Ask the Doctor

From Susannah:-
My husband is 36 and had a Vasectomy, via regular micro surgery, not laser surgery, 6 years ago while married to his ex-wife. He has four children and I do not think fertility has ever been a problem for him. I am 37 and have two children and I also have had no trouble in the past conceiving or carrying to term. My questions are: My husband tends to scar and gets keloids from surface cuts, not horrible thicked, raised, dark scarring, but enough to notice. Is Vasectomy reversal an option for us? Would it be better to go with laser surgery this time vs. tradition surgery? He also says that since his procedure, his ejactulations seem to ooze out like a lava flow rather than spurt out (sorry for the graphic details). Is this a factor to consider? Does this indicate that more internal scarring has occurred than normally expected? Will this contribute to vasectomy reversal failure?

The type of vasectomy performed rarely limits our options at the time of vasectomy reversal. The only limitation to vasectomy reversal surgery is when large segments of the vas deferens are removed at the time of vasectomy by aggressive vasectomy surgeons. Laser vasectomy is still performed by only a few surgeons around the country. There is no proven benefit for using a laser during the vasectomy procedure and some surgeons use it as a marketing gimmick to attract men to get their vasectomy done at their center.

Keloids and hypertrophic scars do occur in some men and are more commonly seen in men with darker skin. I am not aware of any relationship between keloid type scarring of the skin and worse outcomes during vasectomy reversal. Men who form keloids and hypertrophic scars do need to be aware of the fact that their skin incision might show some scarring greater than a man that doesn’t form these types of scars. I would probably recommend that men who are prone to scarring be given a course of strong anti-inflammatory medications in the early post-operative period.

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