Vasectomy Reversals Under Local Anesthesia with Oral Sedation

In-Office Surgery Suite Micro Vasectomy Reversal: What to Expect?

The day before your procedure, you should carefully remove the hair from your scrotum up to the level of the bottom of the pubic bone on both sides of the penis and from the underside of your penis. The night prior to the procedure, you should not eat or drink after midnight. Take one valium pill to help you get to sleep just before bedtime.

On the day of the procedure, take one valium pill, one antibiotic pill, one Celebrex (non-blood thinning anti-inflammatory), and one non-narcotic Tramadol pain pill with a sip of water two hours prior to the procedure. You should shower before arriving at our office, wearing snug jockey style underwear and loose outer pants, socks with your shoes, and a long sleeve shirt.

You should arrive at the office 30 minutes prior to your scheduled surgery time. Please bring the one remaining valium pill with you, so if needed, you can take it as well. Also, please bring your phone or music device and ear pods so that you can listen to the distractions of your choice during the case.

You will then be greeted by our staff and will be told to sign the appropriate consent forms and then be greeted by Dr. Buch. Make sure to use the restroom one more time and then walk back to the surgery suite and lie down on the table.

Dr. Buch will then block sensation for the first side with a single non-burning painless injection of local anesthetic just above the left side testicle. Within 10 minutes, all sensation to the testicle and vas deferens is blocked for the next 10 to 12 hours. You will then be washed with an antiseptic solution, and the scrotum will be draped with sterile drapes that cover your feet and legs as well as over your chest and arms up to your neck.

A sticky grounding pad for the electric cautery used to control any minor ooze of blood during the case will be applied to your buttocks just prior to draping. Once you are draped, Dr. Buch will inject the scrotum skin in a vertical line overlying the left side testicle and vasectomy site with local anesthesia that does not burn or sting. A one-inch incision is then made to access the vas deferens for the microsurgical reconnection, and dissection is carried out to carefully expose the previous vasectomy. More local anesthesia is placed during the case to make sure you are entirely pain-free.

In the course of dissection, the vas deferens will be sharply cut on both sides of the prior vasectomy, and the fluid coming from the vas deferens will be examined for the presence or absence of sperm. Only when we find fully formed sperm with complete head and tail will the straight-forward reversal called vasovasostomy (VV) be performed. If there are only partial sperm or just fluid with no sperm parts seen, this indicates a secondary blockage of the epididymis duct closer to the origin of the sperm from the testicle. Then Dr. Buch will find the proper location in the epididymis where sperm will be documented before performing a bypass to the abdominal side of the vasectomy with a bypass procedure called epididymovasostomy (EV). In both cases, the abdominal end of the vas deferens is irrigated with fluid to assure and open a pathway for sperm to return to your ejaculation. Regardless of the type of reversal, you will feel no pain.

When the procedure is complete, the skin is closed with dissolvable sutures, so there are no sutures or drains to be removed. When the left side has been completed, the same process will be followed on the right-hand side. Each side takes approximately 90 minutes and about 15 minutes longer if an EV is required.

When we are finished, you will be able to carefully get up from the procedure table and walk, but we will wheel you in a wheelchair back to your driver and vehicle as a precaution. We will also have placed a light gauze pad over the incisions and two small ice packs inside your underwear.

The local anesthetic will keep you pain-free for another 8 to 10 hours, and even when it wears off, you will likely need only one or two doses of the Tramadol in addition to the use of ice packs while awake for the first few days to remain comfortable and to hold down swelling. Dr. Buch will call you on your cell phone that evening to check in and to answer any questions you may have. More complete post-operative instructions are contained in our post-op instruction sheet.