Vasectomy - Education

How vasectomy works

Sperm are formed in a man's testes, and they mature in an area attached to the testes called the epididymis. It takes nearly 90 days from the time of sperm production for them to travel gradually up two tubes called the vas deferentia and then become available for ejaculation. Before ejaculation, fluids from the seminal vesicles and the prostate are combined with sperm to form semen. Vasectomy interrupts this process by closing off the vas deferentia, preventing the sperm from joining the other fluids. Because the sperm's contribution to volume is less than 5 percent, there is no noticeable change in the man's semen.

penis A man's virility is not affected by vasectomy, because it doesn't change the testes' production of the male hormone, testosterone. His sex drive, potency, male characteristics, and sexual pleasure should be unchanged. In fact, roughly 30 percent of men report improved sexuality after a vasectomy, most likely because the worry of pregnancy is eliminated. After a vasectomy, sperm continue to be produced but at a decreased rate. Those that are produced die and are absorbed by the body.

How a vasectomy is done

Vasectomy is a minor surgical procedure completed in the doctor's office that removes a small section of each vas deferens and seals off the ends. Prior to the late 1980s, most vasectomies were done using a small scalpel, took about 30 minutes, and required a couple of days for full recovery.

In 1974 Dr. Shunqiang Li introduced the no-scapel technique in China. The no-scapel technique uses specially designed instruments to access both vasa through a single tiny puncture hole in the scrotum. The no-scapel technique was introduced in the United States in 1985. Dr. McClure, founder of Landmark Urology, has been using the no-scapel technique since 1997. Dr. McClure has performed over two thousand no-scapel vasectomies since 1997. Dr. McRackan also routinely performs no-scapel vasectomies.

The no-scalpel vasectomy simplifies the procedure, reducing the total time to about 20 minutes. As no incision is made, no stitches are required. Discomfort during and after the procedure is reduced, complications such as bleeding are minimal, and recovery is quicker.

No-Scapel Technique

The scrotal skin is anesthetized with local anesthesia prior to making a puncture hole in the scrotal skin with the sharp point of a specially designed hemostat. The vasa are individually isolated between the thumb and first two fingers. Local anesthesia is then carefully injected superiorly into the fascia surrounding the vasa. This maneuver anesthetizes the nerve supplying sensation to vasa.

Once the area has been thoroughly anesthetized, a specially designed ring clamp is used to secure the vas. The no-scapel hemostat is then used to dissect the vas from the surrounding fascia and neurovascular tissue. Next, a tiny Titanium hemoclip is used to occlude each end of the vas and a 1 cm portion of vas is excised. An absorbable suture is used to enclose the distal end of the vas with a veil of surrounding tissue. Both ends of the vas are then allowed to retract to their normal position. An identical procedure is performed on the other vas.

The puncture wound is approximated with a single absorbable suture. The suture material usually absorbs within a week. A Band-Aid is applied over the incision. The area remains anesthetized for several hours. Men are encouraged to stay off their feet for the rest of the day and apply an ice pack to the area. Activity can be gradually increased over the next 48 hours. Normal activity can be resumed thereafter. Sexual activity can be resumed within a week.

Click here to download a pdf with information on the no-scalpel vasectomy procedure.

Complications from vasectomy

Complications are typically minor and only occur in less than 5% of vasectomy procedures. Additionally, there has never been a death with a vasectomy. As is the case with any surgical procedure, there's always a minor risk for bleeding, infection, or allergic reaction to the anesthetic, causing a rash. Complications specific to vasectomy include the possibility of a sperm granuloma, testicular pain, and epididymitis. Also, in very rare instances, a man can lose a testicle.

A sperm granuloma occurs if sperm leak from the vasectomy site or a rupture in the epididymis and provoke an inflammatory reaction. About a half-inch in diameter, they require further attention in only about two percent of men. About one percent of men experience aching testicles from congestion in the epididymis. This usually disappears within six months. Epididymitis is an inflammation at the vasectomy site, usually taking place within the first year. Heat and anti-inflammatory medicine usually clear it up in about a week.

Without a doubt, the most common complication we see is swelling of the scrotum and this is seen when men refuse to take it easy for a couple of days after a vasectomy. Regrettably, once the swelling starts, it may take two weeks for it to reduce completely, so prevention is the best method.

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