We just had the pleasure of meeting Gwendolyn and James from Nicaragua. Flying in from Central America, they were able to meet with Dr. Kuang the day before their vasectomy reversal. His vasectomy had been 18 years ago. When such a long obstructive interval, we knew the chances of having to do the more complex bypass vasectomy reversal was approximately 45%. Not unexpectedly, there was very little fluid that did not contain any sperm coming from the main pipe (vas deferens). Consequently, we explored the refinery (epididymis) and were excited to find dilated tubes filled with complete sperm. Seeing this, we knew we had to reroute the pipes (vas deferens) and plug them directly into the refinery (epididymis) on both sides. While this type of bypass reversal is definitely a technical challenge, it is satisfying to know that the pipes were hooked up to the right place to give our first international couple a very good chance of getting sperm back in his ejaculate.