Post-op Miscellaneous

Following vasectomy reversal, common recovery includes:

• Limiting strenuous activities for 8 weeks (see below)
• No penetrative intercourse for 4-8 weeks (see additional instructions under, "When can I have sex again after vasectomy reversal.")
• Pain for a few days to weeks (simple repair) or weeks to months (complex repair)
• Time off of work will depend on the activities required at work

Your recovery time will depend somewhat on whether a simple (vasovasostomy) or complex (epididymovasostomy) repair was performed.  Typically, you will experience discomfort similar to your vasectomy with the simple repair, while the complex repair can be sorer and can last for weeks or months.  Chronic (long-term) pain is rare and is most often related to factors other than the reversal (baseline pain, referred pain from lower back injury, etc.) 

One of the most important things to optimize your chances for success is to limit strenuous activities for 8 weeks following the surgery.  That includes anything that pulls on the vas, such as arching your back, reaching up high, twisting, bending, performing lunges, coughing, sneezing, tightening your stomach muscles (such as is needed to lift something), penetrative intercourse, jogging, and so on.  For the first 8 weeks, the surgical site is still healing, and so you will need to take it as easy as possible to give yourself the best chance of success.

A common question that couples often have is, "how much time will I need to take off work?"  The answer to this will depend on what is required with work.  If your occupation requires you to perform any of the activities listed above, you are better off taking up to 8 weeks to recover.  If you are able to perform desk duties, you may return sooner.  Although returning to strenuous activities earlier is not dangerous to your health, it may cause the reversal to fail. 

Post-operative instructions include the following:

• Activity / lifting restrictions
• Time off of work
• Pain control
• Evaluating for signs of infection

Activity Restrictions

Following reversal, patients are recommended to do everything they can to limit the amount of activity that they do for 8 weeks.  As described in the section under "Why do vasectomy reversals fail," the main cause of failure of a reversal (assuming it was performed correctly) is the two ends pulling apart.  Numerous activities can put strain on the vas deferens, including arching your back, reaching up high, twisting, bending, performing lunges, coughing, sneezing, tightening your stomach muscles (such as is needed to lift something), penetrative intercourse, and jogging, among others. 

The area that was sewed back together also takes a significant amount of time to fully heal.  The weakest stage is generally the first 3 weeks after surgery.  By 4 weeks, the wound has typically healed by 60-80%, while at 6-8 weeks, it is generally 90-95% healed. 

Time Off of Work

The amount of time needed off of work will depend on how much activity is required with the occupation.  In general, a desk job may be resumed as early as a few days after surgery.  More strenuous work may require 8 weeks to optimize the chances for success.  This is ultimately a judgment call, but the key thing to assure a successful result post-operatively is limiting the amount of activity for a full 8 weeks to allow the area to heal completely

Pain Control

The amount of pain following surgery depends if a simple (vasovasostomy) repair or a complex (epididymovasostomy) is required.  The simple repairs typically are only slightly more uncomfortable than the original vasectomy in most cases.  Whereas the complex repair (if performed correctly) is often much more uncomfortable. 

Some complications after surgery can cause post-operative pain as well.  A hematoma is a blood collection that can occur after surgery.  This will resolve on its own over time and is not dangerous, but it can take up to 2 months or more to fully resolve.  Although this is not always avoidable, the chances for a hematoma can be reduced by avoiding trauma to the scrotum (4 year-olds punching the area and dogs are the most common in our experience!).  Also, you should avoid heat such as with a bath or hot tub, as this can dilate veins in the scrotum.

Most men will take Tylenol or Ibuprofen after surgery for about 1 week.  A prescription for stronger pain medicine will also be provided though, in case the Tylenol and Ibuprofen are not adequate.

Infection

Post-operative infections are uncommon but do occur on occasion.  Typically, symptoms of an infection will begin to occur 5-7 days after surgery and may include worsening of scrotal pain, redness, warmth, drainage, or other similar symptoms.  Post-operatively, you will be given phone numbers to contact if you experience any of these symptoms. 

In general, pain is normal following surgery.  If you experience new or worsening of pain, particularly if you are 5-7 days out from surgery, this may signify an infection.  See the Wound Care section for more information. 

For routine post-operative pain control:

• Take one to two tablets of acetaminophen (Tylenol Extra Strength) every six hours of pain (maximum 3000 mg in 24 hours).
• You may also take ibuprofen as needed.  This may be taken in addition to Tylenol.  People who have bad side effects with ibuprofen should avoid this medicine (i.e. those with stomach ulcers, gastrointestinal bleeds, kidney issues, etc.).
• If the pain is not sufficiently controlled with Tylenol and/or ibuprofen, you may take the prescribed narcotic.  This may be taken in addition to Tylenol and ibuprofen.  You may take the narcotic every 4 hours as needed, and if pain is still not sufficiently controlled, you may take more than one narcotic pill at a time.  In general, you will want to limit the use of narcotics and take as few as needed to control pain. 
• For the first 2-3 days after surgery, take pain medication regularly (every 4-6 hours).
• You should be able to take pain medicines less frequently starting around day 4 until they are no longer needed.
• Do not take medication on an empty stomach (may cause nausea).

We recommend not ejaculating at all during the first 3 months with the following exceptions:

• Have intercourse the day before, day of, and day after ovulation.
• Send us a mail-in sample 5 days after you attempt to achieve a pregnancy the first month.

Lumps near the testicle are normal after surgery.  They typically are the area where the repair was performed and will usually decrease in size over time. It is best if you limit touching this area, as it may damage the surgical repair. 

Lumps are often different on each side of the scrotum since the exact repair is often different.  Also, sometimes one side will bleed more than another, and some of the lump may be from a post-op hematoma.  These are not dangerous and will resolve with time (usually several months). 

If you are several months out from surgery, and you feel a new lump inside the testicle itself, this is not normal and should be evaluated by a urologist immediately.  Please be aware, if you have had a complex repair (epididymovasostomy, or EV), you will need to notify the urologist, as sometimes this can be confused with testicular cancer on scrotal ultrasound exams. 

After surgery, it is normal for one or both testicles to be swollen for several weeks or months. Also, the testicles may be higher riding for several months (and in some cases years or permanently).

Temporary elevations in the testicles are due to normal post-operative wound contraction.  This occurs after any surgery and may last several months.  Longer-term elevations may be due to the fact that a segment of the vas deferens had been removed at the time of vasectomy, and this region was bypassed after reversal.  This shrinks the overall total length of the vas.  In many cases, the vas will stretch out with time.  However, particularly in cases of complex repairs (epididymovasostomy, or EV), the testicles may be significantly higher riding for several months or years after surgery.

• A routine follow-up appointment is not necessary.
• Post-op sperm checks will be performed routinely to assess outcomes.
• If you have any concerns regarding your post-operative course, including wound issues, contact us at the numbers below or using the numbers supplied in your post-op packet.