18 giugno 2008

Vasectomy Reversal

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MMHC's National Vasectomy Reversal Center is located in Minnesota and primarily serves the midwest region including Minnesota, Wisconsin, Iowa, North Dakota, South Dakota, Illinois, Indiana, Michigan, Ohio, Missouri, Kansas and Nebraska. However, Dr. Schow is nationally recognized as an expert in microsurgical vasectomy reversal, and patients come from all across the nation to have Dr. Schow perform their vasectomy reversal. Some of the states that patients have come from include Alaska, Arizona, California, Colorado, Florida, North Carolina, Nevada, New York, Pennsylvania, Tennessee, Texas and Hawaii. Dr. Schow has also had international clients including patients from Australia, Canada, Japan and Mexico.

Dr. Schow's success rate for restoring more than 1 million sperm to the ejaculate is 97% based on data from the last 700 vasectomy reversals performed at MMHC's National Vasectomy Reversal Center. Dr. Schow performs 6 - 8 vasectomy reversals per week.

What is Vasectomy?

A vasectomy is a surgical procedure that blocks the vas deferens thus preventing sperm from flowing to the prostate. Obstruction of the vas is usually accomplished by removing a small segment of the vas deferens and placing a suture or small metal clip on the end of the vas.

Vasectomy Reversal

A vasectomy reversal is a surgical procedure that re-approximates the cut ends of the vas deferens, restoring the flow of sperm from the testicle to the prostate. This procedure generally requires an experienced microsurgeon using an operating microscope to achieve the best success rates. A vasectomy reversal can be accomplished in two ways: a vasovasostomy or vasoepididymostomy.

A vasovasostomy, is the most common way to re-approximate the cut ends of the vas deferens. The ends of the vas are sewn together using sutures that are finer than human hair. For some men, 20 - 30%, scarring in the epididymis after vasectomy prevents sperm from getting to the vas deferens. In this setting, reconnecting the two ends of the vas will not be adequate to restore fertility. A vasoepididymostomy, Figure 3b, is then performed to bypass the blockage in the epididymis.

Success Rates

Without the use of microsurgical techniques, vasectomy reversal is successful in only 40 - 50% of cases. Success is defined as the presence of sperm in the ejaculate. The use of microsurgical techniques allows for more precise approximation of the ends of the vas deferens and results in higher success rates.

As the next section discusses, the time from the vasectomy does play a role in the overall success of vasectomy reversals. The more years that have passed since the vasectomy was performed the higher the chance that a vasoepididymostomy will need to be performed, thus decreasing the chance of success. However, most patients do not require vasoepididymostomies no matter how long out the vasectomy has been. Vasectomies that are 30 years old have been successfully reversed.

Dr. Schow’s personal statistics for patency rates (defined as more than one million sperm in the ejaculate) after vasectomy reversals based on review of the last 700 patients are:

97% if Dr. Schow performs a bilateral vasovasostomy

93% for all patients including redo procedures and patients up to 33 years from the vasectomy

Fifty percent of the patients in this group achieved a pregnancy within one year of the vasectomy reversal, some as soon as one month from the surgery. Dr. Schow performs about 6 - 8 vasectomy reversals per week.

Vasectomy Reversal