ABOUT VAS REVERSALS

INTRODUCTION

I have been involved in the treatment of male fertility since 1971, when I first opened my urology practice.  Over the next many years, more and more of my patients were requesting vasectomy reversals.  In the fall of 1988, I began directing my practice toward helping those couples who desired the blessing of children after having undergone a vasectomy.  Vasectomy reversals are of special interest to me for several reasons: first, the joy of participating in the good news children always bring; second, the following of God’s principles of rearing up Godly seed; and  third, the need for a vasectomy reversal personally. 

For the past 20 years, it has been my ministry to perform this procedure at a price that is affordable to most couples.  As you may have seen, the usual surgeon’s fee alone for this procedure ranges from $5000.00 to $15,000.00 plus operating room fees.  This cost is considerably beyond the means of most couples.  I have reduced the costs of performing this procedure to make it affordable to most families.  A free standing operating room was established in my office building to avoid the expenses of a hospital or surgical center based procedure.  Also, the added bonus at my free standing surgery suite is we are able to seat your wife at the head of the table to minister to you during the procedure.

My total charge for a vasectomy reversal (vasovasostomy) done under a local anesthesia is $3000.00.  After 4 months a semen analysis should be performed.  If sperm in the ejaculate is not present, I will repeat the procedure with local anesthesia for $2500.00.  This repeat procedure must be done within one year of your initial reversal surgery.  I require a $500.00 deposit to schedule your surgery.  This deposit is non-refundable.  My operating schedule for reversals beginning in November 2008, will be Tuesday, Wednesday, and Thursday mornings.  I only do two cases per day.  Although this is my Christian ministry, it is not restrictive in any manner.  The same expert care and affordable cost is offered to any couple without regard to race, ethnic background or religion.

TECHNIQUE

I do a microscopic repair of the vas deferens using a Zeiss OPMI-MDM operating microscope using a 10-0 nylon suture (delicate as a spider’s web).  The repair requires 12-15 stitches.  The goal is to create direct and careful alignment of the lumen of the two ends of the vas and a watertight closure.  There is a phenomenon that occurs occasionally after 10-15 years of obstruction called an epididymal blowout.  This means that the vas is obstructed at two levels; at the vasectomy site and by rupture of the tube in the epididymis.  Both require repair for a successful outcome.  Surgeons can only identify this situation by examination of the semen.  It cannot be determined by the age of a vasectomy alone.  If sperm is not present and the semen is pasty rather than liquid this suggests that the additional repair is required.  This procedure can be accomplished at the same time.  The technique for VE (vasoepididymostomy) is a microscopic invagination of the epidymal tube into the lumen of the vas deferens using 10.0 nylon sutures.  There is not an additional cost if both repairs must be done.

Using this technique, there has been a 92-95% success rate of having sperm in the ejaculate post operatively, and a 50-60% pregnancy rate.  This compares very favorably with large reversal centers across the United States.

You will find many surgeons who advertise this procedure for less money.  However, you would be prudent to check their technique.  Ask these specific questions:  1) the size of suture should be no larger than 9.0 or smaller than 10.0 nylon; 2) what type of operating microscope and power of magnification do they use.  If they do not use an operating microscope, then you are not getting a state of the art procedure and are probably signing up for a greater failure rate, therefore, not getting the most out of your health care dollar.  Cheap is not always the best deal.  I have had to repair many vasectomy reversals done with large sutures and low magnification (optical loupes).

POSSIBLE COMPLICATIONS

When you sought a vasectomy for sterilization, you were probably informed of the potential for complications.  The same list of complications exists for the vas reversal.  These are:  1) swelling; 2) pain; 3) hemorrhage; 4) infection; 5) testicular atrophy;
6) loss of testicle; and 7) loss of life. 

Pain and swelling are common, but quickly disappear.  Hemorrhage and infection are rare in my practice.  “Loss of life” I have never seen, but I did read of a case in the world literature.  Out of greater than 3800 reversals, I have had to sacrifice three testes for post operative hematomas, and infection which compromised the blood supply.  Happily, I can say all of these men now have new reversal babies to compensate for their loss of a testicle.

DAY OF SURGERY

It is my policy to interview you the morning of the surgery.  If you have any additional questions concerning the procedure that have not been answered previously, I will answer them at this time.  The surgery is done as a day patient under local anesthesia.  The operating time is usually 1 ½ - 2 hours.  You should bring a bottle of Advil or Nuprin (Ibuprofen), snug fitting underwear, and shave as you did for your vasectomy.  You will be dismissed the day after surgery.  However, about one-quarter of my patients choose to return home the same day.  I prefer your wife to accompany you as she will play a significant role in your convalescent care.  Again, however, many men have come alone and this has worked out satisfactorily.

MY FRIEND

The practice of medicine and surgery, like life, is framed by seasons.  Even though I have no immediate plans to retire because my health and skills are still good, I must acknowledge that over the horizon is the autumn of my surgical practice.  Anticipating this, I want to introduce you to my dear friend of 28 years, Loddie Francis Roeder, Jr.  Dr. Roeder attended the same microsurgical classes with me years ago and has been actively practicing microsurgery in his surgical practice.  I have every confidence in his skills. 

This man’s heart is right with God.  He wants to serve families and assist them in their desires to have more children and return fertility to our Father’s control.  Dr. Roeder has been working with me, and we are transitioning to a combined practice.  Together, we will care for you and offer a state of the art microsurgical vasectomy reversal at a competitive and affordable price.  We offer you the combined experience of almost 4000 vasectomy reversals.  To learn more about my friend, Loddie Francis Roeder, visit his website at www.vas-reversals.com.   

If I can be of further assistance to you, please do not hesitate to contact me.  My office phone is 830.625.2229, my mailing address is 1619 E. Common St., Bldg. B202, New Braunfels, Texas  78130, and my e-mail is leverett@Reversals.com.

Warmest Regards,

Cary L. Leverett, M. D., F.A.C.S.