Kontakt
Praxis für UrologieDr. med. Aref El-Seweifi
Forum Zehlendorf
Teltower Dam 35
D-14169 Berlin
Deutschland
Tel.: +49 30 804 90 950
Fax: +49 30 804 90 951
info@masculine.de
| Vasoepidedymostomy |
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The introduction of microsurgery in urology gave the opportunity for performing the reversal or re canalization of the vas or epidedymis to restore fertility. This requires an operation microscope, microsurgical instruments and sutures and surgical skills. The vas is the connection route between the urethra and the epidedymis. It is the route for sperms to ascend to the seminal vesicles. It is also the descending route for bacteria which produce infection and which can develop inflammation of the epidedymis (Epidedymitis). The epidedymis is the looped string arising from the testicle and uniting into the vas. The canalization is undertaken due to a born obstruction of the structure or obstruction resulting after surgery or trauma while the re canalization was performed in very rare cases after sterilization (vasectomy).
Who qualifies for the operation? Patients who have an obstruction of the vas very near to the epidedymis, i.e. the vas is closed very near to the epidedymis. How does the operation work? The patient lies on his back under general or local anesthesia. The vas is palpated and exposed through an incision done in the scrotum. The vas, the vessels of the testis and the testicles are delivered outside. The vas is explored if the sterility is a primary one. It is pulled as a loop and punctured with a very fine needle while saline is injected into it to insure its patency distally i.e. on the abdominal side. If there is any resistance to the injection of the saline, then a dye is injected under x-ray monitoring to define the obstructed area. This area is then exposed and prepared free if it is under the level of the pelvic bones (most distant part possible to reach). The obstructed area is transversely cut and sliced on both sides until the lumen of the vas is found. The lumen is inspected for the anastmosis. The epidedymis is usually dilated due to the distention of its tubules (canals). A sample of the semen is aspirated from the dilated area of the epidedymis using a special needle. This sample is examined under the microscope for the quality of the sperms. A window is opened in the membranes covering the epidedymis and one of its loops is carefully pulled out under 400 magnification. The loop is opened by the microscisor. The end of the vas and the epidedymis are held together with a special retractor and put on a clear background. The reunion is done to the lining membrane (mucosa) using a surgical microscope and microsurgical instruments. A special suture material is used to prevent any reaction inside the tissues or lumen. A second layer of stitches is added to the muscles the outer layer of the vas and the capsule of the epidedymis. The area of anastmosis is then fixed with two stitches to the surrounding tissues to immobilize it. The structures are returned to the scrotum. The wound is closed in layers. The operation is repeated on the other side if necessary and bandages are put on the wound. Healing: The vas and epidedymis heal within 4 days. The complete healing of the wound requires 10 days. Please go through healing on the page concerning the preparation of the patient. How to prepare for the operation? All you need to do is to follow the instructions on preparation for the operation. It is important to shave your genital area before the day of surgery. Frequently asked questions (FAQ): --
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