Choosing VV or VE?
How doctor’s decide on whether to perform a vas-to-vas (VV) or vas-to-epididymal (VE) bypass and why that is so important.
This is the most critical decision your surgeon must make and sadly the one most commonly ignored.
Open or blocked? The big question is whether or not the tubes are open or if there is deeper epididymal blockage. During the reversal, when we cut across the vas below the scar, we analyze a tiny drop of fluid from the vas and look at this under a lab microscope. If we see sperm or sperm parts in the vasal fluid, then we know that the “system” is open all the way from the vas to the testicle and so a straightforward vas-to-vas connection is the correct connection.
If we see thick toothpaste-like fluid with no sperm or sperm parts, then this tells us that there is a deeper obstruction in the epididymis which is blocking the flow of sperm. When we see this a vas-to-vas connection (that so many doctors would still do) has a zero percent chance of working. When there is no sperm the right procedure is to perform the more challenging vas-to-epididymal connection to bypass the blockage (VE) to restore the flow of sperm.
The right way. When we teach classes on how to perform reversals or we write textbook chapters and the certification courses, it is very clear that true experts agree that it is totally unacceptable and not in the patient’s best interest for doctors to perform reversals and
1. Not analyze the fluid microscopically (they then are just guessing what technique to do) and
2. Not be able or willing to perform the epididymal bypass (VE) when needed.
Number of years. Knowing that men as soon as 2 to 3 years from vasectomy may need a bypass, and up to 1/3 of men will need a bypass on at least one side at 8 to 10 years out from vasectomy, why would a doctor arbitrarily decide to not perform the bypass and only perform a vas-to-vas connection?
What is even more upsetting is why won’t reversal doctors even look at the fluid under the microscope. If they don’t know there are no sperm (and so there is deeper blockage), then they can justify that it is okay to do the wrong vas-to-vas procedure.
Here at ICVR, we have a proven, published success of 99.5% for a vas-to-vas connection and a 70 to 90% success for our vas-to-epididymal bypass. So, our worst case scenario is still better than most doctor’s best case scenario. Another smart reason to consider ICVR for your care.
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