In-office procedure with local anesthesia - prophylactic abx not necessary; can take a Valium 1 hr beforehand 

Divide vas, mucosal cautery of cut ends

Vasectomy post-op:

• Avoid ejaculation x 1 week
• Not considered sterile until sperm testing (at 10-12 weeks = 15-20 ejaculations) - use secondary contraception until then.
• 80% are azoospermic, 20% nonmotile at 12 wks
• Failure if motile sperm after 6 mo; failure rate < 1%
• Still 1/2000 risk of pregnancy with azoospermia
• Complications: scrotal hematoma, infection, spermatocele, scrotal pain (< 5%)
• "We discussed that vasectomy is considered to be a permanent, irreversible form of birth control. Even though the vasectomy reversal exists, it is not 100% successful. He confirmed that he never will want to have children again.
• We reviewed the procedure in detail. We discussed the risks of bleeding, post procedural hematoma, injury to surrounding structures including the testicular artery, infection, risk of permanent scrotal pain in 1-2% of patients, chance that we cannot complete the vasectomy in the office due to his anatomy, and risk of failure of sterilization. We discussed no sexual intercourse or masturbation for 2 weeks afterwards. He will not be considered until he provides two semen analyses 2-3 months after vasectomy showing the presence of no sperm.
• The patient understands the above risks and desires to proceed with vasectomy. California sterilization consent form was signed. Will schedule in 30-180 days."

Vasectomy reversal:

• Consider sperm retrieval & cryopreservation during reversal - drain fluid from proximal vas
• Vasovasostomy (VV) - if sperm present or fluid is copious, watery and clear
• Sperm do not have to be motile; sperm heads are OK as well
• Granuloma is good sign - 'pop-off valve' for sperm production
• 1-layer VV has shorter operative time and same vas patency rates as 2-layer approach
• Otherwise epididymal obstruction may be present (increased with length of time from vasectomy) - perfrom vasoepididymostomy (VE)
• Dissect out an epididymal tubule and then do end to side anastomosis, and intussuscept tubule into the vas
• 65% success rate after VE (sperm in ejaculate)

After reversal

• Avoid ejaculation x 3w
• Takes 6-12 mo for motile sperm to appear in ejaculate (18-24 for bilateral VE)
• Semen analysis at 6-8 wks post-op, then q2-3 mo until stable
• Can repeat reconstruction if azoospermia persists

**hide**Success rates after primary vasovasostomy (VV)