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Microsurgical Vasectomy Reversal - About the Procedure

vasectomyreversal-thumbThanks to his highly specialized training in microsurgical vasectomy reversal, Dr. Lerner's success rate with vasectomy reversals is over 90 percent.

Dr. Lerner has performed hundreds of such procedures and is experienced in both the vasovasostomy surgery and in the more delicate microsurgery called epididymovasostomy.
 
spermproduction-thumbBoth procedures require microsurgery.  The channel of the vas deferens through which the sperm swim is only .3 to .4 millimeters in diameter.  Therefore, Dr. Lerner utilizes the Vasectomy Reversal Center's state-of-the-art microscope that provides 16 times magnification of the operating image.  The training and precise skill of a microsurgeon such as Dr. Lerner is of the utmost importance for a successful surgical outcome.

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Vasovasostomy

A vasovasostomy is the procedure to reconnect the severed ends of the vas deferens. Dr. Lerner performs a vasovasostomy with a two-layer procedure that produces the most optimal watertight result when reconnecting the vas deferens.  This is done with microscopic sutures, using the most advanced microsurgical equipment and the Zeiss operating microscope.   The two-layer procedure involves suturing the mucosal inner layer and a muscular tissue layer of the vas deferens, which requires the high level of training and experience that Dr. Lerner is known for.  The two-layer procedure ensures that the closure is watertight so that sperm do not leak out at the closure site, potentially causing inflammation. With vasovasostomy, more than 80 percent of men have sperm return to their ejaculate.

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Epididymovasostomy

An Epididymovasostomy is an even more complex and delicate procedure that is performed when a blockage is discovered in the epididymis.  The vas deferens is attached directly to the epididymis, which is a tightly coiled tube that stores the sperm while they reach maturation. The muscle of the epididymis contracts to expel the sperm through the vas deferens and into the urethra at the far end of the penis.

This complex microsurgery performed by Dr. Lerner is required in about 30% of vasectomy reversals for men who have a blockage in the vas deferens close to the testicle.  The surgery involves joining the vas deferens to the epididymal tubule in the epdidymis, where the opening may be as small as one fifth of a millimeter. Approximately 60 percent of men have a return of sperm to their ejaculate following an epididymovasostomy.  

The decision to perform a vasovasostomy or an epididymovasostomy depends upon the quality of the fluid contained in the testicular side of the vas deferens.  To check this, Dr. Lerner will express the fluid during surgery, examine it under a microscope, and then determine the best course of action to achieve optimal results.

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