From the Guidelines
Men who have undergone vasectomy can experience a reversal of retrograde flow to the epididymis, but this is not a typical outcome and is often associated with surgical complications or technical failure of vas occlusion 1, 2.
Key Points to Consider
- The American Urological Association (AUA) guidelines recommend that patients use other contraceptive methods until vasectomy success is confirmed by post-vasectomy semen analysis (PVSA) 1, 3.
- Vasectomy reversal, also known as vasovasostomy, may be necessary to restore normal physiological flow and prevent further complications 1, 2.
- The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS) 1.
- Sperm granuloma can lead to reverse flow of urine into the epididymis, a phenomenon also referred to as reflux, but this condition is not typically reversible through medical intervention 1, 2.
- Administration of anti-inflammatory medications such as ibuprofen (400mg, orally, every 4-6 hours) or naproxen (250mg, orally, every 8-12 hours) for a duration of 7-10 days may help alleviate symptoms associated with epididymal reflux, but it does not address the underlying anatomical obstruction caused by the vasectomy 1, 2.
Important Considerations
- The choice of time to do the first PVSA should be left to the judgment of the surgeon, but it is generally recommended to be between 8-16 weeks after vasectomy 3.
- Vasectomy should be considered a failure if any motile sperm are seen on PVSA at six months after vasectomy, in which case repeat vasectomy should be considered 3.
From the Research
Vasectomy Reversal and Retrograde Flow
- The provided studies do not directly address the reversal of retrograde flow to the epididymis in men with vasectomies 4, 5, 6, 7, 8.
- However, some studies discuss the outcomes of vasectomy reversal procedures, including vasovasostomy and vasoepididymostomy 5, 6, 8.
- These procedures aim to restore the flow of sperm through the vas deferens, but the specific topic of retrograde flow to the epididymis is not explicitly mentioned.
- One study notes that after vasectomy, antisperm antibodies can develop, but this does not directly relate to the reversal of retrograde flow 7.
- Another study discusses the causes of suspected epididymal obstruction, including idiopathic, infection, and surgical causes, but does not address the reversal of retrograde flow 6.
Epididymal Obstruction and Vasectomy Reversal
- A study from 2012 found that idiopathic obstruction was the most common cause of epididymal obstruction in a Chinese sample, and microsurgical vasoepididymostomy was effective for idiopathic epididymal obstruction 6.
- This study suggests that vasectomy reversal procedures can be effective in restoring sperm flow, but the specific topic of retrograde flow to the epididymis is not addressed.
- Other studies discuss the outcomes of vasectomy reversal procedures, including patency rates and pregnancy rates, but do not provide information on the reversal of retrograde flow to the epididymis 5, 8.