Masculine

Kontakt

Praxis für Urologie
Dr. 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

Vasovasostomy

The introduction of microsurgery in urology gave the opportunity for performing the reversal or re canalization of the vas in order to restore fertility through vasovasostomy. 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 the sperms to ascend to the seminal vesicles. It is also the descending route for bacteria which produce infection and which can develop into inflammation of the epidedymis (Epidedymitis).

Patients who are in need of vasovasostomy are those who have primary infertility i.e. unable to have children from the start and an operative exploration has reveals the presence of vas obstruction. Patients who have undergone vasectomy for sterilization are also candidates for the operation.

The patient lies on his back under general 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.

In case of vasovasostomy after vasectomy, both ends of the vas will be prepared and sliced until the lumen is reached and similarly inspected. If there is a discrepancy in the lumen, then modulation is done. A sample of the semen is taken from the side of the vas connected to the testicle and examined under the microscope to assess its quality. From then one the operation is performed in a similar manner for both indications.

The ends of the vas 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 around the lumen and the outer layer is closed similarly under the microscope. 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.