When Dr. Werthman performs a vasectomy reversal, he begins at the site of the original vasectomy, making a tiny incision and removing the blockage. Next, he takes a drop of fluid from the bottom end of the vas and examines it under a microscope.
This is a crucial part of the operation because the information obtained is used to decide which type of microsurgical reconstruction needs to be performed.
Since the testicle continues to produce sperm after a vasectomy, the fluid in the vas should contain sperm. If, instead, the fluid is thick, pasty and contains no sperm, it usually means that a “blow out” or rupture has occurred in the epididymis, the organ where the sperm are stored.
The epididymis is a single-cell layered tubule that if uncoiled is approximately 14 feet long. It is coiled into four inches worth of space. Sperm leak out of the epididymis if the pressure in the tubule becomes greater than the resistance in the wall of the tubule, similar to the way a pipe breaks in the basement when the water pressure gets too high.
When the tubule “blows out” from the pressure, the body tries to heal the tubule and a scar forms. This causes a second blockage in the epididymis. If this second blockage is present and is not recognized then the operation is doomed to failure.
Fortunately, Dr. Werthman and his team at the Center for Male Reproductive Medicine in Los Angeles are fully prepared to handle this potential occurrence. If there is a second blockage in the epididymis, Dr. Werthman will bypass that blockage by creating a direct connection between the vas and the tiny and fragile epididymal tubule. This is called a vasoepididymostomy.
Dr. Werthman Invented the Mini-Incision Microsurgical Vasoepididymostomy
When a vasoepididymostomy is called for, Dr. Werthman will need to access and examine the epididymis, open a tubule and check the fluid for the presence of sperm. If sperm are found in the epididymal tubule then we know we are at a spot that is upstream from the second blockage. Dr. Werthman will then need to bring the open end of the vas to meet the epididymis, and sew it to the open epididymal tubule.
Most surgeons make a large opening in the scrotum and remove the testicle and epididymis from the scrotum to gain access to the epididymis and vas.
Dr. Werthman, however, has developed the Mini-incision Microsurgical Vasoepididymostomy, which is performed through a very tiny skin incision. He has pioneered a way of accessing both the vas and epididymis without having to open up the entire scrotum.
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