Vasectomy

Fertility Treatments

Vasectomy

It is performed in less than twenty minutes, local anaesthesia is used in most cases and has a very tolerable postoperative period with little discomfort.

Vasectomy

Table of Contents

DEFINition

What is vasectomy?

Vasectomy is a permanent method of contraception for men. It is based on the ligation of the vas deferens at the scrotal level in order to prevent the passage of sperm from the epididymis to the urethra at the time of ejaculation.

It is a minor surgery, relatively simple and highly effective, which does not affect sexuality. It is currently one of the few methods that allows men to take personal responsibility for contraception.

It is performed in less than twenty minutes, local anaesthesia is used in most cases and has a very tolerable postoperative period with little discomfort. The vasectomy does not affect the quality of the erection, sexual desire, ejaculation, or orgasm. The patient can return to his normal sexual life a week after the operation, although an extra method of contraception must be used until the absence of sperm in the semen analysis test is proven, which will finally guarantee the success of the surgery.

Simplified view of vasectomy

Simplified view of vasovasostomy

Medical evaluation

Level of efficiency

When the effectiveness of this method is measured, the absence of pregnancies is evaluated, with the vasectomy having a failure rate of about 0.5%.

Post-operative semen analysis is a fundamental part of evaluating the effectiveness of the surgery and for the required follow-up of the patient, this is preferably done 3 months after the vasectomy, when the patient has already had about 20 to 25 ejaculations, due to the slowness with which the sperm move in the vas deferens, measuring approximately 50 centimetres in length.

It is important to remember that as long as the seminogram does not result in a total absence of spermatozoa, the patient must continue using an additional contraceptive method during sexual relations, and the test must be performed monthly until azoospermia is determined.

In some cases, a low number of immobile spermatozoa (less than 100,000 immobile spermatozoa per millilitre) may persist for a prolonged period of time. In these cases, follow-ups may also be discontinued, since many studies have shown that azoospermia is reached after 3 years.

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It is a minor surgery, relatively simple and highly effective, which does not affect sexuality. It is currently one of the few methods that allows men to take personal responsibility for contraception.

If the seminogram shows a total absence of spermatozoa, the surgery is considered successful and the patient will be able to have sexual relations without the need to use other contraceptive methods and without the fear of unwanted pregnancies.

Usually 80% of men achieve these results within 3 months after surgery. In case of persistence of motile spermatozoa after 6 to 8 months of follow-up, it is advised to redo the vasectomy.

Techniques and treatment

Contraceptive counselling

Vasectomy should be considered as a semi-permanent method of contraception, so both the individual and his couple should study and discuss very well the decision to perform or not this surgical procedure. It is recommended that the individual be satisfied with his genetic desire at the time he chooses this method of contraception.

There are certain considerations that the physician should keep in mind:

Indications

The main indication is to provide the man with permanent contraception, it is generally performed in healthy patients who only seek to have control of their fertility, however, sometimes it is performed because of the existence in the patient of transmissible genetic alterations, psychic disability or another type of transmissible diseases. Another medical indication that exists, occurs when the patient’s partner has contraindicated pregnancy, either by high-risk obstetric birth or other maternal-fetal disorders.

Contraindications

There are no absolute contraindications for the performance of this procedure, however, there are some conditions that deserve to be evaluated and corrected by the medical team to carry out this surgery, some of these are:

Other relative “social contraindications” could be: under 30 years of age, no children or no relationship at the time of deciding on the procedure.

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Techniques and treatment

Surgical techniques

Vasectomy seeks to achieve discontinuity of the vas deferens, this can be done on an outpatient basis and under local anaesthesia, however, general anaesthesia may be necessary for specific indications.

Different techniques can be applied to achieve discontinuity and occlusion of the ducts:

1. Conventional technique (by Schmidt), lateral, medium, longitudinal or transversal incisions

General anatomy of the testicles

In this technique two incisions are made, one on each side of the medial scrotal raphe or through a single incision that allows access to both vas deferens. The objective is to reach and visualize the vas deferens, open the sheath that covers it and then section it. It is not determined whether the vas deferens should be ligated or whether the lumen should be cauterized.

Vasectomy surgical intervention

No-scalpel vasectomy technique

2. No-scalpel” technique, Percutaneous vasectomy technique (no-scalpel, or Li Shunqiang or No-scalpel vasectomy)

This is the technique we perform at Andromedi in the vast majority of cases. It was developed by Li Shunqiang and collaborators, to increase the acceptance of the procedure by avoiding the fear of incision. Here we can penetrate the skin without the use of a scalpel, employing special instruments, such as thin-tipped pliers that will allow entry into the scrotum and another one to hold the vas deferens. Frequently, no skin suture is needed since the buttonhole that has been made does not bleed and by the same contraction of the skin, its correct healing is produced.

This technique is very minimally invasive and is widely accepted because of its low rate of early complications, such as infections, hematomas and less postoperative pain.

3. Chemical occlusion of the vas deferens

It is a technique that was also developed by Dr Li Shunqiang, it has the same principle as the no-scalpel technique, but in this one it is used the injection of a compound of phenol and cyanoacrylate into the lumen of the vas deferens, this product coagulates and forms a plug in the lumen blocking the passage of the sperm.

The disadvantage is that it has a higher failure rate than vasectomy, and the toxicity or carcinogenicity of the product in the body has not been ruled out.

· Complications ·

There are few complications associated with vasectomy, but among the most frequent there are:

Post-operative bleeding and hematoma

It occurs in 4-22% of all vasectomies. If the bleeding is small, it subsides without treatment, while if it is extensive, drainage may be necessary.

 

Infection of the surgical wound or adjacencies

If the surgery is performed under aseptic conditions and with a qualified team, the occurrence of infections is very rare, however, they occur in 0.2-1.5%, they are usually mild and limited to the wound area, in cases of orchitis and epididymitis the use of broad-spectrum antibiotics is recommended.

Chronic scrotal pain

It may occur in 1-14% of patients, is usually a mild pain, which may require medical and surgical treatment.

Early recanalization

This occurs when, after 3 and 6 months of the intervention, there is persistence of motile spermatozoa in the ejaculated fluid for which reintervention is indicated. This occurs in 0.2 to 5% of cases.

Post-operative care

It is recommended that the patient get absolute rest the day after the intervention, with subsequent return to their daily activities, however, it is indicated not to have sexual relations for at least 3 days after the intervention, also refrain from sports or physical exercise for a period of 4 to 6 weeks approximately.

It is indicated to maintain the wound clean and dry, being able to apply cold on the scrotum to help to reduce the pain and the inflammation. The patient is also instructed to wear tight-fitting underwear after surgery to reduce possible pain and swelling in the area.

Frequent questions

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Is vasectomy a safe method?

Vasectomy is one of the most effective surgical methods of contraception, with a failure rate of less than 1% – about 4 men in 1000 would remain fertile even several months after the vasectomy.

Technical failures could occur with inexperienced surgeons and result in failure due to gradual reconnection of the vas, formation of a new channel, lack of identification and cutting of the vas, for this reason, it is important to complete the seminogram checks to verify the effectiveness of the operation.

Is it a painful procedure?

It is a procedure where local anaesthesia is used and in some cases, general anaesthesia is required, some surgical and post-operative discomfort can be felt, then inflammation and areas of hematoma can be observed, with slight pain, for which non-steroidal analgesics are indicated to help control all these effects.

Will a vasectomy affect my sexual activity?

The post-vasectomy patient’s sex life is completely normal and will not be affected at all. His erections, orgasms and ejaculations will continue as usual. His sexual desire will remain the same as before the operation.

The amount of semen after the operation is only reduced by 5% and retains its usual characteristics. Only with the use of a microscope is it possible to visualize the absence of sperm in the seminal fluid.

What can I do if I regret it and want to reverse the operation?

Although vasectomy is considered an irreversible technique, there is currently the possibility of reversing it, through the vasovasostomy technique, recanalization of the vas deferens is achieved.

The success of this procedure will depend primarily on the quality and quantity of sperm (for conception by natural means) and the technique used in the initial operation, the greater the number of vas deferens that was resected, the less successful the recanalization can be.

It is often said that the time elapsed from the vasectomy also contributes, a time greater than 10 years is also associated with fewer probabilities of success, something that in our long experience in the operating room has not happened.

Does vasectomy protect me from sexual diseases?

Vasectomy does not offer any protection against sexually transmitted diseases, so it is recommended to take other measures such as the use of condoms, reducing or avoiding multiple sexual partners and in more extreme cases, sexual abstinence.

How much does it cost to get a vasectomy?
The price varies depending on the hospital centre where the procedure is performed and the medical fees, however, the cost (all-inclusive) in our office in Seville is approximately 1000 euros.
Will a vasectomy affect my male hormones?

Vasectomy does not affect any male sexual characteristics, as the release of male hormones produced in the testicles continues to occur normally and in the usual amount. These hormones are released directly into the bloodstream and are not interrupted by the cutting of the vas deferens.

Therefore, it is a myth that vasectomy causes erection problems, female traits in men, and that it sharpens the tone of voice.

Are there long-term complications after a vasectomy?

There is no increased risk of prostate or testicular cancer in patients after vasectomy. Nor is heart disease or atherosclerosis associated with this procedure, which is why the World Health Organization considers vasectomy very safe and without long-term complications.

What happens to the sperm after a vasectomy?

Testicular cells continue to produce sperm, but they are naturally reabsorbed by the body, just as when a man has days without ejaculating. This is a normal process and has no complications.

 

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.