Vasectomy reversal
Microsurgical restoration of sperm continuity using vas-to-vas or vas-to-epididymis reconstruction according to intraoperative findings.
Interactive 3D Interactive vasectomy reversal (vasovasostomy and vasoepididymostomy) Open the 3D animation Teaching catalogue only. This coverage record is not a patient pathway or operative instruction.
Typical place in practice
Selected fertility restoration after vasectomy following couple-based assessment and discussion of assisted reproduction.
Alternatives and neighbouring procedures
Surgical sperm retrieval with assisted reproduction, donor sperm, adoption or no fertility treatment.
Same procedure family, explicit technique branches
These are variations of this canonical operation. Complication modules below identify whether they apply to all branches or only to named approaches.
Vasovasostomy
Reconnects healthy proximal and distal vas when the testicular end is suitable.
Vasoepididymostomy
Bypasses secondary epididymal obstruction when direct vas reconnection is unlikely to restore patency.
Combined or crossed reconstruction
Tailors the procedure to asymmetric intraoperative findings.
High-level sequence
Coverage outline only; not a step-by-step technical guide.
- Complete couple-based fertility assessment and plan backup options
- Expose and divide each vas around the occluded segment
- Assess testicular-end fluid and distal patency
- Perform tension-free microsurgical anastomosis appropriate to each side
- Monitor wound recovery, semen patency and pregnancy outcomes separately
Operative notes
Concise operative notes covering the key steps, landmarks and watch points, in the order you encounter them.
Fertility surgery
What it does: operations to find and fix blocked pipes, or to fetch sperm.
Varicocele (open routes; coils via radiology)
- Palomo (high, back of tummy): whole pedicle tied. Artery may go with it. Collaterals save the testis. Fewer veins. More hydroceles. ~15% back if the artery is spared.
- Ivanissevich (groin canal): cord lifted. Separate artery (papaverine, Doppler) and lymphatics from the ~3 veins. Artery NOT tied here. Cut the cremaster vein too, or it recurs.
- Marmar (below the canal, at the ring): no fascia opened. Many veins, branched artery. The confident microsurgeon's route.
Vasography (blocked vas, before repair)
- Transverse nick in the vas. Do not divide it.
- Fluid to a slide. No sperm = block is on the testis side.
- Saline flush runs free = open beyond. Or blue dye + catheter in bladder: blue urine.
- 0.5 mL X-ray contrast down the vas maps the level.
Vasovasostomy (rejoin the vas)
- Trim to healthy ends. Both bleed.
- 2-layer micro join: 3 x 10/0 stitches in the lining, turn 180, 3 more. 9/0 in the muscle. Then sheath layers.
Vaso-epididymostomy (join vas to epididymis)
- Fat-to-thin tube change marks the block.
- Open 1 tube. Sperm confirmed on a slide.
- Vas fixed to the sheath, 6/0. Lining joined 10/0.
- Sperm back in ~70%. Later narrowing common.
TURED (ejaculatory duct)
- Scan rectally first. Dye + contrast into ducts.
- Resect the veru. Spare neck and sphincter.
- Dye in the bed = in the duct.
- Sperm back ~50%. Risks: reflux, dry ejaculation.
MESA / PESA (sperm retrieval)
- MESA: open an epididymal tube. Pipette the fluid. Blocked system: best sperm sit HIGH (unusual).
- PESA: 27G butterfly into the head of the epididymis, held between fingers. Gentle pull. Press firmly 5 min after.
- 2026 update: micro-TESE is the standard for non-blocked azoospermia. Name it in vivas.
From the UroRef Operative Quick Guide. Open the note page →
Every failure mode is its own module.
Timing and variation coverage are recorded for each module.
Bleeding, haematoma or infection
Scrotal or inguinal bleeding can compromise microsurgical reconstruction and recovery.
Applies to: All variantsTesticular vascular injury
Cord dissection can threaten arterial supply, particularly after previous surgery.
Applies to: All variantsAnastomotic leak or obstruction
A non-watertight or technically narrowed join may fail before stable patency develops.
Applies to: All variantsLate re-stenosis after initial patency
Scar can close an initially patent reconstruction.
Applies to: All variantsPersistent infertility despite patency
Restoration of sperm to semen does not guarantee pregnancy because of male, female or couple factors.
Applies to: All variantsChronic scrotal pain
Scarring, nerve injury or ongoing obstruction can produce persistent pain.
Applies to: All variantsSources for this module
Penile prosthesis, Peyronie disease, priapism and reproductive surgery.
Accessed 2026-08-03 · opens source British Association of Urological Surgeons Patient information leaflets by procedureUK patient-facing procedure, alternatives, recovery and complication framing.
Accessed 2026-08-03 · opens source