Preparation A general or regional anesthetic is most commonly used, as this offers the least interruption by patient movement for microsurgery. Local anesthesia, with or without sedation, can also be used. The procedure is generally done on a “come and go” basis. The actual operating time can range from 1–4 hours, depending on the anatomical complexity, skill of the surgeon and the kind of procedure performed. Assessing biology After anesthesia and scrubbing the scrotum with soap and water, the vas deferens is exposed through a small, 1–2 cm incision in the upper scrotum on each side. The vas deferens is cut sharply in half, both above and below the<unk>  site. A special bipolar microcautery is used to judiciously control any bleeding. One end of the vas deferens, termed the abdominal end, is inspected and flushed with salt solution to ensure that it is not blocked as it courses from the scrotum to the prostate (a “saline vasogram”). In order to assess for the presence of possible obstruction above the<unk>  site the testicular end of the vas deferens can be compressed and inspected for fluid. This fluid is examined with a microscope for color, consistency and for sperm. This information is used by some surgeons to decide whether or not a secondary epididymal obstruction is present (see Table below). : Grade Vasal Fluid Findings Procedure Suggested 1 Normal appearing sperm with motility Vasovasostomy 2 Mostly normal appearing, nonmotile Vasovasostomy 3 Mostly sperm heads without tails, nonmotile Vasovasostomy 4 Only sperm heads Vasovasostomy 5 No sperm, creamy fluid Vasoepididymostomy 6 No fluid Vasoepididymostomy 7 Clear fluid, no sperm It depends If sperm are found at the testicular end of the vas deferens, then it is assumed that a secondary epididymal obstruction has not occurred and a vas deferens-to-vas deferens reconnection (vasovasostomy) is planned. If sperm are not found, then some surgeon consider this to be prime facie evidence that an epididymal obstruction is present and that an epididymis to vas deferens connection (vasoepididymostomy) should be considered to restore sperm flow. Other, more subtle findings that can be observed in the fluid—including the presence of sperm fragments and clear, good quality fluid without any sperm—require surgical decision-making to successfully treat. There are however, no large randomised prospective controlled trials comparing patency or pregnancy rates following the decision to perform either microsurgical vasovasostomy to microsurgical vasoepididymosty as determined by this paradigm. Vasovasostomy For a vasovasostomy, two microsurgical approaches are most commonly used. Neither has proven superior to the other. What has been shown to be important, however, is that the surgeon use optical magnification to perform the<unk> . One approach is the modified 1-layer vasovasostomy and the other is a formal, 2-layer vasovasostomy. Vasoepididymostomy A vasoepididymostomy involves a connection of the vas deferens to the epididymis. This is necessary when there is no sperm present in the vas deferens.
Vasectomy reversal
Chemical castration
Tubal reversal
Vas-occlusive contraception
Ovarian stimulation
Vasoepididymostomy
Vasovasostomy
Bladder augmentation