Posts Tagged ‘tubal ligation’

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

December 8, 2014

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

Vasectomy For Male Contraception-What Are the Alternatives?

October 10, 2014

A vasectomy is a method of male birth control that should be considered carefully as it is, for the most part, a permanent form of sterilization. The procedure using the no-scalpel, no needle technique can be done in minutes. However, reversing the vasectomy takes several hours in the operating room and is usually not covered by insurance. Before you move forward with a vasectomy, it is important to review vasectomy alternatives that are available.  If you have any doubts about having children in the future, you should explore temporary birth control options.

Tubal ligation, commonly referred to as getting your ‘tubes tied,’ is a procedure used for female sterilization. The fallopian tubes, the small tubes that transport the egg or ovum from the ovary to the uterus, are closed off by various methods (severed, sealed or pinched) to block the eggs from reaching the uterus.

Essure

Essure is a permanent method of birth control where small metal coils are placed in the fallopian tubes. The coils cause scar tissue to form, which blocks the eggs from reaching the uterus. The coils are inserted vaginally during a hysteroscopy procedure. Unlike tubal ligation, there are no incisions or anesthesia used. Birth control is needed for several months after the procedure until the scar tissue has completely formed.

Bottom Line: Vasectomy should be considered a permanent form of contraception. If there is a possibility that you might want more children in the future, I suggest that you consider temporary forms of birth control that are non-surgical. There are a variety of options available including condoms, birth control pills, cervical cap, diaphragm and, yes, abstinence!

The Sterilization Decision-Vasectomy vs. Tubal Ligation

May 25, 2012

You have had all the children you would like and you like to ensure that you won’t have another pregnancy then you need to make the sterilization decision.

So who is going to become sterilized? This him-or-her question should be decided with great care. For couples weighing whether they’re ready to permanently prevent pregnancy, here are some important questions to ask.

At this time men have just one option when they want to permanently turn off the possibility of sperm getting to an egg– and women can choose from several. For men, the option is a vasectomy. A doctor cuts and seals off the two tubes that allow sperm to travel from the testicles to the outside world.

The vasectomy can be done without a scalpel and without a needle to inject the local anesthetic so it is nearly painless. The procedure takes about 10-12 minutes but the man is not sterile right away. He needs to ejaculate approximately 15 times to purge sperm from the vas above the area where the occlusion of vas takes place. (See Figure)

After 15 ejaculations, a specimen must be examined under a microscopic to be absolutely certain that there is no sperm in the ejaculate and then the man is sterile.
Women can have a tubal ligation, also called a “tubal” or “getting your tubes tied.” Her fallopian tubes are sealed off, keeping her eggs from meeting any sperm. Or a doctor can do an in-office procedure in which he inserts tiny devices into the tubes through the uterus, blocking them permanently.
Women become sterilized nearly three times as often as men. About 16% of reproductive-age women had opted for tubal sterilization in 2002, compared to 6% of the male member of the relationship who submits to a vasectomy.

What Could Go Wrong?
Women were 20 times more likely to have a serious problem related to a tubal than men face from a vasectomy. In addition, men tend to recover more quickly from a vasectomy than women do from a tubal ligation. A tubal ligation requires anesthesia and deep incisions into her abdomen both of which are concerns.
The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.

How Much Does It Cost?
In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy.
If you have health insurance, check on whether it will cover the procedure and what costs may still be your responsibility. Talk with your health care provider to see what your costs are for other birth control options, since other forms of birth control may be more cost-effective.
Bottom Line: There are effective methods of sterilization. A discussion with your doctor will help you decide which one is right for you, vasectomy or tubal ligation.

The Contraception Conundrum-Vasectomy vs. Tubal Ligation

May 28, 2011

Every couple whose family is complete comes to a fork in the road and asks which partner is going to get either a vasectomy or a tubal ligation.  This blog will answer a few questions that may help you make a more informed decision.

First of all both procedures should be considered a permanent form of contraception or sterilization.  A vasectomy isn’t nearly as costly and invasive as the surgery to reverse it. And the odds that you’d be able to father a child again aren’t good enough to count it as a fall-back option down the road, Shih says.

What Could Go Wrong?

A report in a medical journal pointed out that women were 20 times more likely to have a serious problem related to a tubal ligation than men who select to have a vasectomy. In addition, men tend to recover more quickly from a vasectomy.  Most men can return to all activities, including sexual intimacy, 3-4 days after the procedure.   A tubal ligation requires a general anesthesia and incisions into her abdomen.  Both of these can result in significant complications.  However, if a woman is going to have her tubes tied during a planned C-section delivery, the added risk of the tubal is less of a concern.

A vasectomy can be done in the doctor’s office using a local anesthetic and usually takes less than 15 minutes.  The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.  Now that the procedure is performed without an incision but through a tiny puncture wound and does not even require a needle to provide the local anesthesia,

If you’re looking for instant results, a tubal holds the edge: It works immediately. After a vasectomy, a man can still get a woman pregnant until lingering sperm are flushed from his plumbing which usually requires 15 ejaculations.  So it’s crucial for couples to use a backup method of contraception until your doctor says you’re in the clear. And men need to provide a semen sample after a vasectomy that is examined under a microscope to be absolutely certain that no sperm are present.

The Essure and Adiana devices, which are inserted into the Fallopian tubes, also require a checkup to ensure that they’re installed properly and the woman can’t get pregnant.  If you choose these options, be sure you’re going to do the follow-up work. During the first three months after insertion of the device, another form of birth control must be used.

If you’re thinking about your bank account, In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy.

Bottom Line:  Most couples are happy when children are planned.  When the time comes to cut off  “reproduction production”, consider either a vasectomy or a tubal ligation.