Vasectomy

Vasectomy is an operation performed on men to achieve permanent

sterility. Vasectomy is not castration and does not alter a man's sex drive
or sensation of orgasm. Furthermore, it does not alter the male sex
hormones or the male sex characteristics. Approximately 500,000
vasectomies are performed in the U.S.A. every year. he operation is
easily and most commonly performed in an out!patient office setting and
is inexpensive. "atients have the procedure, then leave shortly thereafter,
either driving themselves or #eing driven home.
Anatomy and Physiology
$n men, the testicles %testes& produce the sperm 'hich unites 'ith the
egg in a 'oman to produce a fetus.
he structures that ma(e up the male sexual apparatus are
%Figure )&
Figure ). *ormal male reproductive
anatomy

). esticles %testes& are the t'o small egg shaped structures that
are in the scrotum, the #ag!li(e structure #ehind and #eneath the
penis
+. ,pididymis is -!shaped structure that sits a#ove the testicle. $t is
composed of ). !+0 feet of a very thin coiled tu#e
/. Vas deferens %sometimes called the ductus deferens& is a
heavier tu#ular structure that passes out of the scrotum to'ards
the seminal vesicle and prostate gland. $t is accompanied #y the
testicular artery, vein and nerve, 'hich together form the
spermatic cord
0. Seminal vesicles are clu# shaped structures a#out t'o inches in
length and 1 inch in diameter that lie on the #ac( of the #ladder
5. "rostate gland is a 'alnut shaped structure that surrounds the
urethra as it exits the #ladder
2. Urethra is a tu#ular channel that extends from the #ladder to the
tip of the penis
3. "enis is the male sexual organ. $t encloses the urethra
he sperm from a testicle %testis& travels through the epididymis,
then through the vas deferens and enters into the seminal
vesicles 'here the sperm mixes 'ith a fluid called seminal
plasma
he seminal plasma also contains fluid from the prostate gland.
he sperm mixes 'ith the seminal plasma and, during the act of
intercourse 'ith e4aculation, the seminal plasma containing the
sperm is passed through the urethra in the penis into the vagina
of the partner
History and Examination
5uring the initial history and physical examination the doctor
usually as(s 6uestions regarding
). marital status
+. num#er of children
/. methods of #irth control used and the effectiveness of the
methods
0. general health of the patient
5. any urologic pro#lem %such as an urinary tract infection&
he physical examination is centered primarily on evaluation of
the genitalia, particularly the testicles and spermatic cords. he
vas deferens is a hard, ru##ery tu#ular structure that can easily
#e felt through the scrotum. $f the surgeon cannot feel the vas
deferens or cannot isolate it against the scrotal s(in,
consideration may #e given to doing the vasectomy in the
operating room 'here the scrotum can #e explored 'ith a larger
incision
Indications/Contraindications
here are no a#solute contraindications to vasectomy
he only indication for a vasectomy is a desire for permanent
sterility and it is 'ith this purpose in mind that the operation
should #e underta(en. $f it is in the mind of the patient that at
some future point the vasectomy can #e reversed, so that sterility
can #e changed into fertility, the vasectomy should pro#a#ly #e
postponed
). 7oughly one out of every )00 men 'ho have vasectomies, at
some time consider having the vasectomy reversed. $n the U.S.
approximately 5,000 vasectomy reversals are performed yearly
+. Again, the strong advice is that if there is any hesitation or
uncertainty regarding the desired permanent state of sterility, the
vasectomy should #e postponed
/. Vasectomy reversal has a lo' success rate of achieving
pregnancy and is often not a covered #enefit of insurance plans
0. Some men have had sperm fro8en 4ust in case a child is desired
later. 9ecause a man 'ho considers this pro#a#ly still has
dou#ts, it is pro#a#ly #est he does not undergo a vasectomy
his surgery is purely voluntary and sufficiently simple so that
there are virtually no contraindications though there are
situations in 'hich the man may regret the choice
). Single or recently married
+. :ife is opposed to sterili8ation
/. ;aving #een pressured into having the procedure
0. *o children
5. 9eing under the age of thirty
2. 5ecision made immediately after child#irth
3. :hen there are fe' alternative methods availa#le
Surgical Procedure
5uring intercourse follo'ing a vasectomy, the seminal plasma is
eliminated from the #ody in the usual fashion, it 4ust does not contain
sperm and, therefore, can not cause pregnancy. <n the day of surgery,
patients are usually advised to sho'er in the morning and #ring an
athletic supporter to the doctor's office to 'ear on the 'ay home. he
patient may #e advised to have his 'ife or a friend come 'ith him to drive
him home
Standard vasectomy %Figure +&
Figure +A. he s(in of the scrotum is
opened and the vas deferens is #rought
out 'ith an instrument
Figure +9. he vas is cut and the cut ends
coagulated. %he ends may also #e tied or
clipped.&
Figure +-. he cut ends are then pushed
#ac( into the scrotum
). he procedure is a minor operation 'hich ta(es a#out one!half
hour. $n most cases the vasectomy procedure is carried out as an
outpatient, fre6uently in the surgeons office
+. he s(in of the scrotum overlying the vas deferens is in4ected
'ith local anesthetic
/. he vas is then grasped 'ith a special clamp to hold it up against
the s(in
0. A small incision is made in the scrotum 'ith a scalpel follo'ing
'hich a small piece of the vas is ta(en out of the scrotum and a
piece of the vas removed
5. <ne or #oth ends of the cut vas may #e sealed 'ith clips, cautery
or suture
2. he cut ends are then returned to the scrotal sac
3. he scrotum is then closed 'ith a fe' sutures
:ithout incision
). his procedure, 'hich 'as developed in -hina in the )=30's,
does not re6uire a scalpel and is used #y many surgeons in their
offices
+. he s(in of the scrotum overlying the vas deferens is in4ected
'ith local anesthetic and the vas grasped 'ith the special clamp
to hold it up against the s(in
/. Using a special instrument, a small puncture hole is made in the
s(in, the opening stretched and the vas teased out of the
scrotum
0. he same methods of #loc(ing the vas are used as in the
standard procedure
5. he vas is then pushed #ac( into the scrotum. Usually no sutures
are necessary to close the puncture 'ound
hese t'o procedures are, in fact, essentially the same
Complications
-omplications are uncommon and can #e classified into minor and ma4or.
>inor complications
). 9ruising, even extensive #ruising is something that resolves on
its o'n
+. S'elling, even up to golf #all!si8e on each side 'ill usually
resolve 'ithout any difficulty
/. Some pus and crusting at the incision site usually disappears
disappears over the course of several days as the sutures in the
s(in dissolve and fall a'ay
0. Sperm granuloma is occasionally produced 'hen sperm lea(s
from the cut vas deferens or from a rupture of the epididymis.
he sperm act li(e foreign material and the #ody sets up an
inflammatory reaction that can lead to firm #alls of tissue. hese
#alls rarely cause a pro#lem
>a4or complications
). 5elayed #leeding can occur 'here a vessel that 'as under
control and not #leeding at the time of operation #rea(s loose to
form a #lood clot in the scrotum and may need to #e removed
surgically
+. $nfections of either the epididymis and?or the testicle may occur
re6uiring anti#iotics. Severe cases may re6uire hospitali8ation to
receive intravenous anti#iotics
/. he most severe complication, 'hich is rare, is that the patient
may lose a testicle #ecause of #leeding or infection
0. 7arely pain that lasts over /!0 months and occasionally is severe
7ecently articles have appeared in the medical literature
suggesting vasectomy may predispose to prostate cancer. he
American Urologic Association has ta(en a loo( at these
statistics and the current feeling is that vasectomy is not a ris(
factor in the development of prostate cancer. All patients should
at an appropriate age have regular rectal examinations for
prostate cancer and "SA #lood study. he current
recommendation is that all African!American men over the age of
00 and all other American men over the age of 00 'ho have a
family history of prostate cancer #e evaluated yearly from age 00
on. For non!African Americans, yearly rectal exam and "SA
should start #et'een the ages of 05 and 50
Some studies have suggested that men 'ho have a vasectomy
under the age of 00 may have t'ice the ris( for (idney stones
Failure of the procedure
here are t'o reasons 'hy vasectomy may fail to achieve sterili8ation.
$t ta(es approximately three to four months for the average
healthy male to have enough e4aculations to clear the seminal
vesicles of sperm. A patient is not considered sterile until t'o
consecutive semen specimens sho' no evidence of sperm dead
or alive. he num#er one reason for vasectomy to fail is early
unprotected intercourse
he second cause is called recanali8ation. he vas does not
actually gro' #ac( together, #ut the cells that line the inside of
the vas gro's through the scar tissue to hoo( up 'ith the other
side. Fortunately, this is rare and most urologists do the
vasectomy #y not 4ust cutting the vas, #ut also ta(ing out tissue
to leave a gap #et'een the cut ends
Care After Surgery
After surgery the man should go home, get off his feet and relax
using ice pac(s to cool do'n the scrotum and help prevent
s'elling and inflammation
Full activity usually resumes one to three days after surgery
>ost doctors recommend that vasectomy patients a#stain from
sexual activity for approximately one 'ee(, then the more
fre6uent the activity occurs using #irth control methods, the faster
the #ody clears itself of live sperm
Vasovasostomy %Vasectomy 7eversal&
o Approximately )@ of men 'ho undergo a vasectomy
re6uest reversal of the procedure. he most common
reasons #eing death of a child, remarriage and the
desire for another child 'hen finances improve. $n
comparison to the relatively simple vasectomy
procedure, reversal is a ma4or procedure.
o he procedure is carried out in the hospital, usually 'ith
the patient asleep
o An incision is made in the scrotum
o he cut ends of the vas are dissected free and then cut
#ac( from the scar tissue until normal vas is seen. his is
usually done 'ith the aid of an operating microscope that
magnifies the small opening in the vas so that it can #e
more readily handled
o Fine sutures are then used to se' the t'o ends together
o <ccasionally, the vas must #e sutured to the very fine
coiled tu#ing of the epididymis. $f this is the case the
chance for success is much lo'er
o Success of reversal varies considera#ly #eing as lo' as
+0@ to as high as 20!30@
-opyrightA +000 BourSurgery.-om All 7ights 7eserved