VV or VE?

How doctor’s decide on 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.

The big question is whether or not the system is 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 and look at this under a lab microscope. When we see sperm or sperm parts in the vasal fluid we know that the “system” is open all the way back from the vas to the testicle and so it is appropriate to perform a straightforward vas-to-vas 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 and so a vas-to-vas connection, that so many would still do, has a zero chance of working. When we see no sperm we perform the more challenging vas-to-epididymal bypass (VE).

When we teach classes on how to perform reversals to other reversal doctors and we write textbook chapters and the certification courses, it is very clear that it is totally unacceptable and not in the patients best interest for doctors to perform reversals and

1. not analyze the fluid microscopically and
2. not be able to perform the epididymal bypass when indicated.

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, why would a doctor not perform the bypass if needed? Some even proudly announce that they only perform a vas-to-vas connection.

What is even more upsetting is that though many reversal doctors won’t even look at the fluid under the microscope. If they don’t know there are no sperm and so deeper blockage, then they can justify in their minds that it is okay to do the wrong vs-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.

Call and have your questions answered, 888-722-2929 or info@dadsagain.com
We can also set up a no-charge consultation with one of our two doctors, by phone, Skype, FaceTime or in office.