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Vasectomy Failure

Vasectomy Failure, causing a vasectomy to reverse, seldom happens but failure is possible and there is something you can do to help prevent it. When a vasectomy fails, recanalization or spontaneous recanalization occurs. A vasectomy involves severing the vas deferens, so that sperm can no longer flow through the canal. Recanalization takes place when the vas deferens channel, once again permits sperm to flow through. In turn, the man becomes fertile once again. Doctors categorize  vasectomy failure, called "spontaneous recanalization" into two classes.

Early Vasectomy Recanalization

"Early recanalization" is defined as vasectomy failure within the first few weeks following the vasectomy. After a vasectomy, the man is asked to confirm sterility with semen analysis two and three months following the vasectomy, in case the vasectomy is a failure. If the tests reveal live sperm present in the ejaculate, this does not mean that the vasectomy is a failure immediately. It can take up to six months for the vasectomy to be determined a success or failure. During this period, the doctor instructs the man to use another form of birth control. If the vasectomy is determined a failure, (also called a "technical failure") the vasectomy will be repeated. Statistically vasectomy failure can occur 1% to as high as 5% depending upon the vasectomy doctor.

Late Vasectomy Recanalization

Vasectomy failure from "late recanalization" is also a circumstance in which the vasectomy reverses itself due to spontaneous recanalization. However, it is defined as having occurred anytime after the vasectomy doctor has confirmed the vasectomy was successful. According to the UK national sterilisation guidelines (2004), the failure rate of vasectomy should be quoted as approximately 1 in 2000 (0.05%) after clearance has been given.1  According to Harvard Medical School, "Vasectomy can reverse itself, but it is a very rare event. It develops in only about .025% or one in 4,000 vasectomies".2 Since the vasectomy has recanalized, the vasectomy failure means the rejoined vas deferens canal will highly likely be much smaller. So this failure makes the man fertile but the fertility is lessened. This strongly suggests that vasectomy failure as defined by late recanalization rarely occurs. There are, two recognized ways that this may come about:

  1. Formation of Sperm Granuloma: Sperm granulomas form in about 60% of patients if sperm leaks from the vasectomy site or from a rupture in the epididymis. There is an inflammatory reaction around the site of the leaks. A benign malignant growth known as Vasitis Nodosum forms toward the vas deferens as the granuloma progresses. This growth could then join with the distal vas allowing sperm to flow, causing vasectomy failure.
  2. Micro-Recanalization through Scar Tissue: Vasectomy failure can result, if, after the vasectomy, there is a lot of scar tissue. A process called Microrecanalization can occur where the sperm manage to move through new, very small channels formed by the scar tissue. Scar tissue is associated with bleeding and this much bleeding is associated with poor vasectomy technique.



  There are some surgical techniques that minimize the chances of vasectomy failure from spontaneous recanalization. Fascial interposition 3 is now accepted as the most reliable method of performing vasectomy. An additional advancement is the use of cautery to seal the ends, which increases reliability. Though less important, the ideal length of vas deferens removed is also a contributing factor. Today there are vasectomy doctors who tout a technique called the, “Open Ended" technique, whereby the testicular end of the vas deferens is not closed and fascial interposition and cautery are used on the other ends. All these advancements minimize vasectomy failure and complications.
Standardized fascial interposition technique
A suture is used to position the stump of the prostatic end outside of the fascial sheath and the stump of the testicular end inside the fascial sheath. Source: EngenderHealth: No-Scalpel Vasectomy: An Illustrated Guide for Surgeons. 3rd edition. New York: EngenderHealth; 2003. Reprinted with permission.
 

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