|
|
A vasectomy is on operation to remove a small portion of the sperm ducts in the scrotum to create "permanent" sterility in men. It should not be done when there is any chance that the patient may want to have children again in the future.
Using either local anesthesia and/or sedation, an incision is made into the scrotum, (sac), the vas, (sperm tube), is dissected from the scrotal tissues and a segment removed. The vas ends are then sealed using either cautery, (welding shut), a permanent tie, or clips. Frequently tissue is sewn between the vas ends, to help prevent regrowth. The procedure is repeated on the other vas, and the incision(s) sewn shut with an absorbable stitch. Some surgeons use one incision, some two. (There is a procedure known as the no scalpel vasectomy, where instead of cutting the skin with a scalpel, it is torn open with a very sharp clamp. Otherwise the procedure is the same. (see P.T.Barnum)).
We usually do them at MAUI, but vasectomies can be done in some doctor's offices or a hospital.
How long does it take?
15 to 45 minutes.
How long is recovery?
We recommend 2 days of minimal activity and 4-5 days of no heavy activity or athletics. Usually patients return to full activity at that time though some may have discomfort for a longer period.
What complications can happen?
Bleeding and infection are
the most common problems and a very rare patient may require hospitalization to
control bleeding or infection. On a rare occasion, (less than 1 in a
thousand vasectomies), the vas can regrow or recanalize. This can
happen in two months or twenty years. Rarely a painful lump called a sperm
granuloma may appear early or late. This is a result of the vas trying
to regrow. Sperm granulomas are usually removed surgically. There
may be chronic pain in the scrotum. Several years ago there was a
controversial article suggesting that patients who have had vasectomies are at higher
risk of prostate cancer, although there in no rational for this. There
have been multiple studies which have not confirmed this finding. We
recommend that patients who have had vasectomies more than 20 years previously
get an annual check, (digital rectal examination and PSA blood test). On
the other hand we recommend this for all men over 50, (40 for those with strong
family histories of prostate cancer and African-Americans). In an
exceptionally rare case a testicle may shrivel up or atrophy. This is
more likely in patients who have had previous scrotal or hernia surgery but is a
rare occurrence.
Will it hurt?
Usually not much, but we do give pain medication, and a rare patient has long lasting discomfort.
When will I be able to have unprotected sex?
Not until a negative sperm count is received 6-8 weeks after surgery. It usually requires a minimum of 10-12 ejaculations, but may take longer, especially in older patients.
No, sperm are only about 1% of the ejaculated fluid. You should not see any difference, although there might be a little blood in the first few ejaculates. Vasectomy does not affect testosterone production.
Yes. Recanalization occurs in less than 1 in a thousand vasectomies, but can occur in 2 months, two years or twenty years. We have sperm counts done at 4-8 weeks. If a patient wants later checks, they can be done.
Vasectomy reversals can be done but the success rate in terms of fertility run about 40%. The longer the interval between the vasectomy and the reversal, the less the odds. Some men develop allergy to sperm, so that even if a reversal stays open, the sperm are of poor quality. Reversals may scar and close, so they should be done when a couple is ready to conceive.