No-Scalpel, No-Needle Vasectomy-The Prime Cut

Most practices are impacted at the end of the year by the rush of patients who have met their deductibles. In Urology, aside from patients wanting to get stones busted (Lithotripsy), scrotal issues addressed, and an occasional prostate; by far and away, the number of vasectomies that are done in December is at least 4-5 times the number that our offices perform during any of the other months. The following is intended for any questions that you may have regarding vasectomy and is based on more than 5,000 vasectomies I have performed over 30 years of urologic practice.

Vasectomy Facts

1. Average time for the procedure is 6-8 minutes.

2. Patients are not given any narcotics as Aleve or Advil are sufficient for any discomfort. Less than 1 in 100 patients require a narcotic prescription.

3. Patients are offered the option of Valium 20 mg. to take prior to the procedure with instructions to have a driver.

4. 95% of the men who come in for a vasectomy consult go on to have the procedure.

5. The biggest fear is of someone they do not know holding sharp instruments and working on their scrotum while they are awake. Because of proper education, including an article given to all patients prior to have the procedure, men need not worry about the vasectomy impacting their sexual function.

6. The sperm make up only 5% of the ejaculatory volume so no noticeable change in the semen volume.

7. Rarely men will be seen following the procedure for some discomfort and typically, it is related to some inflammation or small hematoma and Tylenol or Advil are more than adequate.

8. Because of the way the procedure is performed, it is very rare to see a scrotal hematoma, which can occur and creates a small swelling of the scrotum. This occurs most often in men who do not heed the advice of going home, lying down and keeping ice on the incision.

10. Occasionally, a question is asked regarding sperm banking and this can be done in a facility in one of the infertility clinics in the area.

11. Vasectomy reversal is a formal surgical procedure that can take anywhere from 1-1/2 to 2 hours to perform. Through a scrotal incision, the testicle and spermatic cords are brought into the surgical field. The ends of the vas identified, freshened up and scar tissue removed and an operating microscope is used to perform a surgical closure using typically anywhere from 7-0 to 9-0 permanent suture. Success rates for vasectomy reversal is approximately 75% within the first 10 years and drops to about 30% after 10 years.

Anatomy

The vas deferens is a small tube approximately 3 mm (1\8 inch) in diameter that carries sperm from the testicle up into the body where it unites with the seminal vesicles and stores the sperm until ejaculation when the semen is deposited in the vagina in order to fertilize an egg and start the process of conception.

No Scalpel Procedure

Following anesthetizing the skin in the mid-section of the scrotum with a device that deposits the anesthetic without the use of a needle. Then a single puncture is made about 1\4 of inch in length in the middle of the scrotum. Each vas is occluded with very small titanium clip. No sutures or stitches are required. The patient lies on the table for a few minutes and then goes home and lays flat in bed for a few hours using ice over the scrotum for 45 minutes out of every hour until going to sleep.

Office visits

A vasectomy consultation is always performed before the procedure for a number of reasons:

1. To explain the procedure to the patient.

2. To allay fears, address misconceptions, and put the patient at ease.

3. To ensure anatomically that there are no problems with performing the vasectomy which include an extremely large patient with small scrotum, prior evidence of infection, and to screen for extremely anxious patients who probably would not tolerate the procedure being performed in the office under local anesthesia.

4. Pre-procedure instructions are given including the need to shave all the hair on the scrotum preferably the night before.

5. Men are given a prescription for Valium, which they should take 30-45 minutes before the procedure. If the man takes the Valium pill, then he will need a ride home as he should not drive a car after using Valium.

6. Post-procedure instructions are given including the need to go home and stay off his feet and keep ice on for two days. Sexual intercourse can begin typically 3-4 days post- procedure. Additionally the men are instructed to return for a follow-up visit. It takes approximately 15 ejaculations to clear all sperm from the portion of the vas above the legation of the vas.

6. Typically, a man makes a follow-up appointment at 6-8 weeks although the record is one week, but he wasn’t married! They are also informed of the 1 in 1500 chance of reconnection of the vas.

Summary

The majority of men have the procedure performed on Thursday or Friday, spend the weekend resting with ice, return to work on Monday and are back to regular activity including intercourse by Wednesday or Thursday of the following week.

Bottom Line: Having done more than 5,000 vasectomies, I can think of very few men who would not be willing to undergo the procedure again or recommend it to a friend. Certainly, in comparison to tubal ligation, which requires general anesthetic, it is a much simpler, less costly and less painful form of sterilization.
Don’t hesitate to give me a call if you have any questions about vasectomy or go to my website to view a video on vasectomy: http://neilbaum.com/videos/vasectomy

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