In some men seeking vasectomy reversal, a more complex type of microsurgery, called a vasoepididymostomy, may be required. This is found to be the case more often in men who underwent vasectomy 15 years or longer prior to desired vasectomy reversal, due to pressure backup over longer periods of time, causing scarring inside of the tube carrying sperm, so a connection between vas deferens and vas deferens on either side of the vasectomy defect may not be possible in a way that would allow for a successful vasectomy reversal. In these circumstances, the abdominal vas deferens (the segment of vas deferens above the vasectomy defect) is connected to a microscopic tubule in the epididymis (a comma shaped structure attached to the testicle where sperm from the testicle pass through and learn to swim and mature on their way out to the vas deferens).
Vasoepididymostomy is a much higher complexity reconstruction than a standard vasovasostomy (connecting vas deferens to vas deferens after excluding the blocked portion from the vasectomy). This is a much more challenging microsurgery because the opening in the epididymal tubule that has to be connected to the abdominal end of the vas deferens is approximately 1/10th of the diameter than the opening in the vas deferens which itself is only between 0.2-0.7 mm in diameter. It also requires connecting two openings of very different sizes. Therefore, a much higher level of microsurgical expertise is required for optimal outcomes. As Dr. Kavoussi has published, the need for vasoepididymostomy cannot be accurately predicted for an individual patient preoperatively, and is an intraoperative decision that is made by the surgeon at the time of reconstruction. (To read more on this click on https://www.ncbi.nlm.nih.gov/pubmed/18835603) This is why it is important to have vasectomy reversals performed by Reproductive Urologists with specialty fellowship training in this operation, as vasoepididymostomy is not going to be as successful in the hands of those who are not specialty microsurgically trained and do not perform them frequently. (http://e269u1zrecj2j3dec135qeme.wpengine.netdna-cdn.com/wp-content/uploads/2014/05/www.sciencecodex.com_.pdf)
In many centers, there is a higher fee charged to the patient if vasoepididymostomy is ultimately performed due the increased difficulty of the procedure and the longer operative time. At Austin Center for Vasectomy and Vasectomy Reversal, there is no additional fee if vasoepididymostomy is required rather than vasovasostomy.