What Is a Vasovasostomy?

A vasovasostomy is the simpler of the two vasectomy reversal techniques: the surgeon reconnects the two cut ends of the vas deferens so that sperm can travel through it again.

The procedure is done under general or spinal anesthesia, takes 2 to 4 hours, and uses a high-powered surgical microscope. The vas has an inner channel about the diameter of a pencil lead on the outside but only about 0.3 millimeters wide on the inside. Reconnecting it cleanly requires sewing the two ends together with stitches finer than a human hair, often in two layers (an inner layer for the channel and an outer layer for the muscular wall). This is microsurgery, and outcomes depend heavily on the surgeon’s experience.

A vasovasostomy is the right reversal when the upstream plumbing (the epididymis and the section of vas below the original vasectomy) is still healthy and open. The surgeon checks this in the operating room by examining fluid from the testicular side of the cut vas under a microscope. If sperm or clear fluid are present, a vasovasostomy is appropriate. If the fluid is thick and pasty with no sperm, the blockage has extended back into the epididymis, and the surgeon switches to a vasoepididymostomy instead. That call is often made mid-procedure.

Success rates depend on how long it has been since the vasectomy and on surgeon skill. The classic Belker et al. (1991) study found patency (sperm returning to the ejaculate) in roughly 97% of men reversed within 3 years of vasectomy, dropping to about 71% beyond 15 years. Pregnancy rates are lower than patency rates because partner age and other fertility factors come into play.

When this matters

A few practical points for someone considering reversal:

• Vasovasostomy is the default reversal technique. Most surgeons attempt it first and only convert to vasoepididymostomy if intraoperative findings demand it.
• The longer the gap between vasectomy and reversal, the higher the chance the upstream epididymis has been damaged by back-pressure, which makes a vasoepididymostomy more likely.
• A “successful” reversal can mean two different things: patency (sperm in the ejaculate) and pregnancy. Patency rates are higher. Ask your surgeon for both numbers.
• Cost is largely out of pocket; insurance rarely covers reversal. See vasectomy reversal cost.
• Recovery is 1 to 2 weeks of taking it easy, with full activity around 3 to 4 weeks. The first post-reversal semen analysis is usually 6 to 8 weeks out.

Related terms

• What is a vasoepididymostomy?
• Vasovasostomy vs vasoepididymostomy
• Vasectomy reversal cost
• What are anti-sperm antibodies?

Sources

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

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