Selasa, 29 Juli 2008

Vasectomy reversal

The surgery is more difficult than the original vasectomy because the tube that carries sperm from each testicle to your
semen (vas deferens) must be sewn back together or attached to the epididymis. The surgery usually is done on an outpatient
basis — without an overnight stay at the surgery center or hospital. Doctors can perform this surgery in one of two ways:
Vasovasostomy (vas-o-va-ZOS-tah-me). With this procedure, the surgeon sews the severed ends of the vas deferens back
together. However, sometimes this isn't possible and a more complex surgery is needed to restore the flow of sperm. Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tah-me). This surgery attaches the vas deferens directly to the epididymis, the
coiled tube on the back of each testicle where sperm matures. A vasectomy can cause blockages or a break in the vas deferens
or the epididymis. This surgery is used when a vasovasostomy won't work because sperm flow is blocked. The vas deferens is
connected to the epididymis above the point of blockage. You probably won't know ahead of time which technique is needed. The surgeon will make the decision during the operation. You
may need a combination of the two surgical techniques — a vasovasostomy on one side and a vasoepididymostomy on the other.
What can you expect during the procedure?You may have general anesthesia to make you unconscious during the surgery. Or, your surgeon may use an epidural, spinal or
local anesthetic. In any case, your anesthesia will need to keep you completely still because the surgery is so delicate.
It's done using a microscope that magnifies the surgery area five to 20 times, and any movements are magnified by the
operating microscope.
The surgeon will make a cut on the underside of your scrotum, expose the testicle, and release it from surrounding tissues.
Next, he or she will cut open the vas deferens and examine the fluid inside.
Fluid assessmentOnce the vas deferens has been opened, the surgeon will do a naked-eye inspection of the fluid that comes out as well as
examine a drop of the fluid under a microscope. This is an important part of the operation because it helps your doctor
determine what type of surgery you need to restore the flow of sperm.
If the fluid contains sperm and plenty of clear fluid, surgery to reconnect the ends of the vas deferens — a vasovasostomy —
is likely to work. Fluid below the vasectomy site that is thick or pasty, or that contains no sperm or partial sperm, can be a sign that there
is scar tissue blocking the flow of sperm. In this case, attaching the vas deferens directly to the epididymis — a
vasoepididymostomy — may be the best option. Freezing spermIf your doctor finds sperm during the surgery, you may choose to have some frozen in case your vasectomy reversal doesn't
work. If after vasectomy reversal you're not able to father a child through sexual intercourse, your frozen sperm may be
injected directly into an egg. This is a type of in vitro fertilization called intracytoplasmic sperm injection (ICSI).
After surgeryImmediately after surgery, your doctor may cover the incisions with bandages. You'll put on your jockstrap to hold any
bandages in place and apply some pressure to reduce swelling and movement. You'll need to rest with an ice pack placed on
your scrotum to reduce swelling. As the anesthetic wears off, you may have some pain and cramping that can be relieved with
acetaminophen. For most men, the pain isn't severe and gets better after a few days to a week.
After you return home, take it easy. You may be sore for several days, which you can treat with acetaminophen or, if your
doctor prescribes it, acetaminophen plus codeine. You may also have bruising, but the discoloration should lighten and
disappear after about two weeks. Any stitches should dissolve in seven to 10 days.
For the first two days after surgery, avoid bathing and swimming. Refrain from sports and heavy lifting for at least three weeks. If you have a desk job, you'll probably be able to return to work three days after surgery. If you perform physical labor or
have a job that requires much walking or driving, talk to your doctor about when it's appropriate to resume working. You shouldn't have sexual intercourse or ejaculate for about four weeks. At that point, you may resume sexual activity. You'll need to wear a jockstrap for several weeks at all times, except when showering. After several weeks, you'll need to
continue to wear a jockstrap during exercise. ResultsIn successful vasovasostomy, sperm usually appear in the semen after a few months. After a vasoepididymostomy, it takes
longer — from three to 15 months. Vasectomy reversal leads to pregnancy in about 52 percent of couples within two years.
While some pregnancies occur within a few months after a vasectomy reversal, the average is about a year after the procedure.
Sometimes problems with conception are due to female infertility. When the female partner doesn't have fertility problems,
couples are more likely to conceive a child after a vasectomy reversal.
Your surgeon will want to examine your semen after surgery to see if the operation was successful. Unless you achieve
pregnancy, a sperm count is the only way to tell if your vasectomy reversal was a success.
If vasectomy reversal doesn't workVasectomy reversals sometimes fail if there is a sperm blockage that wasn't recognized during surgery, or if a blockage
develops sometime after surgery. Some men have a second-attempt vasectomy reversal if the procedure doesn't work the first
Experts are investigating whether anti-sperm antibodies — proteins that develop after a vasectomy — might interfere with
fertility after vasectomy reversal. Research shows anti-sperm antibodies can inhibit the function and movement of sperm, but
experts are still not sure about their effect on fertility after a vasectomy reversal.
RisksRisks of vasectomy reversal include:
Bleeding within the scrotum. This may lead to a collection of blood (hematoma) that causes painful swelling. You can reduce
this risk by avoiding aspirin before and after surgery and following your doctor's instructions to rest after surgery. Infection at the surgery site. This isn't common, but is a risk with any surgery. Inflammation. Sperm leakage into the scrotum can prompt your immune system to form an inflammatory mass called a sperm
granuloma. Granulomas usually occur sometime after surgery and can be a sign that a vasectomy reversal wasn't successful. Damage to nerves and blood vessels. In some cases, this reduces fertility after a vasectomy reversal. Call your doctor if you develop any of these signs and symptoms:
Fever Swelling that worsens or won't go down Difficult urination A marble-sized lump in your scrotum Bleeding from an incision that continues after you've pinched the site between two gauze pads for 10 minutes Looking aheadDifferent surgical techniques can be used to perform vasectomy reversal. Experts are evaluating the outcomes of various
surgical techniques to determine which ones are most successful. While surgeons can apply research about the best techniques
to their own practice right away, other developments are on the horizon that will take longer before they are commonly used:
Experts are investigating the use of new methods to replace stitches, including glue, use of lasers and biological tissue.
They think that once developed, methods other than stitching may decrease surgery time and provide better results.
Researchers are developing robotic instruments for use in vasectomy reversal and other delicate surgeries. Although the
technology is still in the initial stages, robots have the potential to improve surgeons' ability to perform technically
challenging operations. Experts are testing the use of artificial stents to reconstruct the vas deferens during vasectomy reversal surgery. So far,
the stents haven't been tested on humans, but initial studies with rabbits indicate that their use may lessen the possibility
of sperm obstruction after vasectomy reversal.

What are the disadvantages of vasectomy?

The chief advantage of vasectomy--its permanence--is also its chief disadvantage. The procedure itself is simple, but
reversing it is difficult, expensive, and often unsuccessful. Researchers are studying new methods of blocking the vas that
may produce less tissue damage and scarring and might thus permit more successful reversal. But these methods are all
experimental, and their effectiveness has not yet been confirmed.

What are the side effects of vasectomy?

A major study of vasectomy side effects occurring within 8 to 10 years after the procedure was published in the British
Medical Journal in 1992. Investigators questioned 10,590 vasectomized men, and an equal number of nonvasectomized men, to
determine if they had developed any of 99 different disorders. After a total of 182,000 person-years of follow-up, only one
condition, epididymitis/orchitis (defined as painful, swollen, and tender epididymis or testis)--was found to be more common
after vasectomy. This local inflammation most often occurs during the first year after surgery. Treated with heat, the
condition usually clears within a week.

When can a man have sex again?

A man can resume sexual activity within a few days after vasectomy, but precautions should be taken against pregnancy until a
test shows that his semen is free of sperm. Generally, this test is performed after the patient has had 10-20 post-vasectomy
ejaculations. If sperm are still present in the semen, the patient is told to return later for a repeat test.

What happens after vasectomy?

After vasectomy, the patient will probably feel sore for a few days, and he should rest for at least one day. However, he can
expect to recover completely in less than a week. Many men have the procedure on a Friday and return to work on Monday.
Although complications such as swelling, bruising, inflammation, and infection may occur, they are relatively uncommon and
almost never serious. Nevertheless, men who develop these symptoms at any time should inform their physician.

How does vasectomy compare with female sterilization?

Regardless of how it is performed, vasectomy offers many advantages as a method of birth control. Like female sterilization,
it is a highly effective one-time procedure that provides permanent contraception. Vasectomy, however, is medically much
simpler than female sterilization, has a lower incidence of complications, and is much less expensive.

How is vasectomy done?

In the conventional approach, a physician makes one or two small incisions, or cuts, in the skin of the scrotum, which has
been numbed with a local anesthetic. The vas is cut, and a small piece may be removed. Next, the doctor ties the cut ends and
sews up the scrotal incision. The entire procedure is then repeated on the other side.
A newer method, devised by a Chinese surgeon, has been widely used in China since 1974. This so-called nonsurgical or no-
scalpel vasectomy was introduced into the United States in 1988, and many doctors are now using the technique worldwide.
In a no-scalpel vasectomy, the doctor feels for the vas under the skin of the scrotum and holds it in place with a small
clamp. A special instrument is then used to make a tiny puncture in the skin and stretch the opening so the vas can be cut
and tied. This approach produces very little bleeding, and no stitches are needed to close the punctures, which heal quickly
by themselves. The newer method also causes less pain and fewer complications than conventional vasectomy