NO-SCALPEL VASECTOMY
PURPOSE
Vasectomy is the process of dividing the vas deferens (the tube
carrying sperm from the testicle to the prostate) in order to prevent
conception. It is the most common method
of male birth control in the U.S. Approximately 50,000 vasectomies are done
nationally every year.
Vasectomy prevents pregnancy by interrupting the delivery of the
sperm. It does not change the hormonal function of the testes. Sexual drive,
sexual ability, and male characteristics remain the same. Vasectomy will not change your hair growth,
musculature, sex drive, erections, orgasms, or voice. The semen will look the
same and will be of approximately the same volume, as it is mostly composed of
prostatic fluid.
Some men find sex more enjoyable and relaxed without the concern
of an unwanted pregnancy or the bother of other birth control methods. Vasectomy is felt to be the most reliable
form of permanent male sterilization.
The intent of the operation, known as bilateral partial
vasectomy, is to render you sterile (unable to cause a pregnancy). There is
only a 50-70% chance that a reversal would be successful, once sterility is
achieved. Therefore it is important to
be sure that you do not want to father any children in the future.
Vasectomy should be discussed with your partner. Consider other
forms of birth control, talk to others who have had the procedure, and make the
decision to proceed as a couple.
COMMON REASONS FOR A VASECTOMY
·
You
want to enjoy sex without worrying about a pregnancy
·
You do
not wish to have more children than you can adequately care for
·
Your
partner has health issues that make pregnancy risky or difficult
·
You do
not want to pass along any hereditary disease or disability (such as cystic
fibrosis)
·
You and
your partner cannot, or do not want to, use other methods of birth control
·
You
want to save your partner from the surgery and expense of a tubal ligation
WHEN A VASECTOMY IS THE WRONG DECISION
·
Your
current relationship is not stable or permanent
·
You are
doing it to please your partner and are not certain this is the right choice
for you
·
You are
under a lot of stress
·
You are
counting on a successful reversal at a later date
REASONS TO CHOOSE NO-SCALPEL OVER CONVENTIONAL VASECTOMY
·
No
incision
·
No
stitches
·
Faster
procedure
·
Faster
recovery
·
Less
chance of bleeding and postoperative complications
·
Less
discomfort
·
Same
effectiveness as conventional method
NATURE OF THE OPERATION
The technique of no-scalpel vasectomy was originated in China in
1974 by Dr. Li Shunqiang. It was introduced in the United States in 1988 and
now the majority of physicians who perform vasectomy have mastered the
technique. The operation takes about 15 minutes, using local anesthesia, and is
safe and simple.
Vasectomy carries risks such as bleeding, swelling, bruising
(discoloration of scrotum and/or groin region), infection, pain, and hematoma
(clot formation under the surface). Serious problems are unusual. There is
always a small chance that the vas deferens will rejoin themselves. That is why
it is necessary to perform semen analyses. There are no proven long-term risks.
Sperm is manufactured in the testicles and travels from there
through the tube called the vas deferens into the prostate gland. Semen is made in the prostate gland and
mixes with the sperm cells. The
prostate is connected to the channel in the penis through semen and sperm are
ejaculated. In bilateral partial vasectomy, the vas is blocked, by dividing and
sealing it, so that sperm cannot reach the prostate gland. With no sperm in the
semen a pregnancy cannot occur.
No-scalpel vasectomy is different from a conventional approach
used to reach each vas deferens and block them from transporting sperm. An
improved method of anesthesia helps make the procedure less painful.
After injecting the scrotal skin and each vas with a local
anesthetic, we use a special vas-fixation clamp to encircle and firmly secure the
vas without penetrating the skin. One tip of a sharp curved clamp is used to
puncture the scrotal skin along the center “seam”. The tips of the clamp are
separated, opening the skin as if spreading the weaves of a fabric. Each vas
deferens is exposed, lifted out, divided, and sealed with electrocautery. A
segment may or may not be removed. No sutures or clips are used. Because there
is no incision there is very little bleeding. The skin wound contracts to a few
millimeters in size, does not need sutures, and heals quickly without scarring.
A conventional vasectomy will have one or two incisions, made
with a surgical knife. Clips, suture or electrocautery may be used to seal the
vas. Suture is used to close the skin incision(s). Compared to the traditional
incisional technique, the no-scalpel vasectomy usually takes less time, causes
less discomfort because there is less manipulation and trauma to the scrotum
and tissues, and may have lower rates of bleeding and infection. Recovery
following the procedure is usually complete in about 3 days. Hard work or
straining (athletic pursuits, heavy lifting) is not recommended for at least 3
days. Most patients wait to have intercourse for one week, or until no
discomfort is felt when sexually aroused.
It is important that you do not have unprotected intercourse
until the absence of sperm has been confirmed 2 consecutive times through semen
analyses.
ANESTHESIA
The operation will be performed using local anesthesia. The skin
of the scrotum and the nerves to the vas deferens will be numbed by injecting
anesthetic such as Lidocaine. You will be fully conscious. At least one
injection will be given on each side of the scrotum. Discomfort is experienced
in the area of the groin and testicles during the injection. Once anesthesia
has taken effect you should feel no pain.
You may fell a pulling sensation during the procedure.
POSTOPERATIVE CONCERNS
You will be sore for a few days following the procedure. A mild
pain reliever such as Tylenol extra-strength is generally adequate. Plan to use
ice on the area for the first 24 hours and use a supportive device (athletic
supporter or jockey briefs) for as long as necessary for comfort. Complete
instructions for your postoperative period are included in the packet you will be
given at the consultation visit.
Some minor postoperative problems are not uncommon. These could
include:
·
Bruising
of the scrotum and/or groin
·
Swelling
of the puncture site and/or scrotum
·
Tenderness
around the puncture site and in the testicles
·
A
feeling of fullness or pulling in the testicles, especially once you have
become more active
·
Clear
or bloody discharge from the puncture site
Complications that sometimes occur include:
·
Epididymitis-painful
swelling of the tissues alongside the testicles. This could include swelling of
the testicle. This inflammation can take several months to subside.
·
Sperm
Granuloma-persistent tenderness and swelling under the skin above the testicle.
This is commonly due to leakage of sperm from the severed ends of the vas into
the tissues.
·
Hematoma-hemorrhage
due to undetected bleeding into the scrotal sac. In this instance the scrotum
may become swollen and discolored. An incision could be necessary to drain
accumulated blood.
·
Abscess-pus
may form within the scrotum and require an incision to drain it.
·
Recanalization-
the ends of the vas may rejoin into a patent connection causing you to remain
fertile. If sperm are present in the semen later on, the operation may need to
be repeated.
PATHOLOGY EXAMINATION
We routinely send a section of the vas to an outside laboratory
for examination to confirm the vas deferens is present and to assure there is
nothing abnormal in the tissue. This is billed to your insurance company. As a
rule, if your insurance covers vasectomy it will cover the pathology exam also.
You may request that we not submit the tissue; it will then be labeled and
stored for 2 years in our office.
FAILURE OF PARTIAL VASECTOMY
You will need to use an alternate form of birth control until
there have been 2 separate, consecutive, semen analyses that show no sperm
cells. About 4% of the time the vasectomy will be unsuccessful. It is your
responsibility to have the semen analyses performed. The first one should be 6
weeks after the procedure and the second 2-4 weeks after that. You will be cleared if both of these are
negative.
If any sperm cells are apparent, you will be asked to bring
additional samples until there are 2 negative samples in a row. You should
continue contraceptive measures during this time.
LAST UPDATED: May 14, 2005