Vasectomy

No Scalpel Vasectomy

Enough is Enough!For couples interested in permanent birth control, vasectomy is safe, convenient, and effective.  The Vas Deferens is the tube, which carries sperm to the ejaculatory ducts.  A doctor can easily feel it through the skin of the scrotum.   “No Scalpel Vasectomy,” is the name for the fastest and most painless method of vasectomy with the quickest recovery.  Although a traditional vasectomy is simple and effective, it requires a small incision in the scrotum.  Small blood and lymphatic vessels, and nerves are cut. No Scalpel Vasectomy employs the spreading of a tiny puncture wound in the numbed skin of the scrotum.  This pushes muscle fibers, nerves, and vessels aside, and allows the vas deferens to be exposed. The exposed Vas Deferens can be cut, and the ends can be sealed shut.  The puncture wound in the skin is so small that it seals itself shut.

 Recovery from No Scalpel Vasectomy

With No Scalpel Vasectomy, recovery time if fast.  To understand why this is so, consider your body’s response to an injury: If you bang your knee on a piece of furniture hard enough, it will swell up.  This is one of the most obvious signs of inflammation – the body’s response to injury.  Another symptom of inflammation is pain.  Inflammation peaks within 48 hours of an injury. The more tissue that is injured, the more swelling that occurs.  Bleeding prolongs inflammation by requiring the body to stop the blood flow with a clot.Quick Recovery After Vasectomy

The blood and clot must be re-absorbed.   All the fluid in the inflamed tissue must be absorbed as well.  Rest and elevating the injured body part speeds absorption.  Spreading the tissues of the body (as is done with No Scalpel Vasectomy) instead if cutting drastically reduces inflammation.  I advise my patients to rest, elevate their legs, and keep an ice pack on the scrotum as much as possible for 48 hours after the procedure.

  After No Scalpel Vasectomy

Freedom After Vasectomy

There are still sperm downstream of the vasectomy site after the procedure.  80% of men have no sperm in the ejaculate after 6 weeks.  Most of the others are free of sperm after 3 months.  This means you must use birth control after the vasectomy until it is confirmed that there are no sperm.  You may choose to check at 6 weeks or wait until 3 months.  There are reports of men who have persistent, rare sperm in the ejaculate.  The risk of pregnancy is thought to be far less than 1%.  Should that occur, the patient could decide to repeat the procedure.

There is no change in the amount of ejaculate after vasectomy.  Only the microscopic sperm are missing.  The only way to determine when this occurs is through microscopic semen analysis.he procedure.  80% of men have no sperm in the ejaculate after 6 weeks.  Most of the others are free of sperm after 3 months.  This means you must use birth control after the vasectomy until it is confirmed that there are no sperm.  You may choose to check at 6 weeks or wait until 3 months.  There are reports of men who have persistent, rare sperm in the ejaculate.  The risk of pregnancy is thought to be far less than 1%.  Should that occur, the patient could decide to repeat the procedure.

There is no change in the amount of testosterone in the body after vasectomy.  Physically, the “sex-drive” will not change.  Many couples experience a new freedom and spontaneity in their sexual relationship since birth control is no longer a concern.  There is no change in the ability to have or quality of erections (hardness of the penis).  There is no change in sensation during sex.

The No Scalpel Vasectomy Procedure


Vasectomy in the Office

What is it like to have a vasectomy?  It is done in the doctor’s office. Most men tolerate the procedure with just local anesthesia.  If you are nervous, we can give you some Valium when you arrive.  I send people home with a narcotic pain reliever for pain that is not controlled with an ice pack, or for sleeping (it’s hard to keep ice on your scrotum when you are asleep).  You can take one of these pills before the vasectomy as well.  We clean your skin with an antiseptic solution and apply numbing medication.  The numbing medication feels like a bee sting lasting one or two seconds.  After this, we test to make sure there is no pain.  Occasionally, you will feel a pulling or crampy sensation.  If you tell me this, I can adjust what I am doing to make things better.  I have had men have a “vaso-vagal” reaction due to anxiety – they feel light headed and faint, and sometimes nauseated.  It’s OK if this happens.  We can stop and let it pass.  This is rare, so I tell people that it’s OK to eat before the vasectomy.  It’s best not to have a heavy meal as it would make any nausea worse.  After the fifteen-minute procedure, you’re ready to go home.  You should not drive, either because of medications you may have taken, or because any minor discomfort may delay your reaction time should it be necessary to jam your foot on the brake.  A ride from a spouse, a friend, or a taxi is the best.  A short ride on public transportation is possible.

New York State Waiting Period Prior to Vasectomy

30 Day Waiting Period for VasectomyIt is a state law that you must sign an official consent form for permanent sterilization and then wait at least 30 days to have the procedure.  It is true for all vasectomies in New York. The consent form is good for 180 days.  This law was passed to protect people from unwittingly having any form of sterilization procedure, including tubal ligation.  You must sign the form again just before the procedure to re-affirm your consent.

Risks of No Scalpel Vasectomy

What’s the downside?  There are uncommon complications of vasectomy.

Sperm granuloma is the term for the body’s response to sperm leaking from an unsealed end of the Vas Deferens after vasectomy.  The no scalpel vasectomy technique is designed to prevent this through cautery of the inside of the tube, and clipping the end shut with a tiny titanium clip.  Sperm granulomas are tender nodules in the scrotum.  They are treated with ibuprofen.

Epidiymitis is inflammation of the coiled end of the Vas Deferens (near the testis).  It is temporary and can be confused with sperm granuloma.

Chronic Pain is usually the result of a sperm granuloma or excessive inflammation.  No Scalpel Vasectomy greatly reduces both compared to traditional vasectomy.

Failure of vasectomy results from communication between the two cut ends of the Vas Deferens.  Removal of a segment of the Vas Deferens helps prevent this.  A sperm granuloma can be the cause, because it indicates the presence of a sperm filled space between the two ends and the fact that at least one end is open.  We remove a segment of the Vas Deferens, cauterize the inside of the tube, and clip the end of the tubes closed to prevent this.  The rate of re-formation of the vas has been shown to be 1/500 short term, 1/4500 long term.

Infection can occur to due to bacteria on the skin.  A wound infection would appear 3 – 5 days after the vasectomy.  Pus from the puncture site, increasing redness, swelling, and pain, or fever indicate infection. Aseptic technique and bacitracin are used to prevent this. It is treated with oral antibiotics but occurs at such a low rate, we do not give antibiotics unless it occurs.  A large study of almost 180,000 men who underwent vasectomy using no scalpel technique demonstrated infection in only 1,631 men (0.91 %).1

Bleeding

Bruising is common and does not indicate a poor outcome.  A few drops of blood on the dressing over the puncture wound are typical and is not of concern.  Because it spreads tissue and pushes blood vessels aside, No Scalpel Vasectomy will reduce bleeding that fills the scrotum and must be absorbed.  A large study of almost 180,000 men who underwent No Scalpel Vasectomy demonstrated this rate of bleeding in only 160 men (0.09 %).1

References

1 Li S., Goldstein M., Zhu J., et al: The No-Scalpel Vasectomy. J. Urol 1991; 145; 341-4.

 Vasectomy Reversal

Reversal of vasectomy is possible.  It requires highly technical skill involving suturing with materials thinner than a human hair under a microscope.  It is expensive and is often a seven hour procedure.  Results are better if time from vasectomy is shorter, and if there is a sperm granuloma.  Obviously, surgeon volume will result in better outcomes and surgeons who can achieve truly good outcomes are rare.  For this reason, I counsel my patients to choose a different form of contraception if they think that they will desire reversal in the future.

The focus of my practice is not on vasectomy reversal.  Given the highly specialized and technical nature of this procedure, I have chosen to refer reversal to a specialist.  One such specialist is Marc Goldstein, M.D.  He is a pioneer in the field who trained me to perform the No Scalpel Vasectomy, and I have spent many hours assisting him in vasectomy reversal.  I owe a debt of gratitude towards Dr. Goldstein.  He practices in New York and is a professor of Medicine at Cornell University Medical School.

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