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It is important to remember that unfortunately most vasectomy reversals are performed by doctors
that do not have the skill, expertise, qualifications, access to the correct microsurgical equipment
and instruments, or daily experience to offer you the best chances for success.
Take the time to go to the best microsurgeon and the best dedicated vasectomy reversal center.
Chances are it will not be one of your local general urologists. You’ll be glad you did.
- Are you certified by the American Board of Urology?
- Are you a member of the Society of Reproductive Surgeons?
- Do you perform a microsurgical vasectomy reversal with six sutures of 10-0 (ten-0) or 11-0 (eleven-0) to reconnect the inner lumen (tube where the sperm travel)?
- Do you personally perform the entire vasectomy reversal surgery, from the beginning to the end?
- Do you have your own dedicated vasectomy reversal operating suite, microsurgical instruments and personal surgical staff?
- Do you use a high-powered surgical microscope to place and tie the stitches?
- Do you use a formal multi-layer (microdot) microsurgical vasectomy reversal technique every time?
- What about laser vasectomy reversals?
- Do you use conscious sedation in an outpatient setting when performing a vasectomy reversal?
- Do you offer a fixed price, "all-inclusive" vasectomy reversal package?
- Do you offer the ability to retrieve sperm intraoperatively for freezing and sperm banking in a state-of-the-art andrology lab?
- Do you limit your practice to no more than one vasectomy reversal in a day?
- Do you provide your patients with your personal cell phone number so they can have access to you any time, any day or night, before or after the vasectomy reversal surgery?
- Does an uneventful vas-to-vas (VV) vasectomy reversal take about two and a half to three hours?
- Do you perform more vasectomy reversals than any other major procedure in your practice?
- Do you routinely perform vas-to-epididymis (VE) connections if necessary?
- Do you have patients come to see you for a vasectomy reversal from all over the United States…From all over the world?
- Do you have successful vasectomy reversals on men as far out as 35 and 42 years from the vasectomy?
- Do you have an andrologist, pharmacist and anesthesiologists on staff to work with you as needed?
- Do you routinely perform re-do and re-do -- re-do microsurgical vasectomy reversals?
The answer should be yes. Not everyone is certified. This doesn't mean they are not
qualified, but being certified means that your doctor has passed a rigorous two-day written and oral exam testing
key points, felt to be essential by the leaders in urology, to maintain high practice standards.
There are only a handful of urologic micro surgeons who are a member in good standing of the
Society of Reproductive Surgeons. This elite specialty society requires letters of
recommendation from established and respected specialists. In addition, acceptance
requires a detailed review of an 18-month surgical log of fertility related cases (vasectomy
reversals) and their outcomes. When you ask around, most offices will tell you that their
doctor is a member of all societies…but only a few are members of the Society of
Reproductive Surgeons.
Each multi-layer vasectomy reversal should be done with only the most advanced and
proven technique (and most difficult to perform) - the formal multi-layer (Microdot)
microsurgical closure, using the tiniest 10-0 or 11-0 Nylon sutures. This technique provides
the most accurate and natural repositioning of the two cut edges of the tube (lumen) where
the sperm must pass. This technique offers the best chances for success with the least risk
for scarring or leakage. Many doctors still use older, less effective techniques with more
sutures or thicker sutures (lower numbers), which can dramatically reduce success rates.
Your microsurgeon should personally perform the entire operation, from start to finish.
Ideally there will be no hidden assistants or residents, fellows or medical students in training doing any of the
surgery or learning their skills during your reversal. This ensures that you receive the absolute best
operation, each suture is placed precisely by your microsurgeon, therefore assuring you the best
chances for success.
Many true microsurgical specialists have their own dedicated operating suite, designed and built for
one purpose - microsurgical vasectomy reversals. Some of the elite specialists have even put
together an elaborate assortment of the finest titanium microsurgical instruments, again only for each
doctor's use during reversals. Only a handful of microsurgeons have a dedicated surgical staff to
assist them with every case. This consistency and stability of staff, equipment and supplies
guarantees a smooth, efficient and harmonious operating suite and the best chances for success.
Your microsurgeon should only perform microsurgical vasectomy reversals, using a
state-of-the-art high-power surgical microscope (Leica or Zeiss). This provides the best visualization possible,
necessary for the accurate and precise placement of each suture. Others that use lesser
magnification, as with "loupes" or magnifying glasses, know that studies prove the best successes
are with the use of a high-powered surgical microscope.
It is accepted by true experts that they can achieve the highest success rates using the formal
multi-layer technique. With continual improvements, consistency and outcomes are the best ever
using this refined technique. Through the formal multi-layer using 10-0 or 11-0 suture is more
challenging and time consuming, experts will tell you that it is better operation, providing far better
results than older less precise techniques. Older techniques using stents or larger sutures (lower
numbers, such as 7-0 or 8-0) may work on occasion but have been abandoned by true vasectomy
reversal experts.
Laser Reversals were a great idea back in the late 1980's. Then the world's top
microsurgery researchers investigated and experimented with lasers to see if this would improve the results of a
reversal. Over a decade ago, each researcher independently came to the same conclusion - the
laser caused more injury in critical areas and reduced success of the reversal. They felt that nothing
was better than well placed microsutures by an experienced microsurgeon. Sure, using the laser
could allow the doctor to go faster, but that really wasn't and shouldn't be the goal. This is why
every single leading true expert in vasectomy reversal has abandoned this idea and recommends not
using laser. For more information, please go to the following website:
http://www.laser-vasectomy-reversal.com
Many microsurgeons have used all the anesthetic techniques over the years but believe that their
patients feel better and have a more uneventful recovery when they have mild conscious sedation to
relax them and keep them comfortable during the reversal. There are occasions where general
anesthesia or a deeper sedation is preferred by the patient, but these are relatively infrequent. If you
desire a deeper level of anesthesia, this can be arranged as well. An additional benefit for mild
conscious sedation is the dramatically reduced cost to the patient, not having to pay for an
anesthesiologist to be in attendance and the very expensive medications. Throughout the procedure,
while receiving conscious sedation you can direct the level of relaxation you prefer, with most men
simply falling asleep and remaining asleep throughout the procedure. If you wish, you can choose to watch the procedure on your video monitor. And after the surgery is over, you are ready to go
home or back to the hotel, feeling good (though perhaps a bit woozy).
It is best to have your vasectomy reversal at a center that has established a fixed,
"all-inclusive price" so there are no hidden or unexpected surprises later on. There are stories of men who were
told the facility fee would be about $2,000, only to receive a bill for over $12,000! There are also
some doctors that come out after surgery and surprise their patients with the news that additional
surgery was performed and the patients must now pay an additional hundreds to many thousands of
dollars. Look for a fixed price for a vasectomy reversal which is all-inclusive of consultations and
support before, during and after surgery; all surgery related facility fees, nursing expenses,
surgeon's fees, microsutures, sedation and medications--regardless of whether it is a vas-to-vas (VV) or
vas-to-epididymis (VE) procedure. For those patients that have had a failed vasectomy reversal by
another surgeon, there is often a higher fee due to the generally more complicated nature of a re-do
or re-do, re-do vasectomy reversal.
You should limit your options to reversal centers that have their own state-of-the-art and
high-complexity certified sperm banking facility, where banking and andrology services are
available on-site. With this option, you can secure and preserve sperm obtained at the time of the
reversal. It cannot be a true reversal center unless the microsurgeon has made the commitment to
be able to offer all relevant banking services during your reversal at the same location. Anyone else
is just a “wanna-be.”
Your microsurgeon should commit to perform only one reversal per day. This way, they can take
the time to do their very best, and focus all of their energy and concentration on your vasectomy
reversal without being preoccupied about finishing up and getting on to the next surgery, nor are
they fatigued from earlier cases. After several hours of intense focus performing a microsurgical
reversal, anyone offering two or more reversals in a day cannot honestly perform to the same
degree of concentration as in the first case. There are many experts that believe that anyone that
performs more than one a day may be more interested in the factory/profit mindset that in obtaining
the absolute best outcomes for every single reversal they perform.
It is believed by a small number of truly dedicated microsurgeons that if you are going to trust them
with such an important operation, they want to hear directly from you if you have any questions,
concerns or potential problems. For this reason, their reversal patients are given their personal cell
phone numbers, so they can be reached directly, day or night. There is nothing more frustrating than
to call you doctor with a question and have to talk with residents on call, answering services or
other doctors that don’t know you.
An uneventful microsurgical vasectomy reversal, connecting vas to vas, takes an average of two
and one half to three hours. More complicated reversal can obviously take longer. Be wary of the
one hour reversals or, just as bad, the routine 5 or 6 hour or even 8 to 10 hour (yes 8 to 10 hours!)
reversals.
Your microsurgeon should be a true specialist, focusing his surgical practice on vasectomy
reversals. Be wary of the "expert" who actually is a general urologist that may do an occasional
reversal as well as multiple other types of urologic operations. Studies looking at other technically
challenging surgical specialists such as heart and brain surgeons clearly demonstrate that the true
experts achieve far better successes than the 'jack-of-all-trades', and with much lower complication
rates.
Your microsurgeon should be focused on one thing - reversing vasectomies for the purpose of
return to fertility. Therefore, just as each patient is different, each surgical procedure (and even each
side) is different. When it appears that a vas-to-vas (VV) connection will not allow the passage of
healthy sperm, a well-trained and experienced microsurgeon will locate the best possible spot in the
epididymis to connect the vas (VE). The VE is commonly performed, and depends on how each
patient presents intraoperatively.
A true reversal specialist will have patients from not only their own region but from throughout the
US and internationally. Just having patients travel to a doctor does not mean they are skilled or
competent. If they are skilled, experienced with an international draw, that is usually a good sign.
Only a small number of true microsurgeons have successful reversals on men as far out as 29, 30,
31, 35 and even 42 years from their vasectomy. Success in these situations is possible, when
performed by experienced microsurgeons.
A full-time, experienced and trained andrologist should be part of the team, available to consult
with patients before, during, and after surgery if there are questions relating to semen analysis
results or cryopreservation. The true reversal center will have a working relationship with
pharmacists, anesthesiologists, and even a nutritionist to assist if questions come up before, during
or after your vasectomy reversal.
Yes, true microsurgery experts routinely provide re-do and even re-do, re-do vasectomy reversals
on men from around the world who have had an unsuccessful attempt at reversal elsewhere.
Though more challenging because of scarring from prior attempts, they should have excellent results
with many children from these re-do vasectomy reversals.
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