What Is a Vasoepididymostomy?

A vasoepididymostomy is the more complex vasectomy reversal technique: instead of reconnecting the two cut ends of the vas deferens, the surgeon connects the vas directly to a tubule of the epididymis, bypassing a blockage further upstream.

The procedure is done under general anesthesia using a high-powered surgical microscope and typically takes 3 to 5 hours, longer than a standard vasovasostomy. The technical challenge is the size and fragility of what is being sewn together. An epididymal tubule is roughly 0.2 to 0.3 millimeters across with extraordinarily thin walls, and the surgeon has to sew the vas onto a single tubule with multiple sutures finer than a human hair. Outcomes depend heavily on surgeon volume and experience. This is one of the more demanding microsurgeries in urology.

The need for a vasoepididymostomy is usually discovered in the operating room. The surgeon plans for a vasovasostomy, opens the vas, and examines the fluid from the testicular side under a microscope. If the fluid contains sperm or appears clear, the simpler reconnection works. If the fluid is thick, pasty, and contains no sperm, that signals a blockage in the epididymis from back-pressure, and a vasovasostomy alone will not restore fertility. The surgeon switches to a vasoepididymostomy and bypasses the blocked segment.

Success rates are lower than for a vasovasostomy. Patency (sperm returning to the ejaculate) is typically reported in the 60 to 85% range when performed by experienced microsurgeons, with pregnancy rates lower still because of the time it takes for sperm to return and partner fertility factors. Outcomes drop sharply when the procedure is done by surgeons who do not perform it regularly.

When this matters

If you are weighing a reversal:

• Time matters. The longer since the vasectomy, the higher the chance that one or both sides will need a vasoepididymostomy.
• Find a microsurgeon who does vasoepididymostomies routinely, not occasionally. Ask how many they perform per year. The Belker et al. data and subsequent studies are clear that volume drives outcomes.
• Both options should be discussed before surgery. Many reversal surgeons quote a single fee that covers either technique, since which one is needed is decided in the OR.
• Recovery is similar to a vasovasostomy: 1 to 2 weeks of rest, 3 to 4 weeks before full activity, and the first semen analysis 8 to 12 weeks out (slightly later than after a vasovasostomy, because sperm take longer to appear).

Related terms

• What is a vasovasostomy?
• Vasovasostomy vs vasoepididymostomy
• Vasectomy reversal cost
• What is the epididymis?

Sources

• American Urological Association Vasectomy Guideline
• Cleveland Clinic: Vasectomy
• Mayo Clinic: Vasectomy

Editorial and informational. Not medical advice. Read the full disclaimer.