Precise, Expert & Safe Vasectomy Reversals in Austin
Our goal is simple: to help you become a dad again. To give our patients the best chance of success, all of our Vasectomy Reversal Austin, TX patients are personally seen and treated by the award-winning and world-renowned Dr. Parviz Kavoussi or Dr. G. Luke Machen. Dr. Parviz Kavoussi and Dr. G. Luke Machen are the only physicians in Austin and Round Rock with specialty fellowship training in vasectomy reversals and Reproductive Urology. This is the highest level of training that is available for this procedure in order to gain an expertise for the techniques and meticulous tissue handling which allow our patients to benefit from such high success rates. This level of experience is crucial for successful results for this precise microsurgical procedure, as the lumen (opening) in the vas deferens which must be reconnected for a successful vasectomy reversal measures anywhere from 0.4 mm to 0.7 mm in diameter. The diameter of the lumen of the vas deferens is approximately the size of the period at the end of this sentence.
Incidence and reason for vasectomy reversal:
Around half a million men undergo vasectomy every year in the United States, 6% of whom will elect to have their vasectomy reversed. When a vasectomy is performed, the vas deferens, the tube that carries sperm from the testicle to the semen, is divided and obstructed to not allow sperm to reach the semen anymore as a means of contraception. When a man elects to have his fertility restored following a vasectomy, the vasectomy is reversed by reconnecting the two ends of the vas deferens on either side of the blockage that was made during vasectomy.
Traditional microsurgical vasectomy reversal:
Due to the microscopic nature of the connections that need to be made to put the vas deferens back together, a high level of magnification is required for the best results with vasectomy reversals. Microsurgical vasectomy reversal consists of the use of an operative microscope that is positioned above the patient’s body that magnifies the vas deferens and the connection is made under magnification.
Robot Assisted Microsurgical Vasectomy Reversal
Dr. Parviz Kavoussi is also one of the leading experts in the world on the application of Robot Assisted Vasectomy Reversal and has been offering robot assisted microsurgical vasectomy reversals since 2011. Over this time-frame he has become one of the highest volume surgeons in this specialized operation world-wide. He has been specialty credentialed by the robot assisted microsurgical and endoscopic society (RAMSES) to perform robot assisted vasectomy reversals since 2011.
“combining the surgical technique and knowledge of skilled microsurgeon with the precision of a machine”The robotic system consists of the surgeon’s console where the surgeon sits with hand and foot controls and his monitor for visualization, a patient side robotic cart with 4 robotic arms which are manipulated by the surgeon’s controls simultaneously, and a cutting edge magnifying camera unit which provides the surgeon with a sharp 3-dimensional, high-definition visualization. The surgeon controls microsurgical instruments docked above the patient, with hand and foot controls at the console. The potential surgical advantages of robot assistance with vasectomy reversal include: improved stability, surgical instruments that make twists and turns that the human hands and wrists cannot (known as 7 degrees of freedom), excellent surgeon ergonomics which decreases surgeon fatigue with multiple back to back procedures, scalability of motion – allowing the surgeon to move his hand control a certain distance and having the microsurgical instrument move one third of that distance for finer precision, allowing the surgeon to manipulate 3 surgical instruments and the camera simultaneously without having to stop operating, and the potential to decrease operative times.
Dr. Kavoussi, one of the pioneering experts in the use of robotic microsurgery to assist with vasectomy reversal, combines the precision of a machine with the knowledge and technique of a specialty trained Reproductive Urologist with an expertise in microsurgery. As an expert in this procedure, Dr. Kavoussi has written the second ever published scientific article in humans on robot assisted vasectomy reversal in a peer-reviewed medical journal. Click on the link below for access to the article.
Dr. Kavoussi has also published the study assessing the learning curve for microsurgeons becoming proficient at applying the robotic platform to microsurgical vasectomy reversal. Click on the link below for access to the article.
Smith’s Textbook of Endourology is widely considered as the primary text for minimally invasive, high-technology urological surgery. Dr. Kavoussi was invited to author the chapter on the evaluation and preparation of men prior to robot assisted vasectomy reversal, along with the step by step details of the surgical techniques and maneuvers to perform robot assisted vasectomy reversal, in the 4th edition of Smith’s Textbook of Endourology.
Dr. Kavoussi has also contributed a chapter on all aspects of robot assisted vasectomy reversal to the second edition of the textbook, Male Infertility.
Dr. Parviz Kavoussi as written the textbook chapter on surgical, radiographic, and endoscopic anatomy of the male reproductive system in the 11th and 12th editions of Campbell’s Walsh Urology textbook, which is considered the “bible of urology” used for training urology residents as well as the primary reference for practicing urologists. A mastery of this anatomy is paramount to optimize outcomes in men undergoing vasectomy reversal.
As an international leader in robot assisted vasectomy reversal, Dr. Kavoussi has a seat on the executive advisory board of RAMSES to help advance the field and he has served as a national and international invited lecturer/faculty moderator at multiple scientific conferences including: Mid-Atlantic section of the American Urological Association meeting, the Society of Laparoendoscopic Surgeons meeting, Robot Assisted Microsurgical and Endoscopic Society meeting, and the World Congress of Urology meeting; amongst others. He has also been appointed as member of St David’s South Austin Medical Center robotic surgery steering committee since 2013.
Click on the following links for information on his presentations on robot assisted vasectomy reversal:
Robotic Vasectomy Reversal: Father’s Day
Robotic Reversal Lecture in the Netherlands:
Robotic microsurgical instruments being used to sew on a model of vasectomy reversal:
Dr. Kavoussi lectures on the advantages of robotic vasectomy reversal in Geneva, Switzerland:
Dr Kavoussi lecture on robotic vasectomy reversal at the RAMSES meeting:
St David’s Robotic Assisted Vasectomy Reversal:
Robotic Vasectomy Reversal :
Anesthesia for vasectomy reversal:
Vasectomy reversal is optimally performed under general anesthesia with the patient asleep. This is not because a vasectomy reversal is such a big operation per se, as it is to ensure that the patient does not move during this very fine, microsurgical procedure to give the best chance at success while the vas deferens is being reconnected with suture which is smaller in diameter than a human eyelash.
Regardless of whether patients choose to reverse vasectomy by way of the microsurgical technique or with robotic microsurgical assistance, both vasa deferentia are reconnected through one small incision in the scrotum. Dr. Kavoussi and Dr. Machen typically makes this incision no larger than one of the incisions made for the original vasectomy and the scar in the skin from the incision heals so well that it is typically difficult to see one month following the vasectomy reversal. This also allows for a recovery with minimal discomfort.
Vasovasostomy versus Vasoepididymostomy:
A vasovasostomy is the more simple type of vasectomy reversal where one end of the vas deferens is reconnected to the other end after excluding the portion that was blocked by the vasectomy. A vasoepididymostomy is the more complex repair, which is more commonly required in men who are seeking a vasectomy reversal 15 years or greater since the time of vasectomy. This is a much more complex microsurgical reconstruction where the upper (abdominal) end of the vas deferens has to be connected to a microscopic tubule from the epididymis. The epididymis is the structure which is made up of a tubular network located between the testicle and the vas deferens, where sperm travel through to learn how to swim and mature before reaching the vas deferens. This becomes a much higher complexity of microsurgical reconstruction because the opening made in the epididymal tubule for the connection to be made is approximately 1/10th of the size of the period at the end of this sentence. Also, a vasoepididymostomy requires a connection of a very small opening to a much smaller opening making the connection more technically challenging with these uneven sized openings. As it cannot be predicted preoperatively for certain, which patients will require which repair, and this decision is based on a number of findings at the time of surgery; it is recommended that vasectomy reversals are only performed by Reproductive Urologists with a high level of microsurgical skill and training to allow for optimal success rates, regardless of whether the findings during surgery dictate that a vasovasostomy should be performed or a vasoepididymostomy should be performed. At ACVVR there is no additional fee if it is deemed necessary to perform a vasoepididymostomy. Nearly all vasectomies are reversible. Very rarely a vasectomy cannot be reversed because a very long length of the vas deferens was removed at the time of vasectomy or due to the extent of scarring. This is extremely uncommon but possible.
The majority of our patients who reverse vasectomies report that the recovery from their procedure is very similar to that of the original vasectomy, with some soreness, swelling, and bruising which is typically very well tolerated. Oral narcotic pain medicine will be available in case it is needed after vasectomy reversal. Many patients just use Tylenol. The majority of our patients are back to typical activities of daily living 1 week following vasectomy reversal and it is recommended to refrain from heavy lifting, exercise, or strenuous activity for 2 weeks following vasectomy reversal. It is important to abstain from sexual activity and ejaculation for 3 weeks following vasectomy reversal.
Dr. Kavoussi’s and Dr. Machen’s vasectomy reversal success rates:
Vasectomy reversal success rates are highly surgeon dependent and are stratified by the timeframe since vasectomy. The man’s age does not typically play a role in success rates. A successful vasectomy reversal is considered one which results in a patent vas deferens, which is proven by having return of motile sperm to the semen on a semen analysis, indicating that the connections are open allowing sperm to pass through them. These are Dr. Kavoussi’s and Dr. Machen’s personal success rates and include men who underwent vasovasostomy, vasoepididymostomy, first time vasectomy reversals, and redo operations who failed vasectomy reversal under the care of other surgeons.
|Time Since Vasectomy||1-8 years||9-14 years||≥15 years|
Redo operations tend to be more challenging as the first attempt is the best opportunity for success with a vasectomy reversal, so it is important to know your surgeons personal success rates and level of specialty training.
Prior to vasectomy reversal:
Do not eat or drink anything after midnight the night prior to your procedure. You will need to have a driver bring you to and from the procedure. Due to anesthesia, you will not be allowed to drive after the vasectomy reversal. Wear loose fitting comfortable clothing the day of the procedure.
Following the vasectomy reversal:
For the first 2 days following the procedure, using an ice pack at 20 minute intervals will help minimize swelling and discomfort.
You may shower the day after the vasectomy reversal, but do not submerge in water such as baths or pools.
You will be sent home wearing snug fitting undershorts that will be placed on you immediately following the vasectomy reversal. These can be removed to shower the morning after the procedure. It is recommended to wear snug fitting underwear such as briefs or boxer-briefs for the 2 weeks following vasectomy reversal. You may wear looser underwear after that.
Although you may shower the day after the vasectomy reversal, you will be instructed to not submerge in water such as pools or tubs for 4 weeks following the procedure.
Do not do any heavy lifting, strenuous activity, or exercise for 2 weeks following the procedure.
It is very important to abstain from sexual activity or ejaculation for 3 weeks following the vasectomy reversal.
You will have a prescription for a narcotic pain medicine available for after the procedure in case it is needed. Some patients need to use it, others do not. If you do use it, you should not drive, operate heavy machinery or consume alcohol while using this pain medicine. Most of Dr. Kavoussi’s patients equate their level of discomfort in the post-vasectomy reversal period to that of the recovery period after the original vasectomy.
Post-vasectomy reversal semen analysis:
You will be scheduled for a semen analysis 6 weeks following the vasectomy reversal and the results will be reviewed with you. Statistically, it may take up to 6 months to see the return of sperm to the semen on semen analysis, however, the majority of Dr. Kavoussi’s patients have return of sperm to the semen at the 6 week semen analysis.
Time to pregnancy:
The average time to pregnancy following vasectomy reversal is 1 year, however, we see many couples achieve a pregnancy much sooner than 1 year, some as early as 5 weeks after vasectomy reversal, and it may occasional take longer than a year, or require further assistance depending on other fertility factors. Dr. Kavoussi and Dr. Machen will continue to guide the couple over time after the vasectomy reversal. As a division of Austin Fertility & Reproductive Medicine, Austin Center for Vasectomy and Vasectomy Reversal can initiate care for the couple in a comprehensive manner. The female partner will be offered the opportunity to be evaluated by our Reproductive Endocrinologist, Dr. Shahryar Kavoussi, prior to vasectomy reversal and to explore all options if the couple chooses to do so. If the couple is not achieving a pregnancy after a successful vasectomy reversal, the female partner may be evaluated and consider levels of assistance to help with conception when indicated. An advantage at our center is the ability to evaluate and treat the male and female partners to help the couple reach the ultimate goal of becoming parents.
An additional advantage of being a division of Austin Fertility & Reproductive Medicine, includes the potential of having a sperm retrieval performed at the time of vasectomy reversal. This may be a useful consideration for men who elect to undergo vasectomy reversal 15 years or longer from the time of vasectomy, or for those who are undergoing redo vasectomy reversals who have failed with prior attempts by other surgeons. Because these tend to be more challenging cases with lower success rates, as indicated above, sperm retrieval at the time of vasectomy reversal with cryopreservation of sperm at Westlake IVF can prevent the man from requiring a second, separate procedure, should his reversal fail and the couple require assisted reproductive techniques (ART) such as in vitro fertilization (IVF). The embryologists from Austin Fertility & Reproductive Medicine/Westlake IVF will accompany Dr. Kavoussi and Dr. Machen to the operating room for such cases to evaluate and cryopreserve the retrieved sperm.
Testosterone and Vasectomy Reversal:
A large number of men in the United States are diagnosed with low testosterone or hypogonadism and are treated with testosterone replacement therapy. Although this is an effective treatment for low testosterone, it suppresses sperm production and a vasectomy reversal should not be performed while a man is on testosterone replacement therapy. For men on testosterone who are interested in proceeding with vasectomy reversal, testosterone replacement has to be stopped and Dr. Kavoussi or Dr. Machen will treat these men with other medications that can stimulate the body to produce testosterone in a way that will not suppress sperm production. A man needs to remain off of testosterone and on one of these medications for at least 3 months prior to having his vasectomy reversed. Dr. Kavoussi is an expert at the use of such medications and has put together a textbook on such treatments for which he is the editor-in-chief.
To learn more about medical therapy options for low testosterone when considering vasectomy reversal click on the following links:
As a renowned expert in vasectomy reversal, Dr. Kavoussi has published multiple scientific articles on vasectomy reversal including one reviewing the evaluation, techniques, and outcomes of vasectomy reversal in a peer-reviewed medical journal. Click on the link below for access to the article.
He has also published an article evaluating the ability to predict whether a man would require a simple vasovasostomy or a more complex vasoepididymostomy prior to surgery. Based on this study, there was no way to predict which operation would be required before surgery indicating that all vasectomy reversals should be performed by specialty trained Reproductive Urologists who are well versed in the more complex vasoepipdidymostomy for the best patient outcomes, as the need for this level of technical skill cannot be predicted preoperatively. Click on the link below for access to the article.
He has also written the chapter on male infertility, including the section on vasectomy reversal, in the textbook of Reproductive Endocrinology & Infertility: Handbook for Clinicians 2nd edition.
With his expertise in the male reproductive system, Dr. Kavoussi was honored to write the chapter on Surgical, radiographic, and endoscopic anatomy of the male reproductive system in the 11th edition of Campbell-Walsh Urology. This is universally considered the premier urological textbook world-wide and is known as “the bible” of urology. An in-depth knowledge of this anatomy is mandatory to perform vasectomy reversals at the highest level.
Interested in a Vasectomy Reversal? Trust this delicate, precise procedure to Austin’s only Fellowship-trained, highly credentialed Vasectomy Reversal Surgeon. Call (512) 444-1414 for a personal appointment in either of our two world-class Austin clinics or contact us online.