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Vasectomy
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Vasectomy is a minor surgical procedure to cut and close off
the tubes (vas deferens) that deliver sperm from the testes;
it is usually performed as a means of contraception. The
procedure typically takes about 30 minutes and usually causes
few complications and no change in sexual function. About
500,000 vasectomies are performed annually in the United
States. A vasectomy is less invasive than a tubal ligation
(i.e., the procedure used to prevent a woman’s eggs from
reaching the uterus) and more easily reversed. An increasing
number of couples choose it as a means of permanent birth
control.
Male Reproductive System
To understand a vasectomy, it is helpful to understand the
male reproductive system and how it functions. The testicles,
or testes, are the sperm- and testosterone-producing organs.
They are located in a sac at the base of the penis called the
scrotum. Each testicle is connected to a small, coiled tube
called the epididymis, where sperm are stored for as long as 6
weeks while they mature. The epididymes are connected to the
prostate gland by a pair of tubes called the vas deferens. The
vas deferens are part of a larger bundle of tissue, blood
vessels, nerves, and lymphatic channels called the spermatic
cord. During ejaculation, seminal fluid produced by the
prostate gland mixes with sperm from the testes to form semen,
which is ejaculated from the penis.
Preparation
Surgeons typically require men to do 4 things
before vasectomy:
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Shave and
wash the scrotum (to prevent infection and to allow easier
access)
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Bring a pair
of tight-fitting underwear or athletic supporter (to
support the scrotum and minimize swelling)
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Arrange for a
ride home (to minimize exertion and movement that
exacerbates swelling)
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Avoid
anti-inflammatory drugs, such as ibuprofen and aspirin,
before surgery (they thin the blood and can cause
excessive bleeding)
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Procedure
A urologist performs a vasectomy on an outpatient basis,
frequently in the office. The procedure takes about 30
minutes. The patient typically remains clothed from the waist
up and lies on his back. The scrotum is numbed with one or
more injections of local anesthetic (lidocaine), the vas
deferens is gathered under the skin of the scrotum, and a
small incision (usually 1 centimeter or less) is made. The vas
deferens is then pulled through the incision, cut in two
places, and a 1-centimeter segment is removed. Each end of the
vas deferens is surgically tied off or clipped, and placed
back in the scrotum. The incision is sutured and the procedure
is repeated on the other side of the scrotum. Some urologists
cauterize the ends of the vas deferens, but others find that
cauterization complicates reversal and is unnecessary. The
incisions are dressed and most men go home immediately after
the procedure.
No-scalpel Vasectomy
In the no-scalpel vasectomy, a surgical clamp is used to hold
the vas deferens while a puncture incision (instead of a cut)
is made with special forceps. The forceps are opened to
stretch the skin, making a small hole through which the vas
deferens is lifted out, cut, sutured or cauterized, and put
back in place. The puncture incision does not require
suturing. Some urologists recommend the no-scalpel method
because they find it is quicker and minimizes postoperative
discomfort and the risk for bleeding and infection. Recently,
as encouraging studies are reported, more vasectomies are
being performed using this approach.
"Scalpel vs. No-scalpel Vasectomy"
Vasclip® is an alternative to vasectomy that does not involve
cutting or cauterizing the vas deferens. In this procedure, a
small plastic device is clamped around the vas deferens to
prevent sperm from entering the semen. The Vasclip procedure
does not require urologists to modify their techniques for
scrotal access and closure.
Because the vas deferens is not cut or cauterized, Vasclip may
result in a shorter recovery time and fewer complications
(e.g., swelling, inflammation, infection) than vasectomy.
Statistics on reversal are not yet available. The procedure
should be considered permanent.
Postoperative Care
Rest and limited mobility are required for 1 to 3 days
following the procedure to reduce swelling and to allow the
vas deferens to heal. Most men lie on their back with their
feet elevated. Although it is not necessary to remain
immobile, excessive motion, lifting, and excessive walking
increases the chance for inflammation and bleeding in the
scrotum. Moderate discomfort is normal for a week or more.
Anti-inflammatory drugs and prescription painkillers may be
used. Ice packs applied 15 minutes on and 15 minutes off can
minimize swelling. Strenuous exercise and lifting should be
avoided for a few days or longer if it causes pain or
discomfort. The degree of discomfort should dictate activity,
as overexertion can postpone healing and a return to normal
routine. It may take a week before erection and ejaculation is
comfortable.
It may be necessary to keep the incisions dressed for a few
days to control bleeding from the healing incisions. Showering
is usually allowed, but soaking and swimming should be avoided
until the sutures have dissolved.
Additional postoperative
information
Sterility
Vasectomy does not result in immediate sterilization. Sperm
may live for more than a week in the vas deferens, between the
sutured ends and the ejaculatory ducts that lead to the penis.
For most men, it takes 10 to 14 ejaculations and 1 to 2 weeks
before the ducts are free of sperm. Usually, at least two
semen samples are produced and collected for analysis 1 week
to 1 month after the procedure. When sperm count is zero, the
man is sterile. Men who undergo any sterilization procedure
(e.g., vasectomy, no-scalpel vasectomy, Vasclip®) should use
another form of birth control until semen analysis confirms
sterility.
After sterility, semen is still ejaculated, but it lacks
sperm. The testes continue to produce sperm, but sperm are
prevented from reaching the prostate because they are blocked
in the tied-off vas deferens, where they die and are absorbed
into the body. Because semen is about 5% sperm, there is no
discernible difference in the amount of semen ejaculated after
vasectomy. The procedure does not affect testosterone
production or libido.
Complications
Serious complications are rare. Up to 10% of men experience
more pain, bleeding, or inflammation than others, and
discomfort may persist longer than expected. This may be
caused by a temporary buildup of pressure within the vas
deferens. In rare cases, sperm is present in the semen for up
to a year after surgery. This may be the result of poor sperm
migration out of the vas deferens after surgery, or it may
indicate that the severed ends of the vas deferens have
reattached, a condition called recanalization. The solution to
this problem is repeat vasectomy. Occasionally, a condition
called sperm granuloma develops, in which residual sperm make
their way out of the tied ends of the vas deferens, producing
irritation and a small nodule. These usually heal in time,
although surgical removal is occasionally required.
There is no evidence that vasectomy increases a man’s chance
for prostate cancer. Nevertheless, as a precaution, the
American Urological Association (AUA) recommends that men over
40 who had a vasectomy more than 20 years previously should
have an annual test for prostate cancer. Annual exams are
recommended for all men age 50 to 70.
Reversal
In most cases, it is possible to restore the flow of sperm to
the vas deferens. Vasovasostomy is a microsurgical procedure
that involves the use of a tiny camera and ultrafine sutures
to reattach the inside and outside of the vas deferens.
Vasoepididymostomy is performed when inflammation or scarring
from the original vasectomy blocks the epididymis and prevents
a successful vasovasostomy. The blockage is bypassed by
connecting the vas deferens directly to the epididymis in a
new location. Most vasectomy reversals are done on an
outpatient basis.
Needle aspiration is an alternative method to obtain sperm
after vasectomy. A special surgical needle is inserted
directly into the testes and sperm is collected in the
syringe. Sperm can then be used with a variety of alternative
insemination techniques.
For more information on vasectomy and vasectomy reversal visit
www.Vasectomy.com
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