- Minimally Invasive Vasectomy -
Introduction
"Vasectomy" is the procedure to interrupt the tubes (vasa deferentia) that transport sperm from the testicles to the urethra. Vasectomy is both the most effective form of birth control and the least expensive over the long-term. Further, 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, vasectomy is performed in this country about 500,000 times annually.
Vasectomy needs to be 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
In the traditional vasectomy, 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. The incision(s) are then closed with a suture. While effective, the traditional method of vasectomy has a 3-4% risk of post-procedure compliations, particularly bleeding and infection.
No-Scalpel Vasectomy, Major Advance
The No-Scalpel Vasectomy (NSV) technique eliminates the incision with a scalpel and the need to suture the skin closed. Dr. Shunqiang Li in China developed specialized instruments and pioneered the new technique. A single small skin puncture in the scrotal mid-line is used to access the vas deferens from each side. At the end of the procedure, the small skin opening does not need to be sutured closed and heals very quickly, often without a visible scar. Several benefits have been proven:
- reduced procedure time
- reduced size of the opening in the skin
- reduced post-procedure pain and pain medication needs
- reduced risk of bleeding
- reduced risk of infection
No-Needle No-Scalpel Vasectomy
The latest advance in the vasectomy procedure is the elimination of the needle for delivering the anesthetic. By utilizing a pressurized spray anesthetic device, improved anesthesia is achieved with significantly less discomfort or anxiety (fear of needles), less anesthetic medicine, and less tissue trauma than when a needle is used. The risk of injury to a blood vessel is reduced, so the risk of bleeding is far lower. These advances have elmiinated nearly all of the discomfort and much of the risk 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 actually constitute a tiny amount of the total semen volume. The majority of the semen comes from the seminal vesicles and prostate gland. Removing the small (but very important) contribution from the testicles does not 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. Men are advised to refrain from sexual activity for 5-7 days after vasectomy.
3. How much does the vasectomy procedure hurt?
There is some minor discomfort, but rarely 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. In the unlikely event that pain occurs during the procedure, your doctor can easily provide more local anesthesia at the site.
4. Is there anything available to help me feel less anxious during the procedure?
Yes, although it is rarely necessary. Vasectomy is usually performed in the urologist's office, requiring only local anesthesic. In some cases, however, an individual may be exceptionally anxious about the procedure. In this situation, the oral relaxation agent valium can be taken about an 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 such a medication is that someone else must be available to drive the patient home after the procedure.
5. What are the risks of the vasectomy procedure?
While 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 statistics have been compiled from several large series:
- 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 need for semen analysis 6-8 weeks after the procedure. Until this test is performed, one be considered fertile.
- post-procedure testis or epididymal discomfort occurs in some men, but typically resolves within 1-2 months. Very rarely (2 in 1000), a man will have chronic testicular pain that leads him 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 with a fear of needles
- anesthetic is effective more quickly than when delivered by a needle
- due to the pressurized spray delivery system, less total anesthetic is required, but the numbing effect is more thorough
- 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 lifting anything 20 pounds or more 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 5-7 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. After 6 weeks or 20 ejaculations after the procedure, Dr. Golden will look at a fresh semen specimen under a microsocope to determine sperm-free status. You must consider yourself fertile and use contraception until this test is done. Note that there is no additional charge for the post-procedure semen analysis. Alternatively, the newly approved SpermCheck Vasectomy test can be used in the privacy of your own home.
9. Is there any way to confirm success of the procedure without providing a semen sample?
Yes. SpermCheck Vasectomy is now available, allowing the test to be performed in the privacy of your home. This test is similar to a pregnancy test, detecting even small amounts of specific sperm proteins. The test is available by mailorder directly from the manufacturer by following the link above.
10. Does vasectomy increase the risk of prostate cancer?
In the early 1990s, the question of an association between vasectomy and prostate cancer was raised. Multiple respected journals soon published articles showing there to be no association. Because the question of a relationship has been raised, however, the American Urologic Association recommends that men who have had vasectomy and are over 40 be screened for prostate cancer with an annual prostate exam and blood test (PSA).
11. How difficult is it to reverse a vasectomy?
This question is 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.
12. 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. |
