Introduction
Vasoepididymostomy is a surgical procedure done to restore fertility. It is designed to bypass an obstruction in the male genital tract. Vasoepididymostomy is a technically challenging procedure. The method involves anastomosis of the epididymis to the vas deferens to bypass the epididymal obstruction. The epididymal obstruction is often secondary to long-standing vasal obstruction, which causes damage to the epididymal tubule or may be due to epididymal trauma or infection.
What Is the Indication of Vasoepididymostomy?
The purpose may include:
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Restore Fertility: Individuals decide to have biological children after a vasectomy.
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Post-Vasectomy Pain Syndrome: The person experiences long-lasting pain for three months after the vasoepididymostomy. The procedure may be performed to relieve the pain.
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Emotional Changes: When the person starts a new relationship with a new partner and wants to start a family.
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Azoospermia: It refers to the absence of sperm in the ejaculate or epididymal obstruction. The fluid examines epididymal obstruction in the vasal end or epididymal tube.
Is Vasoepididymostomy Commonly Performed?
Vasectomy is one of the most commonly performed procedures in men. Although most individuals undergo preoperative counseling before the procedure, around five to six percent want a vasectomy reversal. The top reasons for reversal are for conception and to relieve post-vasectomy pain. About 7.4 percent of the infertile males who have not undergone a vasectomy procedure have a primary genital tract obstruction. The cause for obstruction may involve:
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Epididymal trauma.
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Infection.
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Congenital hypoplasia of the ductal system.
What Are the Causes of Epididymal Obstruction?
The causes include:
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Vasal obstructions are caused by surgical sterilization (vasectomy) and occasionally involve iatrogenic trauma such as pediatric hernia repair or herniorrhaphies.
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Epididymal obstruction may be congenital, inflammatory, traumatic, or post-vasectomy. Congenital epididymal obstruction can occur in concurrence with vas deferens atresia. It is usually associated with cystic fibrosis genetic mutation. Individuals with normal vas deferens disjunction of the epididymis with the vas deferens can profit from vasoepididymostomy. Inflammatory obstruction is caused due to bacterial epididymitis. Neisseria gonorrhoeae affects the distal epididymis, which helps in a more proximal bypass during vasoepididymostomy. Trauma can be caused by scrotal surgeries such as spermatocelectomy, hydrocelectomy, and testis biopsy. Post-vasectomy obstruction is the most common cause of epididymal obstruction. Post vasectomy, there is a buildup of high intraluminal pressure inside the epididymis, which causes rupture of the epididymal tube leading to obstruction. This is common in individuals who opt for a reversal after ten years or men who have had a failed vasovasostomy.
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Young's syndrome.
History and Physical Examination:
The physician takes a brief medical history, and the decision may be taken on whether to perform the surgery. The medical history and a physical exam may confirm whether the individual is a good candidate for surgery. For example, suppose the individual or the family has a history of hypogonadism (a condition where the body does not produce enough sperm or hormone responsible for growth and development during puberty). In that case, they should inform the physician. The individual is advised to give an accurate history of when the vasectomy was performed and how long it has been since the procedure. The history of any scrotal or penile surgery should be mentioned to the physician. If the individual wants to undergo the procedure to have children, the physician may suggest tests to check for the partner's fertility. Specific factors that depend on whether the surgery has to be performed or not:
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History of bleeding disorders.
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Allergy to local anesthesia or antibiotics.
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Injuries like a hernia on the groin area.
Individuals should inform their physicians about preexisting health conditions, over-the-counter medications, and herbal supplements. For example, certain herbal supplements and anti-inflammatory drugs can cause bleeding. Individuals wanting a reversal procedure usually self-refer for evaluation. Others self-refer due to infertility after unprotected sexual intercourse. A physical examination is done to check for vasal or epididymal obstruction. Individuals with genital tract obstruction have a normal testis greater than 25 mL volume of 4 cm length and consistency. The epididymis feels prominent proximal to the site of obstruction and is flat at the distal portion of the open tubule. The dilatation of the complete epididymis suggests an obstruction at the junction of the epididymis with the vas deferens. The individual is also examined for possible vasal defect, sperm granuloma, and the length of the testicular vasal segment, which may be used for treatment planning. A varicocele is an important finding that impacts an individual's fertility and can be surgically treated during the procedure.
What Happens During Vasoepididymostomy?
Preoperative Details:
A urologist often performs the surgery, and the anesthesiologist discusses anesthesia options beforehand. Vasoepididymostomy is generally performed under general anesthesia, but local anesthesia may be preferred in a few cases. The procedure generally does not require hospital admission and takes up to four hours. Thirty minutes after the surgery, a broad-spectrum antibiotic is administered.
Intraoperative Details:
Vasoepididymostomy provides better results with a microsurgical approach. It is often difficult to determine if the individual may require a vasoepididymostomy or not preoperatively. The surgeon may have to decide whether to perform a vasoepididymostomy or vasovasostomy. A scrotal incision is placed, and the vas deferens are isolated on the medial side of the spermatic cord. It is then mobilized to the proximal area, usually the convoluted tubule. The vas deferens are transected through the spermatic cord, which is positioned next to the epididymis. A microscope is used to check for any epididymal obstruction. If no obstruction is detected, tunica albuginea is incised, and pressure is applied to the epididymal tube. The fluid from the tube is examined for sperm. If sperms are not detected, the procedure is repeated more proximally until sperm is detected. Anastomosis is often performed with an end-to-end technique.
Postoperative Details:
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The individual may be discharged three to four hours after the procedure.
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The individual can resume work after three days of the procedure.
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The person is allowed to shower two days after the procedure.
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Care must be taken not to soak the incisions under water for two weeks as it may lead to premature dissolution of the sutures.
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Individuals should refrain from strenuous exercises for three weeks and nonstrenuous activities for one week.
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Refrain from sexual activities for a month.
Conclusion
Vasoepididymostomy is a surgical procedure to treat any obstruction in the male genitalia. It is a standard procedure and helps to restore fertility. Discussing the options with the physician and spouse helps choose the best option.
