Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral
CPT4 code
Name of the Procedure:
Epididymovasostomy (Unilateral)
Summary
Epididymovasostomy is a surgical procedure that reconnects the vas deferens to the epididymis, effectively restoring the pathway for sperm. This is typically performed on one side (unilateral).
Purpose
The procedure addresses male infertility caused by blockages that prevent sperm from traveling from the epididymis to the vas deferens. The goal is to restore fertility by enabling sperm to be present in the ejaculate.
Indications
- Obstructive azoospermia (absence of sperm due to blockages)
- Prior vasectomy with subsequent desire for reversal
- Congenital or acquired epididymal obstruction
Preparation
- Fasting for at least 8 hours before surgery
- Preoperative blood tests and semen analysis
- Discontinuation of certain medications as advised by the doctor
Procedure Description
- Anesthesia: The patient is usually placed under general anesthesia.
- Incision: A small incision is made in the scrotum to access the vas deferens and epididymis.
- Isolation: The surgeon isolates the vas deferens and selects a segment of the epididymis.
- Microsurgery: Using a surgical microscope, the surgeon creates a precise incision in the epididymis and connects it to the vas deferens using fine sutures.
- Closure: The incision is then closed with sutures.
Duration
The procedure typically takes between 2 to 4 hours.
Setting
Epididymovasostomy is usually performed in a hospital or specialized outpatient surgical center.
Personnel
- Urologist or specialized microsurgeon
- Operating room nurses
- Anesthesiologist
Risks and Complications
- Infection
- Bleeding or hematoma formation
- Scarring that could lead to re-blockage
- Chronic pain
- Anesthesia-related complications
Benefits
Successful reestablishment of the sperm pathway, potentially restoring fertility. Results may be seen in sperm counts several months post-procedure.
Recovery
- Pain management with prescribed medications
- Scrotal support via tight-fitting undergarments or athletic supporters
- Avoid heavy lifting and vigorous activities for a few weeks
- Follow-up appointments for semen analysis
Alternatives
- In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI)
- Pros: Immediate options for fertility
- Cons: Higher cost, more invasive for the female partner, no permanent reversal solution
Patient Experience
Patients can expect some discomfort and swelling in the scrotal area post-surgery. Pain can usually be managed with medications, and most patients can resume normal activities within a week, though full recovery may take longer.