Vasovasostomy: Surgical Reversal of Vasectomy

What Is Vasovasostomy?

Vasovasostomy is the microsurgical reconnection of the vas deferens—the tube that transports sperm from the epididymis to the ejaculatory ducts. It is the standard procedure for reversing a prior vasectomy, restoring the pathway for sperm to appear in the ejaculate and enabling natural conception.

Procedure Overview

• Performed under general or regional anesthesia, typically as an outpatient surgery.
• Operating microscope or high-magnification loupes are used for precise mucosal approximation.
• The obstructed ends of the vas are trimmed, and patency is confirmed by expressing fluid from the testicular end; fluid quality guides the decision between vasovasostomy and vasoepididymostomy.
• Multiple-layer microsutures (9-0 or 10-0 nylon) approximate the mucosa and muscularis.

Success Factors

• Time since vasectomy: Patency rates exceed 90% if ≤10 years; decline with longer intervals.
• Surgeon experience: Microsurgical expertise significantly improves outcomes.
• Female partner age and fertility: Overall pregnancy rates depend on both partners.

Recovery

Most men resume light activity in 2–3 days; strenuous activity and sexual intercourse are avoided for 2–3 weeks. Semen analysis at 3 months confirms sperm return.