Epididymovasostomy
Epididymovasostomy is required during vasectomy reversal when there is absent sperm in the vas deferens. This signifies that a secondary epididymal obstruction has developed upstream from the vasectomy site. This situation is encountered in approximately 40% of individuals after a vasectomy. Epididymovasostomy can only be performed using a high powered operating microscope, under general anesthesia, by microsurgeons using the finest suture (10-0 nylon).
The epididymis is opened and a single tubule is isolated to bypass the obstruction that has developed.
The vas deferens is then attached to the epididymis using fine sutures (9-0 nylon). This attachment brings the vas deferens into close proximity of the single epididymal tubule.
The single epididymal tubule is sewn to the inner lumen of the vas deferens using microscopic sutures to create a water-tight closure, similar to vasovasostomy.
Additional fine sutures are placed in the outer layer of the epididymis to secure the vas deferens in place and to release tension off of the fine inner sutures.
This final lower power image shows the relationship of the testis, epididymis and the bypass site after an epididymovasostomy. Sperm are made in the testis, stored in the epididymis and bypass the second obstruction through the bypass site.