Microscopic Vasectomy Reversal- Factors to Consider in the Decision-Making Process

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Northeast Georgia urologist performs cost effective microscopic vasectomy reversal in Urologic Ambulatory Outpatient Surgery Center.

Dr. McHugh performing a microscopic vasectomy reversal.

In the U.S.A. approximately 500,000 men undergo a vasectomy a year and approximately 6% or 30,000 pursue a reversal.

Although the average urologist performs hundreds of vasectomies a year, the same is not true for vasectomy reversals. There are several reasons for this. Whereas vasectomies are covered by insurance, reversals are not so couples have to pay for the procedure with cash. If the reversal is performed in a hospital this in turn accelerates the cost further discouraging the couple wanting to have another child. In the U.S.A. approximately 500,000 men undergo a vasectomy a year and approximately 6% or 30,000 pursue a reversal.

Because the number of patients desiring a reversal are so few the average urologist will not have the skills necessary or the comfort level to do the procedure. Most couples find a urologist who has an interest in doing reversals and does enough of them to be proficient in performing the procedure.

Performing a microscopic reversal with the use of the operating microscope and microscopic suture (smaller than a human hair) makes for a tedious and trying procedure for the urologist not accustomed to performing the procedure with regularity. It is for this reason that couples research their doctor thoroughly before consenting to the inconvenience of travel and paying out of pocket to have the procedure done.

Dr. John C. McHugh of Northeast Georgia Urological Associates uses his Urological Ambulatory Surgery Center to perform microscopic reversals.

"I have done microscopic reversals throughout my 26 year career in Gainesville, Georgia but it was not until we opened our Ambulatory Surgery Center that I was able to increase the number of procedures I perform. Having my own operating room and microscope allows me to perform the procedure without having to go to a hospital which results in both a convenient and cost efficient experience for the patient desiring this procedure," says Dr. McHugh.

Success of a vasectomy reversal is more complicated than one would think. Certainly the skill of the surgeon is important. Using an operating microscope and microscopic suture has been to been shown to have the highest success rates. Whether a true two layer repair versus a modified two layer technique is performed has not been shown to significantly alter the outcome.

The time period between the vasectomy and performance of the reversal is probably the biggest factor in the success of the procedure. The patient less than a year out from his vasectomy probably has a higher chance of having good sperm than that of the patient at ten years out. This explains why there is a difference in patency and pregnancy depending on how long ago the vasectomy was performed. Patency means that sperm are now in the ejaculate however whether those sperm will achieve pregnancy is another matter and this is influenced by the length of time since the vasectomy. Both patency and and the probability of pregnancy are both negatively influenced by the length of time from the vasectomy.

Of course the skill and experience of the surgeon is important as well, but this has caveats as well that need to be understood by the couple contemplating a vasectomy reversal. First of all the average urologist either does not perform the microscopic vasectomy reversal or does very few. The few that are performed by the urologist in this category are usually performed at a hospital. So in this scenario the couple has a doctor who has performed a limited number of reversals and they are paying a premium for it.

The next category of urologist is one who performs many cases a year and is very comfortable with the microscopic technique of the reversal and performs the procedure in his own operating room and usually with conscious sedation. This urologist usually performs the modified two layer technique and will not do an epididymovasostomy. In this case the patients are selected in such a way to limit the need for such a procedure.

The third type of urologist does vasectomy reversals only, usually at a hospital, and has the ability of doing the technically challenging epididymovasostomy but at the expense of time, the need of general anesthesia, and the added expense incumbent with this. It has been shown that after about 9 years out from a vasectomy a patient is more likely to need a epididymovasostomy. If it happens during the reversal the condition of the of the fluid released at the time of the repair does not require a epididymovasostomy, then the patient is prepared for all scenarios but paid more and may have needed to travel for an option he did not require.

So the decision of where and who a couple choose to perform their procedure is a multifactorial one that takes into account the skill of the surgeon, the years since vasectomy, cost and the likelihood of pregnancy. The patient beyond 10 years from the vasectomy in which money and travel is not an impediment might likely arrange to see a urologist who does reversals exclusively. However the couple less than 10 years from the vasectomy, the cost and convenience of a surgeon who performs a reversal commonly but not exclusively becomes more attractive.

"I offer a free consultation to the couple desiring a vasectomy reversal and clearly delineate the issues related to what is important to make an informed decision about this procedure and who performs it. I want patients to have realistic expectations regarding outcome," says Dr. McHugh.

Dr. McHugh's Book "The Decision: You're prostate biopsy shows cancer. Now what," is in the top ten books and Kindle for the subject on Amazon.com

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Kathy Burton

Dr. John C. McHugh M.D.
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