- No Needle, No Scalpel Vasectomy -
Introduction
A "vasectomy" is any procedure that interrupts the tubes (vasa deferentia) that transport sperm from the testicles to the urethra. This is the most effective form of birth control available and is also the least expensive over the long-term. It is significantly safer, faster, and less expensive for a man to have a vasectomy than it is for a woman to undergo tubal ligation. For these reasons an increasing percentage of married couples choose this form of contraception. Vasectomy is performed in this country about 500,000 times annually.
Vasectomy is considered permanent, so only men who are sure they do not want any more children should have a vasectomy. If you are not sure, then use another method.
The Original Vasectomy Procedure
Vasectomy can be accomplished by a number of methods, some more invasive than others. The traditional method is pretty straightforward. A needle is used to inject local anesthetic (lidocaine) into the skin, after which a scalpel cuts the skin to provide access to the vas. The vas is pulled out and cut on each side, then cauterized and/or tied off with suture. While effective, the traditional method of vasectomy has a 3-4% risk of post-procedure compliations, particularly bleeding and infection. These issues left room for significant improvements.
No-Scalpel Vasectomy - A Major Advance
The No-Scalpel Vasectomy (NSV) technique eliminates the scalpel and the need to suture the skin closed. By developing specialized instruments, Dr. Shunqiang Li in China pioneered the NSV technique. Not only did this decrease the time required to perform the procedure, but also substantially decreased the size of the opening in the skin, post-procedure pain, and the risks of bleeding or infection. A single small skin puncture in the scrotal mid-line is used to access both sperm-carrying tubes (vasa). At the end of the procedure, the skin does not need to be sutured closed and heals very quickly, often without a visible scar. The incidence of adverse events has been clearly shown to be significantly lower than the traditional vasectomy, down to ~1.5% risk of bleeding with exceedingly low infection rate.
No-Needle No-Scalpel Vasectomy
Dr. Brian Golden and Dr. Michael Kaplan both perform No-Needle No-Scalpel Vasectomy (NNNSV), the least invasive vasectomy procedure. NNNSV eliminates not only the knife and suture, but also the needle. By utilizing a jet-anesthetic device, improved anesthesia is achieved with significantly less anesthetic medicine. The numbing effect of the pressurized spray is nearly instantaneous and causes significantly less discomfort or tissue trauma than a needle. These advances have elmiinated nearly all of the discomfort associated with the vasectomy procedure.
Frequently Asked Questions
1. After the vasectomy, will I still produce semen?
Yes. There is no appreciable change in the ejaculate after vasectomy, except when viewed under a microscope. Why not? The sperm acutally constitute a tiny amount of the semen volume. The majority of the semen comes from the seminal vesicles and prostate, so removing the small (but very important) contribution from the testicles does note change the volume, appearance, or consistency.
2. Will sex or my erections be different after vasectomy?
No. There is no alteration in a man's hormone production or sex drive after vasectomy, so no change in erectile function occurs. Sexual pleasure, orgasm, and ejaculation are unchanged.
3. How much does the vasectomy procedure hurt?
There is some minor discomfort, but almost no pain during no-scalpel vasectomy. The scrotal skin and vasa are numbed with lidocaine, so there is minimal discomfort. Some men feel a vague pulling sensation as the vasa are delivered through the skin puncture.
4. Is there anything available to help me feel less anxious during the procedure?
Yes. Vasectomies are usually performed in the urologist's office, with local anesthesic to ensure patient comfort. In some cases, an oral relaxation agent such as valium can be taken one hour prior to the procedure. This alleviates anxiety and has the added benefit of allowing the scrotum to be more relaxed. The downside of taking valium is that someone would have to be available to drive you home.
5. What are the risks of the vasectomy procedure?
While it must be recognized that all forms of contraception and all procedures carry some risk, No-Scalpel Vasectomy (NSV) is very safe. The rates of the most common complications are about one tenth the rates of conventional scalpel vasectomy. The following numbers are compiled from several large series of NSV:
- risk of hematoma formation (bleeding into the scrotum) is 0.4%
- risk of scrotal infection is 0.01%
- risk of vasectomy failure (sperm still present in ejaculate) is 1 in 500. This highlights that a semen analysis must be done about 12 weeks after the procedure before a patient can be considered infertile
- post-procedure testis or epididymal discomfort occurs in some men, but typically resolves within 2-3 months. About 1 in 1000 men will have chronic testicular pain that leads them to seek additional treatment
6. What are the advantages of the No-Needle Anesthetic?
- decreases risk of hematoma due to needle tearing small veins
- reduces anxiety in many people who are afraid of needles
- anesthetic is effective much more quickly than when delivered by a needle
- much smaller total volume of anesthetic is required, but the numbing effect is much greater
- higher patient satisfaction demonstrated in several studies
7. What is the recovery period after vasectomy?
A few days. After your vasectomy, plan to return home and relax. You can do desk work the day after the procedure, but should avoid any heavy lifting for at least 5 days. A scrotal support (snug briefs, jock strap, or biking shorts) should be worn for at least 48 hours after the procedure. This alleviates potentially uncomfortable tension on the scrotum and minimizes bruising. Placing an ice pack on the scrotum intermittently helps minimize bruising and discomfort. A bag of frozen peas serves this purpose very well. For a week, avoid situations where scrotal trauma is probable. Watch out for young children who might run into you! You should also refrain from sexual activity for at least 5 days.
8. Will I be sterile immediately after vasectomy?
No. Vasectomy does not induce sterility at the time of the procedure, because sperm are still present in the tubes (vas deferens) after the procedure. It takes some time to clean out the remaining sperm, after which an examination of the semen needs to be done for confirmation. This "test of success" can be performed about 6 weeks or 20 ejaculations after the procedure. Dr. Golden or Dr.Kaplan will look at your semen specimen under a microsocope to determine sperm-free status. You must consider yourself fertile until this test is done. Contraception must be used until then. Note that there is no additional charge for the post-procedure semen analysis.
9. Is there any way to confirm absence of sperm without providing a semen sample?
Unfortunately, this is not currently possible. At this time, the only way to confirm the success of the procedure is to look at a semen sample that is less than an hour old under a microscope. However, a new home test kit, SpermCheck Vasectomy, is scheduled to become available sometime in 2008, allowing the test to be performed in the privacy of your home.
10. How difficult is it to reverse a vasectomy?
This question is a bit of a red flag for doctors performing vasectomies. If you are not certain that you are finished having children, then another form of contraception should be chosen instead of vasectomy. While cutting the vas deferens is an easy, inexpensive long-term contraceptive, reconstructing the vas deferens is a much more complex and expensive undertaking. Vas reconstruction costs in the range of five to ten thousand dollars, has about a 60% success rate.
11. How can I schedule a vasectomy?
Call the scheduling line to make an appointment. During you initial consultation, a history and physical exam will be performed, all of your questions answered, and the procedure reviewed. |
