaching centers which means they have a great name but it also means that they are there to not only care for patients but also to train doctors. That means that once you are sedated or asleep many times the doctor in training actually is throwing the critical stitches and the doctor that you think is doing it is the surgeon of record. It’s always important to ask the doctor what role a resident or fellow will be having in the surgery and what role the attending physician that you’re talking to will have in the surgery. This is just the same as for aftercare because many times if you have questions concerns or problems the doctor himself or herself will not be the one taking or returning the call but rather a doctor in training-, many times it’s not even a doctor that has done that specific rotation and does not know you.
So that’s another question to ask is if I have questions concerns or problems who is going to reach out to me and be the resource during my recovery. Lashley regarding famous doctors somebody noted I think it’s important to understand why the doctors are famous. Is it because they work at a prestigious institution or is it because they’ve published a lot of papers or is it because they have really high success rates with happy patients and excellent long-term follow-up care? The key was looking for a doctor is to find the one that will give you the absolute highest chances for success. There are clues to this. Here are just some of the questions that I think as an insider it’s important to ask. These are in no particular order. How many vasectomy rehearsals did that doctor actually perform as a fellow? How many reversals did that doctor perform as a resident? Be aware that many times the doctor in training is participating in the surgery but it’s not doing it entirely. I’d also want to know how long the average reversal takes because it should take about 2 to 2 1/2 hours. Reversals that routinely are 60 to 90 minutes make me nervous as I wonder what they’re doing to cut corners. Just the same I worry about reversals that take 3 to 4 hours or longer routinely. I’d like to know what technique is performed if they’re doing a one layer or a modified one layer or a two layer or the most up to date 3 to 4 multi layer closure?
I’d also like to know what size suture they use for the inner mucosal layer, which should be 10-0. I’d also like to know if they send you home on anti-inflammatory medications and how soon they like to check a formal semen analysis. In my practice we check accounts in four weeks and every four weeks until the numbers reach target levels and stabilize. Some doctors have long delays which makes me uncomfortable because I’ve seen many men scar up by three months or later. A sneaky question is what kind of pain medication do they send you home with because in our practice it is very very rare for a man to even ask for a plain Tylenol so if they send you home with a jar of narcotics that makes me worry. Another question is what is their success rate for a straight forward vas to vas connection to restore the flow of sperm. For comparison we published a study that showed a 99.5% success rate. You also want to ask what is their definition of success. We use and have published a return of at least 1 million motile sperm where I know of other doctors that say seeing one sperm is good enough.

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Wow. what a write up. I’ll be asking these questions in the patient portal.

One thing is that she mentioned she’ll be sending me home with meloxicam and tramodol. I told her I can’t do Vicodin as it really messes me up. Tramadol seems to be good enough for pain relief that I prefer it. This will be my 5th surgery, so that’s just my experience on narcotics.

She mentioned the surgery will take about 4 hours. She also mentioned that she will be with me the entire time as she doesn’t schedule things on top of this. Something she took time to reassure me when signing the consent form. But I think, based on what you’re telling me, it’s a good thing to clarify anyways. I’ll be asking about techniques and reporting back, if that’s okay. I’d be genuinely interested to hear your thoughts.

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You just got some insider information from one of the best hand reversal surgeons in the world @ope.

I am going to drop some of my thoughts too. As one of several moderators, I feel obligated to post as unbiased as possible. In my reversal thread, I tried to write about this site as a whole, and everything I have ever seen or know about reversals as balanced as possible. If I didn’t, I’m sure there would be some sort of significant backlash eventually.

In the past, I have been accused of all sorts of stuff. I’ve had all kinds of silly drama happen just because I recommended a name like Dr Marks, ICVR, etc, on the open forum several times. I have been accused of somehow profiting via recommendation. I have been accused of being a fan boy. Accused of all kinds of silly stuff. Between stuff like that, and the liability aspect, I don’t recommend anyone anymore - especially on the open forum.

I am absolutely certain that there are many other VR surgeons in the world that are up to the task, but I did post one link in my reversal thread this morning for a reason.

What Are the 20 Questions Everyone Should Ask?

https://www.dadsagain.com/questions/

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It’s heartwarming to continue to see Dr. Marks posting here.

Following up, and posting here for other people to see.

Questions I asked:

Hey Dr. Helo,

I have more questions regarding the upcoming procedure.

  1. What role will a fellow have in this procedure? Will there be a doctor in training helping with the stitches?

  2. Regarding layers: Do you do a one layer, modified one layer, two layer or a 3 to 4 multi layer closure?

  3. Regarding inner mucosal layer: what size suture do you use?

  4. Follow-up care: how often do you check for sperm after the procedure to make sure it hasn’t scarred back over?

  5. Length of time: Another doctor mentioned that this procedure generally take them 2 to 2.5 hours. Since you mentioned that it takes 4 hours, why the difference? Mainly curious.
    Great questions !

Dr. Helo’s responses:

  1. I will likely have a fellow with me, Dr. Yang, who has done over 30 reversals with me over the past year. He may do some suturing, but I will be scrubbed in and present for the entire procedure. I do require an assistant under the microscope to help with irrigating and cutting sutures. I am very hands on with the reversals because I understand the stakes are high and want you to have a successful outcome.

  2. We do a 2 layer closure of the vas deferens, with a 3rd reinforcing layer of the surrounding tissues with a stronger suture.

  3. We use a 10-0 (inner) and 8-0 (outer), then a 5-0 for the surrounding reinforcing sutures.

  4. When doing this procedure for fertility, we check a semen analysis at 6 weeks. If no sperm or few sperm are present, then I offer those patients a 4 week course of prednisone. We then repeat the semen analysis in 8 weeks. I don’t generally repeat the semen analysis otherwise unless the couple is having difficulty getting pregnant, then we can repeat it to make sure that it hasn’t scarred down.

  5. When doing a vasovasostomy (simple) connection on both sides it generally takes us 2.5-3 hrs in the clinic. When we’re in the operating room it generally takes longer due to the time it takes to put you to sleep and wake you back up from anesthesia.

Thank you, again @DrMarks, It’s good to know ahead of time these things and her responses in turn.

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