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Spring 06 2 27.Qxp University of California, Irvine School of Medicine Spring 2006 UCI Medical Center Department of Urology 101 THE CITY DRIVE SOUTH ORANGE, CA 92868-5395 N E W S L E T T E R Re-United: The facts about vasectomy reversal "When a man consents to undergo a vasectomy, he is usually instructed that the procedure should be considered Aaron Spitz, MD to be permanent and irreversible.... Nonetheless, even the Assistant Clinical Professor Male Reproductive Medicine most insightful, thoughtful decision can ultimately prove and Surgery wrong. When that decision is a vasectomy, a man may still change his mind." re you considering a vasec- tomy. Therefore, before undergoing a tomy reversal? Thousands vasectomy, a man should be as sure as A of men undergo vasectomy possible that he is finished having chil- each year as a permanent means of dren. Nonetheless, even the most birth control, yet for some of these men insightful, thoughtful decision can ulti- life brings unexpected turns, which mately prove wrong. When that deci- leads them to change their mind. For sion is a vasectomy, a man may still Epididymo-vasostomy some, there is a strong desire to have change his mind. sperm travel from the testicle to the another child a few years later. For urethra. It feels like a piece of under- others, there may be a tragic loss of a What is a vasectomy? cooked spaghetti in each side of the child. For many men, a new marriage To understand the vasectomy reversal, scrotum. The sperm are produced in brings a new opportunity for creating a it is important to understand the vasec- the testicle, and then they exit out the family. Regardless of the circum- tomy. A vasectomy is the surgical top of the testicle and into the epi- stances, a vasectomy can be reversed. removal of a small piece of the vas didymis. The epididymis is a very tiny, When a man consents to undergo a deferens. The vas deferens is the long tightly coiled tubule, which runs along vasectomy, he is usually instructed that narrow muscular tube through which the back of the testicle from top to bot- the procedure should be considered to tom. be permanent and irreversible. This is an appropriate admonishment, because “When a vasectomy is performed, the doctor feels for these a vasectomy reversal is not 100% guar- "pieces of spaghetti," and surgically removes a small seg- anteed to work, and it is a significantly more complex operation than a vasec- ment of vas deferens from each side. The cut ends are then clipped, sutured or cauterized.” UCI School of Medicine - Urology Copyright © 2006 The Regents of the University of California. All rights reserved. continued from previous page Technique of vasectomy Success rates: Success rates for vasectomy reversal It then turns a corner, heading back reversal: are surprisingly good. A variety of fac- north towards the pelvis, and becomes A vasectomy reversal is the rejoining of tors determine the outcome for an indi- the thicker, straighter vas deferens. the blocked tubes. In cases where there vidual patient. In cases where there is During ejaculation, the muscular walls is no excess pressure build up and no no epididymal blow out, the fluid from of the vas deferens tube contract to pro- epididymal blow out has occurred, the the cut end of the vas deferens has pel the sperm up to the urethra of the vas deferens can be rejoined to the vas motile sperm, the time interval since prostate. In the urethra, the sperm are deferens. This is called a vaso-vasosto- vasectomy is moderate (less than 10 then joined by fluids from the prostate my. The surgery is technically chal- years), and the procedure is performed and then ejaculated out of the penis. lenging, and it is performed with an operating microscope utilizing sutures by a skilled microsurgeon, success rates When a vasectomy is performed, the which are finer than a human hair. approach 95%. If the time interval is doctor feels for these "pieces of The vas deferens is usually reconnected greater than 15 years, the success rate is spaghetti" and surgically removes a with two layers (inner lumen and outer about 75%. In cases where vaso-epi- small segment of vas deferens from surface). In cases where there has been didymostomy is required, the success each side. The cut ends are then rates are closer to 75%. Success, in this clipped, sutured or cauterized. case, is defined as restoration of sperm Suddenly, the sperm can go no further to the ejaculate. Actual pregnancy rates than this new point of blockage. are less: 75% for vaso-vasostomy and about 40% for vaso-epididymostomy. So what happens to all the The lowered pregnancy rates are due to sperm? a variety of biological variables includ- Vaso-vasostomy What most men don't realize is that ing female infertility factors as well as once the vasectomy is performed, an epididymal blow out, the vas defer- a 15% incidence of clinically signifi- sperm production does not stop! Ever! ens north of the vasectomy scar must cant antisperm antibodies. Unlike women, men produce their be rejoined with the epididymal tube gametes (sperm) for their entire life. A (tiny and tightly coiled) south of the Alternatives: vasectomy does not stop sperm produc- blow out scar. This procedure is called An alternative to vasectomy reversal is tion, rather it simply blocks the entry of a vaso-epididymostomy. This surgery minimally invasive sperm retrieval. sperm into the urethra. Like other is even more technically challenging This sperm cannot be used for artificial cells, the blocked sperm are eventually than a vaso-vasostomy and should only insemination. It must be injected broken down by the body and reab- be performed by a microsurgeon expe- directly into the woman's eggs (Intra- cytoplasmic Sperm Injection-ICSI) as Like other cells, the blocked sperm are eventually part of an in-vitro fertility (IVF) cycle. broken down by the body and reabsorbed. This alternative is more appropriate for some couples. In cases where there is sorbed. New sperm are continually rienced with this procedure. An epi- no female infertility factor and the time being produced. A variable amount of didymal blow out is diagnosed during since vasectomy is less than 15 years, pressure can build up in the tubes surgery by examining the fluid from the vasectomy reversal is clearly recom- behind the vasectomy scar. In some cut end of the vas deferens under a mended over sperm retrieval with cases, so much pressure builds up that microscope. Because an epididymal IVF/ICSI by both the American Society the tiny tubule of the epididymis can blow out cannot be accurately diag- for Reproductive Medicine and the rupture. This is commonly referred to nosed until the time of surgery, it is American Urological Association. as an epididymal "blow out." If this important for the patient to select a sur- Dr. Aaron Spitz is the author of several happens, the site of the blow out devel- geon ahead of time who can perform peer reviewed articles and book chap- ops scar tissue, and this actually this procedure. ters regarding the treatment of male becomes the new level of blockage to Vasectomy reversal is typically per- infertility. He is a board certified urol- the sperm. This is neither painful or formed with general anesthesia, and the ogist, specialty fellowship-trained in dangerous, but it is significant in that patient goes home the same day. The microsurgery and male infertility, for a vasectomy reversal to be success- recovery is typically rapid, but only Baylor College of Medicine, Houston, ful, it must be performed in such a way light duty work and refraining from Texas. that bypasses this new level of block- heavy exercise or sex is recommended age at the epididymal blow out site. for the first two to three weeks. For appointments and referrals, please call: 714-456-8573 UCI School of Medicine - Urology www.ucihs.uci.edu/urology 2 Kudos to Dr. Regina Hovey and Moon-Ja Yunouye Urology residency training program receives highest rating: Full 5-year accredi- tation The Department of Urology is pleased to announce that the Residency Review Regina M. Hovey, MD Committee (RRC) has accredited the Associate Clinical Professor residency training program for the next Residency Program Director five years. This is the maximum dura- Department of Urology tion for RRC residency program Department of Urology Residents accreditation before re-review. The program now accepts two residents per year in the 5-year training program. Center for Urological Ralph V. Clayman, MD, Professor and Chair of the Department of Urology and Care Receives Award Julie Limfueco, RN, Administrative Nurse Manager he UCI Medical Center Associates recently provided a $4,200 grant award to the Department of Urology’s Center for Urological Care. Acknowledging receipt of the grant is, pictured above, Dr. Ralph V. Clayman, Professor and T Chair of the Department of Urology, and Ms. Julie Limfueco, RN, Administrative Nurse Manager for the Center for Urological Care and Professional Surgical Practices. The Associates is a volunteer organization dedicated to supporting UCI Medical Center’s mission of patient care, education and research. The grant funds were used to purchase a music system for the Center for Urological Care’s new waiting room in order to make it more pleasing to patients and their families. In addition to serving urological patients, the new waiting room also serves patients for dermatology, pain management, pulmonary, general surgery, trauma, vascular surgery, cardiothoracic surgery, and renal transplant services. On behalf of all the surgical specialties using the new Pavilion III suite, the Department of Urology and the Center for Urological Care wishes to thank the members of The Associates for their kind and generous award.
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