Epididymal Dissociation to Facilitate Vasectomy Reversal in a Patient With Sizeable Vasal Defect: A Case Report

Close to a quarter of men seek paternity after vasectomy. Microsurgical vasectomy reversal is a common choice for men seeking children after vasectomy, with outcomes dependent on surgical expertise and intraoperative decision-making. Here, we describe the case of a patient with an unexpectedly long vasal gap that necessitated the dissection of the tail and midbody of the epididymis from the testis during a vasoepididymostomy.

We report a case of a 31-year-old male who underwent vasectomy reversal that required a rare surgical approach. During the operation, we discovered a secondary distal obstruction and an additional proximal obstruction on the patient's left side, which resulted in a long vasal gap that did not permit a tension-free vasoepididymostomy. To bridge the long gap, the tail and midbody of the epididymis were carefully dissected and mobilized from the testis. Dissociation of the epididymis from the testis allowed a tension-free vasoepididymostomy. Postoperative semen analysis confirmed patency, and the patient had no concerns.

Dissection of the tail and midbody of the epididymis is discussed in textbooks, but is not readily documented in real-world patients. Here, we provide a case discussion where the dissection of the epididymis from the testis was successfully performed to gain additional length to bridge a long vasal gap.