Vasectomy Reversal red flag!
Vasectomy reversals, like all highly technical surgeries, are not a cookbook, one-size-fits-all procedure. Each person, and in fact each side, has to be individually evaluated for evidence the vas is open and the correct reversal technique performed specific to the findings on that side for that particular patient.
You should be very concerned about anyone that tells you that every patient gets the exact same procedure, no matter what.
Not every heart patient gets the same surgery, nor does every knee reconstruction need the very same procedure. So then why should anyone go to a doctor that can’t and won’t do the right thing and individualize each patient to receive the correct vasectomy reversal technique? Anyone that simply says that “most people will need this therefore this is all I will do” is not being honest with themselves or their patients.
What is the correct way to assess the findings and perform the technique needed? During your vasectomy reversal, the fluid that comes out of the vas is evaluated – we look at and document the color, consistency and volume. Then that fluid is analyzed by our experienced and trained andrology team under a 400 power laboratory microscope to see if there is evidence that the vas is open and there is no deeper blockage. If we see whole sperm or sperm with long tails, then we know that the tubes are in fact open and a vas-to-vas connection is correct. If we see creamy or paste-like fluid with no sperm and only debris or old heads, then that tells us there is deeper blockage in the epididymis and then a more challenging epididymal bypass is the correct technique that should be performed.
This is a key concept we really emphasize every year when we teach the post-graduate course on state-of-the-art vasectomy reversals at the annual American Urologic Association meeting. We reinforce to urologists from all over the world that any doctor that starts a reversal should be skilled and experienced to be able to perform what is best for that patient- not necessarily the technique that is fastest or cheapest or the only one that they know. While a resident at Mayo Clinic, the rule was “don’t start something unless you can finish it correctly.” That common sense rule still applies when performing a vasectomy reversal.