Narrator: In certain conditions, a more complex reconstruction is required known as an epididymovasostomy or vasoepididymostomy. The animation provides a brief overview of the relevant anatomy with the vas deferens, prior vasectomy site, epididymis and testicle highlighted. This procedure begins in a similar manner to a vasovasostomy. A midline scrotal incision is made after which the obstructed vasal segment is removed and the fluid on the testicular side is sampled under microscopy. In this particular case, microscopic analysis does not demonstrate the presence of any sperm. In that scenario, we would proceed with an epididymovasostomy. The scrotal midline incision is extended after which the testicle is delivered through the wound. This permits better visualization of the epididymis. Next, the epididymis is incised and an obstructed epididymal tubule is selected for anastomosis. The vas deferens is brought down to the level of the epididymis and secured using some initial stitches. Two double-armed smaller sutures are then placed into the epididymal tubule after which the epididymal tubule is incised. The fluid is again sampled and this time demonstrates the presence of normal sperm. Once sperm are identified, the stitches are then placed inside the lumen of the vas deferens and the vas deferens is tied down to the epididymal tubule. Additional stitches are then placed to secure the vas deferens to the epididymal sheath for additional strength. This final animation demonstrates the post-operative result with the attachment of the vas deferens to the epididymis directly.
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