Vasectomy

Vasectomy, or vasoligat ion, is an elect ive surgical procedure for male st erilizat ion or permanent
cont racept ion. During t he procedure, t he male vasa deferent ia are cut and t ied or sealed so as t o
prevent sperm from ent ering int o t he uret hra and t hereby prevent fert ilizat ion of a female
t hrough sexual int ercourse. Vasect omies are usually performed in a physician's office, medical
clinic, or, when performed on an animal, in a vet erinary clinic. Hospit alizat ion is not normally
required as t he procedure is not complicat ed, t he incisions are small, and t he necessary
equipment rout ine. The leading pot ent ial complicat ion is post -vasect omy pain syndrome.
 Vasectomy

Background

Type Sterilization

First use 1899 (experiments from 1785)[1]

Failure rates (first year)

Perfect use 0.10% [2]

Typical use 0.15% [2]

"Vas-Clip" nearly 1%

Usage

Duration effect Permanent

Reversibility Possible

User reminders Two consecutive negative semen specimens

required to verify no sperm.

Clinic review All

Advantages and disadvantages

STI protection No

Benefits No need for general anesthesia. Lower cost and

less invasive than tubal ligation for females.

Risks Temporary local inflammation of the testes,

long-term genital pain.
There are several met hods by which a surgeon might complet e a vasect omy procedure, all of
which occlude (i.e., "seal") at least one side of each vas deferens. To help reduce anxiet y and
increase pat ient comfort , t hose who have an aversion t o needles may consider a "no-needle"
applicat ion of anest hesia while t he 'no-scalpel' or 'open-ended' t echniques help t o accelerat e
recovery t imes and increase t he chance of healt hy recovery.[3]

Due t o t he simplicit y of t he surgery, a vasect omy usually t akes less t han 30 minut es t o
complet e. Aft er a short recovery at t he doct or's room (usually less t han an hour), t he pat ient is
sent home t o rest . Because t he procedure is minimally invasive, many vasect omy pat ient s find
t hat t hey can resume t heir t ypical sexual behavior wit hin a week, and do so wit h lit t le or no
discomfort .

Because t he procedure is considered a permanent met hod of cont racept ion and is not easily
reversed, pat ient s are usually counseled and advised t o consider how t he long-t erm out come of
a vasect omy might affect t hem bot h emot ionally and physically. The procedure is not oft en
encouraged for young single childless people as t heir chances for biological parent hood are
t hereby permanent ly reduced, somet imes complet ely.

Medical uses

A vasect omy is done t o prevent fert ilit y in males. It ensures t hat in most cases t he person will
be st erile aft er confirmat ion of success following surgery. The procedure is regarded as
permanent because vasect omy reversal is cost ly and oft en does not rest ore t he male's sperm
count or sperm mot ilit y t o prevasect omy levels. Those wit h vasect omies have a very small
(nearly zero) chance of successfully impregnat ing someone, but a vasect omy has no effect on
rat es of sexually t ransmit t ed infect ions.

Aft er vasect omy, t he t est es remain in t he scrot um where Leydig cells cont inue t o produce
t est ost erone and ot her male hormones t hat cont inue t o be secret ed int o t he bloodst ream.
Some st udies have found t hat sexual desire aft er vasect omy may be somewhat diminished.[4][5]

When t he vasect omy is complet e, sperm cannot exit t he body t hrough t he penis. Sperm is st ill
produced by t he t est icles but is broken down and absorbed by t he body. Much fluid cont ent is
absorbed by membranes in t he epididymis, and much solid cont ent is broken down by t he
responding macrophages and reabsorbed via t he bloodst ream. Sperm is mat ured in t he
epididymis for about a mont h before leaving t he t est icles. Aft er vasect omy, t he membranes
must increase in size t o absorb and st ore more fluid; t his t riggering of t he immune syst em causes
more macrophages t o be recruit ed t o break down and reabsorb more solid cont ent . Wit hin one
year aft er vasect omy, sixt y t o sevent y percent of t hose vasect omized develop ant isperm
ant ibodies.[6] In some cases, vasit is nodosa, a benign proliferat ion of t he duct ular epit helium, can
also result .[7][8] The accumulat ion of sperm increases pressure in t he vas deferens and
epididymis. The ent ry of t he sperm int o t he scrot um can cause sperm granulomas t o be formed
by t he body t o cont ain and absorb t he sperm which t he body will t reat as a foreign biological
subst ance (much like a virus or bact erium).[9]

Efficacy

Frequency Risk Source

1 in 1400 Unwant ed pregnancy (failure of vasect omy) [10]

1 in 11 For comparison: unwant ed pregnancy w/ t ypical use of pill [2]

1 in 6 For comparison: unwant ed pregnancy w/ t ypical use of condom [2]

1 in 40 Infect ion aft er surgery [11]

1 in 7 Pain at 7 mont hs aft er vasect omy [12]

1 in 110 Pain at 7 mont hs affect ing qualit y of life [12]

Vasect omy is t he most effect ive permanent form of cont racept ion available t o males.
(Removing t he ent ire vas deferens would very likely be more effect ive, but it is not somet hing
t hat is regularly done.[13]) In nearly every way t hat vasect omy can be compared t o t ubal ligat ion
it has a more posit ive out look. Vasect omy is more cost effect ive, less invasive, has t echniques
t hat are emerging t hat may facilit at e easier reversal, and has a much lower risk of post operat ive
complicat ions.
Early failure rat es, i.e. pregnancy wit hin a few mont hs aft er vasect omy, t ypically
result from unprot ect ed sexual int ercourse t oo soon aft er t he procedure while some sperm
cont inue t o pass t hrough t he vasa deferent ia. Most physicians and surgeons who perform
vasect omies recommend one (somet imes t wo) post procedural semen specimens t o verify a
successful vasect omy; however, many people fail t o ret urn for verificat ion t est s cit ing
inconvenience, embarrassment , forget fulness, or cert aint y of st erilit y.[14] In January 2008, t he
FDA cleared a home t est called SpermCheck Vasect omy t hat allows pat ient s t o perform
post vasect omy confirmat ion t est s t hemselves;[15] however, compliance for post vasect omy
semen analysis in general remains low.

Lat e failure, i.e. pregnancy following spont aneous recanalizat ion of t he vasa deferent ia, has also
been document ed.[16] This occurs because t he epit helium of t he vas deferens (similar t o t he
epit helium of some ot her human body part s) is capable of regenerat ing and creat ing a new t ube
if t he vas deferens is damaged and/or severed.[17] Even when as much as five cent imet ers (or
t wo inches) of t he vas deferens is removed, t he vas deferens can st ill grow back t oget her and
become reat t ached—t hus allowing sperm t o once again pass and flow t hrough t he vas deferens,
rest oring one's fert ilit y.[17]

The Royal College of Obst et ricians and Gynaecologist s st at es t here is a generally agreed-upon
rat e of lat e failure of about one in 2000 vasect omies— bet t er t han t ubal ligat ions for which t he
failure rat e is one in every 200 t o 300 cases.[18] A 2005 review including bot h early and lat e
failures described a t ot al of 183 recanalizat ions from 43,642 vasect omies (0.4%), and sixt y
pregnancies aft er 92,184 vasect omies (0.07%).[10]

Complications

Procedure

The t radit ional incision approach of vasect omy involves numbing of t he scrot um wit h local
anest het ic (alt hough some people's physiology may make access t o t he vas deferens more
difficult in which case general anest hesia may be recommended) aft er which a scalpel is used t o
make t wo small incisions, one on each side of t he scrot um at a locat ion t hat allows t he surgeon
t o bring each vas deferens t o t he surface for excision. The vasa deferent ia are cut (somet imes a
sect ion may be removed alt oget her), separat ed, and t hen at least one side is sealed by ligat ing
(sut uring), caut erizing (elect rocaut erizat ion), or clamping.[35] There are several variat ions t o t his
met hod t hat may improve healing, effect iveness, and which help mit igat e long-t erm pain such as
post -vasect omy pain syndrome or epididymit is, however t he dat a support ing one over anot her
are limit ed.[36]

Fascial interposition: Recanalizat ion of t he vas deferens is a known cause of vasect omy
failure(s).[37] Fascial int erposit ion ("FI"), in which a t issue barrier is placed bet ween t he cut ends
of t he vas by sut uring, may help t o prevent t his t ype of failure, increasing t he overall success
rat e of vasect omy while leaving t he t est icular end wit hin t he confines of t he fascia.[38] The
fascia is a fibrous prot ect ive sheat h t hat surrounds t he vas deferens as well as all ot her body
muscle t issue. This met hod, when combined wit h int raluminal caut ery (where one or bot h sides
of t he vas deferens are elect rically "burned" closed t o prevent recanalizat ion), has been shown
t o increase t he success rat e of vasect omy procedures.
 No-needle anest hesia: Fear of needles for inject ion of local anest hesia is well known.[39] In
2005, a met hod of local anest hesia was int roduced for vasect omy which allows t he surgeon
t o apply it painlessly wit h a special jet -inject ion t ool, as opposed t o t radit ional needle
applicat ion. The numbing agent is forced/pushed ont o and deep enough int o t he scrot al t issue
t o allow for a virt ually pain-free surgery. Lidocaine applied in t his manner achieves anest hesia in
less t han one minut e. Init ial surveys show a very high sat isfact ion rat e amongst vasect omy
pat ient s.[39] Once t he effect s of no-needle anest hesia set in, t he vasect omy procedure is
performed in t he rout ine manner. However, unlike in convent ional local anest hesia where
needles and syringes are used on one pat ient only, t he applicat or is not single use and cannot
be properly cleaned leading t o concerns regarding infect ion cont rol.

No-scalpel vasect omy (NSV): Also known as a "key-hole" vasect omy,[35] is a vasect omy in
which a sharp hemost at (as opposed t o a scalpel) is used t o punct ure t he scrot um. This
met hod has come int o widespread use as t he result ing smaller "incision" or punct ure wound
t ypically limit s bleeding and hemat omas. Also t he smaller wound has less chance of infect ion,
result ing in fast er healing t imes compared t o t he larger/longer incisions made wit h a scalpel.
The surgical wound creat ed by t he no-scalpel met hod usually does not require st it ches. NSV
is t he most commonly performed t ype of minimally invasive vasect omy, and bot h describe t he
met hod of vasect omy t hat leads t o access of t he vas deferens.[40]

Open-ended vasectomy

Open-ended vasect omy: In t his procedure t he t est icular end of t he vas deferens is not
sealed, which allows cont inued st reaming of sperm int o t he scrot um. This met hod may avoid
 t est icular pain result ing from increased back-pressure in t he epididymis.[9] St udies suggest
t hat t his met hod may reduce long-t erm complicat ions such as post -vasect omy pain
syndrome.[41][42]

Vas irrigation: Inject ions of st erile wat er or euflavine (which kills sperm) are put int o t he dist al
port ion of t he vas at t he t ime of surgery which t hen brings about a near-immediat e st erile
("azoospermat ic") condit ion. The use of euflavine does however, t end t o decrease t ime (or,
number of ejaculat ions) t o azoospermia vs. t he wat er irrigat ion by it self. This addit ional st ep in
t he vasect omy procedure, (and similarly, fascial int erposit ion), has shown posit ive result s but is
not as prominent ly in use, and few surgeons offer it as part of t heir vasect omy procedure.[36]

Other techniques

The following vasect omy met hods have purport edly had a bet t er chance of lat er reversal but
have seen less use by virt ue of known higher failure rat es (i.e., recanalizat ion). An earlier clip
device, t he VasClip, is no longer on t he market , due t o unaccept ably high failure rat es.[43][44][45]

The VasClip met hod, t hough considered reversible, has had a higher cost and result ed in lower
success rat es. Also, because t he vasa deferent ia are not cut or t ied wit h t his met hod, it could
t echnically be classified as ot her t han a vasect omy. Vasect omy reversal (and t he success
t hereof) was conject ured t o be higher as it only required removing t he Vas-Clip device. This
met hod achieved limit ed use, and scant reversal dat a are available.[45]

Vas occlusion techniques

Injected plugs: There are t wo t ypes of inject ed plugs which can be used t o block t he vasa
deferent ia. Medical-grade polyuret hane (MPU) or medical-grade silicone rubber (MSR) st art s
as a liquid polymer t hat is inject ed int o t he vas deferens aft er which t he liquid is clamped in
place unt il is solidifies (usually in a few minut es).[46]

Intra-vas device: The vasa deferent ia can also be occluded by an int ra-vas device (IVD). A
small cut is made in t he lower abdomen aft er which a soft silicone or uret hane plug is insert ed
int o each vas t ube t hereby blocking (occluding) sperm. This met hod allows for t he vas t o
remain int act . IVD t echnique is done in an out -pat ient set t ing wit h local anest het ic, similar t o a
t radit ional vasect omy. IVD reversal can be performed under t he same condit ions making it
much less cost ly t han vasovasost omy which can require general anest hesia and longer surgery
t ime.[47]

Bot h vas occlusion t echniques require t he same basic pat ient set up: local anest hesia, punct uring
of t he scrot al sac for access of t he vas, and t hen plug or inject ed plug occlusion. The success
of t he aforement ioned vas occlusion t echniques is not clear and dat a are st ill limit ed. St udies
have shown, however, t hat t he t ime t o achieve st erilit y is longer t han t he more prominent
t echniques ment ioned in t he beginning of t his art icle. The sat isfact ion rat e of pat ient s
undergoing IVD t echniques has a high rat e of sat isfact ion wit h regard t o t he surgery experience
it self.[48]

Recovery

Incision stitches and a shaved

scrotum

14 days after vasectomy surgery

Sexual int ercourse can usually be resumed in about a week (depending on recovery); however,
pregnancy is st ill possible as long as t he sperm count is above zero. Anot her met hod of
cont racept ion must be relied upon unt il a sperm count is performed eit her t wo mont hs aft er t he
vasect omy or aft er 10–20 ejaculat ions have occurred.[49]

Aft er a vasect omy, cont racept ive precaut ions must be cont inued unt il azoospermia is confirmed.
Usually t wo semen analyses at t hree and four mont hs are necessary t o confirm azoospermia.
The Brit ish Andrological Societ y has recommended t hat a single semen analysis confirming
azoospermia aft er sixt een weeks is sufficient .[50]
Post -vasect omy, t est icles will cont inue t o produce sperm cells. As before vasect omy, unused
sperm are reabsorbed by t he body.[51]

Conceiving after vasectomy

Prevalence

History

Society and culture

See also

References

External links

Retrieved from
"https://en.wikipedia.org/w/index.php?
title=Vasectomy&oldid=1120797781"

Last edited 6 days ago by 41.149.75.103