HowtoChooseaDoctor

HOW TO CHOOSE A DOCTOR:

QUESTIONS YOU NEED TO ASK!

There are many aspects of reversal that are extremely important to be educated in prior to choosing your surgeon. Many who are now scheduling a second reversal due to a failed first one, are suddenly learning just how critical these items are. Take time to read the entire page below and then really dig in and resesarch all of them. You need to interview many doctors, not just one! And you need to ask them ALL of the questions. Keep a journal as you proceed through the decision-making process so that you do not forget their answers. While finances often play a role in making choices, take the time to interview even the doctors you are sure you can't afford. Their consults are almost always free and you will learn from each one. You may also find that saving up for the choice of surgeons is worth the wait. The most important determining factors are listed below for you to use when interviewing surgeons:

1. HOW MANY REVERSALS DOES THIS DOCTOR DO?

A doctor who truly specializes in reversals will do approx. 2 reversals per week, averaging

100 reversals a year. Ask how many reversals your surgeon will do in a single day.

A reversal requires approximately 2 1/2 hours looking into a microscope. That is an awful lot

of eye strain if you are the last patient of the day and the surgeon is tired. In that case,

you may want to schedule to be the first patient of day and/or try for a Monday appointment

when the doctor is fresh and at his best.

2. DOES THE DOCTOR USE MICROSURGERY OR MACROSURGERY?

A doctor who uses microsurgery can see the fine details necesssary for suturing the

Vas Deferens, a tiny channel only as big as the shaft of a pin. This needs to be done under

an operating microscope, not a loop. This operating microscope should be available to him

at all times, continuously throughout the surgery. Reversal specialists who have their own

operating suites usually don't have a problem with this. Surgeons who practice within a

hospital will need to schedule the microscope to be available to them for the whole surgery

time. Remember, "microsurgical technique" does not necessarily mean they use a microscope, YOU MUST ASK!

3. WHAT SIZE SUTURES DOES THE DOCTOR USE?

Due to the delicate nature of this surgery, and the narrow passage of the vas deferens,

sutures size 10-0 and 9-0 are preferred. They are as thin as a spider's web and will not

constrict or block the very tiny passage term must travel.

4. WHAT TYPE OF TECHNIQUE DOES THE SURGEON USE?

There are various techniques for reversals: a one layer, modified one layer, multi-layer, etc.

The most commonly used is a modified one layer, which is two layers really. However,

some of the reversal specialists are now claiming to do 4, 5, and 6 layer techniques sealing

the thinnest layers of the vas and getting great results. They work delicately to stitch layer

to matching layer as opposesd to running through multiple layers at one time. This is an

extremely important aspect of reversal, you must take time to understand it and ask the

surgeons you interview.

5. DOES THIS DOCTOR DO VE'S (VAS TO EPIDIDYMUS CONNECTION) AS

WELL AS VV'S (VAS TO VAS CONNECTION)?

There are two main types of reversal surgeries. The usual and simplest is a VV, Vas to Vas

connection. This is where the two ends of the Vas Deferens that were severed during the

vasectomy are cleanly cut and then delicately resewn back together forming a tight seal. But

in some cases a VV is not really the surgery that would provide successful results. This

is for cases where blowouts have occurred or there is extensive scarring due to the original

vasectomy or previous reversal. In these instances, a VE, Vas to Epididymus, connection is

a better option. Many people believe this is only necessary in older vasectomies. THIS IS

NOT NECESSARILY TRUE! Young vasectomies can have blowouts as well Almost all

reversal surgeons do a VV. Very few are capable of a skilled VE. You need to know what

will happen if the surgeon gets in there and can not do a VE and one is necessary. Some

doctors will then refer you on to have yet another specialist do it, or some will just auto-

matically do the VV and wait to see if it works. A surgeon who can do a VE wiill see it is

necessary and just change gears and do the VE. NOT ALlL DOCS PERFORM BOTH and

DOCTORS CAN'T TELL YOU WHICH YOU WILL NEED PRIOR TO SEEING INSIDE UNDER

A MICROSCOPE. You need to determine if you will seek only surgeons who are capable

of both a VV and a VE which affords you every option once under the knife.

6. WHAT ANESTHESIA OPTIONS ARE AVAILABLE TO YOU AND WHERE IS

THE SURGERY PERFORMED?

Anesthesia options range from a local to light sedation to a general. These options may be

determined by the place in which they perform the surgery. Reversal surgeons often have

their own operating suites which allows all the important elements such as microscopes,

proper suture materials, etc., to always be available to them. Some hospitals may not

always have everything in stock all the time. Other doctors work at major hospitals and

may have to follow anesthesia rules for that facility. Check with the doctor, find out what

options are available and then research them carefully.

7. WHAT TYPES OF MEDICATIONS DOES THE DOCTOR USE PRIOR TO,

DURING AND AFTER THE SURGERY?

Some doctors recommend some vitamins before and after surgery which are shown to be

very beneficial in increasing sperm counts and motility. Also, they may encourage you to

stop any type of aspirin or blood thinning type medications prior to surgery. Advanced

reversal specialists use IV anti-inflammatories which are commonly used in facial and

plastic surgeries to dramatically reduce swelling. They may also use prescription anti-

inflammatories after surgery for a while to keep swelling and subsequently

bleeding, hematomas, scarring, etc., to a minimum. Other doctors prescribe over-the-

counter ibuprofen following surgery only.

8. DOES THE DOCTOR USE DRAIN TUBES?

Drain tubes may sound daunting to some. They are really only very thin pieces of latex

that are left in a tiny opening for the rest of the day after surgery. This does allow the maximum draining of fluid build-up that comes naturally after any surgery or trauma to any

area. They slip out naturally and easily and leave a very tiny opening that quickly seals itself

shut. While this may even sound technically grotesque to some who will experience

the surgery, there is nothing to it actually, and it may even provide for less swelling

due to the amount of fluid that is allowed to drain.

9. WHAT TYPE OF TRACK RECORD DOES THE DOCTOR HAVE?

Be sure to ask your doctor what his basic statistics and success rates are, as well as

asking about any incidence of testicular injury or testicular loss due this surgery.

While many may say that these things are always possible, it is a rarity.

10. HOW CAN I COMPARE DIFFERENT DOCTORS?

VasReversal-NewBeginnings has begun to offer a Physicians Profile Packet. It is a form that was filled out by reversal surgeons so that you could put them side by side and make comparisons. This will help you make an educated choice. The Physicians Profile Packet contains all the doctors' profiles, not just one or two. This way you can make the comparisons you need to, in order to make an educated decision. You may order the Physicians Profile Packet for only $5.95 at the Physicians Profile page.

The above is not meant to be a substitute for medical advice, but is

a tool to help you begin the resesarch process and

learn for yourself the important

aspects of reversal.