Vasectomy Reversal Treatment

Dr Lekich’s personalised use of ultrasound for assessment and planning of the scrotum

Ultrasound allows visualisation of the structures in detail, and from this he is then able to map and plan the surgery, reducing my need for “exploration” during the procedure. His high resolution scanning of over 2000 sides since 2008 has enabled me to see diverse pathology and details of the micro-tubules deep within the body of the testicle, epididymis and scrotum, NOT visible with the naked eye or with the microscope. This is particularly useful for past IVF extractions and past failed vasectomy reversal attempts. The ultrasound has allowed Dr Lekich to advise patients regarding the likelihood of surgical success – particularly patients who have had previous scrotal procedures and previous failed vasectomy reversals.

For example: one patient had his vasectomy 23 years ago, had two failed reversal attempts elsewhere and then had three sperm extractions through IVF. Several clinics had told him that reversal was now impossible. After careful ultrasound assessment and planning, we successfully reversed this patient – achieving a 35 million sperm per ml count nine months after our procedure, with a wound that was one (1) cm in length on both sides. His wife is currently pregnant with their baby.

For this reason we invite patients who have been told nothing can be done to reverse their vasectomy or have had failed vasectomy reversal/s to consider a second opinion

The use of the ultrasound in has facilitated the delivery of safe and minimally invasive Owen Three Layer Micro-surgical Vasectomy Reversals, difficult vasectomies and the management of post vasectomy congestion syndrome. Coupled with Dr Lekich’s micro-surgical training, the ultrasound has helped our team assess and plan what often becomes relatively straightforward surgery once there is a clear map. This is particularly important in the following challenging cases;

• Failed vasectomy reversal/s
• Multiple IVF sperm aspirations
• Past scrotal trauma
• Past scrotal surgery (torsion, undescended testis, varicocele and hydrocoele)
• Where patients have been told that a vasectomy reversal is not possible due to the original vasectomy
• A combination of all of the above

There has been open criticism with regards to the use of ultrasound by competing surgeons, with suggestions that this is a waste of time. At Metrocentre we respect these opinions as all surgeons try their best – open exploration has been common place during vasectomy reversal procedures for many years. With the benefit of ultrasound, Dr Lekich has almost completely eliminated the need to explore the scrotum during the procedure, which preserves the precious vas deferens. This subsequently reduces the risk of bleeding. To date we have never had a patient experience a scrotal haematoma after surgery. We do not routinely use drains which are often used in other practices.