Vasectomy and Vasectomy Reversal

No Scalpel Vasectomy

The no scalpel vasectomy is a minimally invasive, low discomfort and extremely effective form of permanent contraception. Vasectomy is a very reliable form of contraception with a failure rate far lower than that of tubal ligation or use of the oral contraceptive.

Vasectomy involves excising a segment of vas deferens which are the tubes which carry sperm from the testicles to the prostate gland. Following vasectomy there is no perceptible change in the appearance or volume of semen, this is because the majority of the ejaculate is compromised of fluid produced by the prostate gland and seminal vesicles. Vasectomy can be reversed however reversal is a technically difficult & expensive procedure without a guarantee of success. For these reasons vasectomy should be considered permanent.

Procedure

Most vasectomies are performed in the office under local anaesthetic only. Some men prefer oral sedation and some a general anaesthetic.

Delivery of anaesthetic is via a fine spray or needle. Following this the vas is grasped in a small ring clamp then the skin overlying the vas is split over a 5mm length. A 1cm segment of vas is excised then the ends of the vasa are cauterised and one end of the vas buried in the sheath. This results in a very low failure rate. A suture is not usually used to close the skin. The procedure takes 30 minutes. Prior to vasectomy please shave the hair from the front of your scrotum.

Preparation for Surgery

A fifteen minute consultation with Rod Studd will cover important details of the surgery. A brief examination will be performed and you will have the opportunity to ask questions. An appointment for the procedure will be made. If you would like oral sedation prior to the procedure then come in 45 minutes prior to surgery & we will give you a mild sedative.

Two hours before surgery you should have a shower and thoroughly wash the scrotum, penis and area around the anus. Following this dry off the area and put on a clean pain of underpants. This helps reduce the numbers of bacteria present and thus lower the risk of infection.

Post Procedure

Unless you have received sedation you should be able to drive home following vasectomy. We advise taking the remainder of the day off work. Most men can return to a desk type job the following day however heavier work involving lifting should be avoided for five days. As the local anaesthetic wears off an ache usually develops.  Regular paracetamol (2 tablets four times per day) is recommended for four days. Sex can be resumed once you feel comfortable. Contraception needs to be continued until the semen tests show a clear sperm count. The first count should be at three month weeks post vasectomy. Semen is collected by masturbation into the specimen container provided then delivered to the laboratory. We will contact you with the results of the test. If the sperm count is not clear then the test needs to be repeated four weeks later. If you have any concerns following surgery then you should contact my office.

Risks

Pain

Resolution of the initial mild discomfort associated with surgery usually takes one to two weeks. In a minority of men, pain can however persist or re-appear months or years following vasectomy. The usual cause of this pain is congestion of the epididymis due to ongoing sperm production with an occluded vas. Sperm granulomata can form – these are peas sized tender nodules adjacent to the epididymis. They remain tender for several weeks before naturally resolving.

Infection and Haematoma

If an infection develops then you will notice increasing pain, swelling and redness of the scrotum. Contact us if you suspect infection. A haematoma is a collection of blood beneath the skin. Haematoma occurs due to bleeding from small vessels around the vas or in the skin. If you notice increasing swelling then a haematoma may be present. And you should contact our office. A small haematoma can be managed simply by scrotal support and rest. In the unlikely event of a larger haematoma occuring then repeat surgery to drain the haematoma may be required.

Failure of the Vasectomy

Failure means that viable sperm remain in your ejaculate, this may lead to pregnancy. Viable sperm will remain in your ejaculate for several weeks following vasectomy. For this reason you must continue with contraception until a semen test at three months shows no viable sperm. Following vasectomy there is a small chance that the vas may heal (termed re-canalisation) thus allowing sperm to pass through and cause a pregnancy. The risk period for re-canalisation is within the first three months, this is one reason why we recommend delaying the first semen test for three months. Re-canalisation after three months is extremely rare (a one in several thousand chance).

Sperm Storage

Sperm may be collected and stored for potential future use prior to vasectomy. This service is available through Fertility Associates: Phone: 04 384 8401. Email faw@fertilityassociates.co.nz

Vasectomy Reversal

It is possible to reverse the vasectomy by reconnecting the cut ends of the vas. This is delicate microsurgery. The chances of success of the reversal relate in large part to the time from vasectomy. The longer a man has had a vasectomy the more likely it is that there will be upstream epididymal scarring leading to obstruction within the epididymis. Epididymal obstruction is not reversible. In most men, sperm will return to the ejaculate however, only 50% of men will father a child following reversal.

Change of life circumstances leading to a desire for further children is the most common reason for vasectomy reversal. Long-term pain following vasectomy may also be an indication for vasectomy reversal.

Reversal of vasectomy is a very different operation to vasectomy. Reversal of vasectomy is a microsurgical operation. An operating microscope, microsurgical instruments and very fine sutures are used to re-connect the vas deferens. The procedure is performed under a general anaesthetic and usually takes 1-2 hours.

Procedure

Vasectomy reversal is performed in an operating theatre under a general anaesthetic. 1-2cm skin incisions are made on either side of the scrotum. The cut ends of the vas are identified and the blocked sections excised. An operating microscope is used to magnify the field then fine sutures used to suture the ends of the vas back together. Several layers of sutures are placed. Following this the skin wounds are closed.

Post-procedure

Most men are able to head home on the day of surgery. Most men can return to normal non-strenous activities within a week of surgery. Vigorous exercise and sex should be avoided for one month.

Success Rates

Sperm returns to the ejaculate in most men. The shorter the time from vasectomy, the higher the chance of a successful reversal. This is due to long term vasal obstruction causing upstream scarring and obstruction of the epididymis. Return of sperm to the semen may take several months. The chance of a successful pregnancy rests not only on sperm being present in the semen but also importantly on your partners age. The younger your partner the higher the chance of successful pregnancy

Risks

Wound Problems

Swelling – It is common for the scrotum to temporarily swell with fluid following surgery; this usually subsides over one week.

Infection

Increasing pain, swelling and wound redness may be indicators of infection. Should you notice these signs or symptoms then please contact my office.

Return to Work

Most men can return to work within seven days of vasectomy reversal. If you have a more physical job then you will need to avoid strenuous activity for four weeks.

Follow-up after Surgery

A semen test will be ordered three months following surgery. The results of this test will be discussed with you at the three month appointment.