NO-SCALPEL(INCISIONLESS) VASECTOMY

• Aren't All Vasectomy Methods the Same
• Why Should I Have a Vasectomy?
• Preparing for Your Vasectomy
• No-scalpel, Incisionless Vasectomy Procedure
• Immediate POST OP
• POST-OP Follow-Up
• The Cost of a Vas Reversal
• My Experience

A vasectomy is a minor procedure to help males achieve voluntary sterility.

Because it is low risk, minimally invasive, and highly effective,it is one of the most popular methods of birth control. It is intended to be permanent.

In a vasectomy, both vas deferens, the two small tubes that carry sperm from the man's testicles to his prostate, are sealed to stop the testicle's delivery of sperm.

The procedure is performed as an outpatient, under local anesthesia with a pre-op dose of oral valium, and usually takes only 10-15 minutes. Since vasectomy simply interrupts the delivery of the sperm, and doesn't affect male hormone levels, the procedure does not change a man's sex drive or his ability to have intercourse or climax as before. Within several months, his semen won't contain any more sperm and, from then on, he cannot father any more children.

Aren't All Vasectomy Methods The Same? No!

The No- Scalpel or Incisionless method is the most minimally-invasive route to get to each vas, and using cautery is the most sure way to seal each vas once you've reached them. Compared to the traditional "incisional" technique, the No -Scalpel vasectomy takes less time, causes less discomfort and has lower rates of bleeding and infection. Studies show sealing with cautery has both a much lower risk of failure and post -op bleeding than tying or clipping. I perform the No-Scalpel technique and seal each tube with electrocautery.>

Why Should I Have a Vasectomy?

Vasectomy is right for you if you are absolutely certain you wouldn't want to father any more children under any circumstances. It would be best if you and your partner made this decision together and considered all other kinds of birth control. Vasectomy is intended to be permanent, so it wouldn't be right for you if you entered into it with the idea that you could "always reverse it later"

Common Reasons For Having a Vasectomy Include:

• You do not want to have more children than you can care for.
• You want to enjoy sex without worrying about pregnancy.
• Your partner may have health problems that make pregnancy difficult or jeopardize her health.
• You or your partner doesn’t like other forms of birth control.
• Other forms of birth control may be more risky for your partner.

Preparing For Your Vasectomy

Before:

When you come to the office to discuss having the vasectomy, you'll receive the antibiotics and the prescription for the valium. The valium script will be dated ,and will expire in a few days. Since valium is a controlled substance, the pharmacist may refuse to fill it if he thinks the script is outdated. To prevent this, get the script filled promptly after our first visit. Don't leave this go until the last minute and risk having the pharmacist reject the script. Hold the valium at home until you need it just before the procedure.

Stop aspirin and all other blood thinners a full 5 days before the vas. One of the possible complications of vasectomy is bleeding. The risk is extremely low with the use of cautery. To further prevent undue bleeding you must make sure you are not taking any medications that thin your blood. Nonsteroidal anti - inflammatory medications (like advil and motrin), aspirin, plavix, and coumadin are blood thinners. All of these medications must be stopped five days before a vasectomy. Regular tylenol is the only medication you can take in the five days pre-operatively that will not increase your risk of bleeding.

Shaving the site: The day before your vasectomy, you’ll need to shave the hair away from the scrotal sack and the base of the penis.

For best results: do this while sitting on toilet, letting cut hair / razor trimmings fall into the bowl. First, pre-cut long hair with a scissors, then, using a fresh blade, dry shave (no cream), putting the skin on stretch. The surgical site must be bald. This decreases the risk of infection.

Antibiotics: You will be given a sample or a prescription before the procedure. Usually take one a day, on the day before, the day of, and for two days after your procedure.

On the day of your vasectomy: take the antibiotic. Take one valium one hour before the proceedure. Have someone drive you to the procedure. The site will be washed with sterilizing soap. Sterile drapes will be applied. A small nickel-sized area of scrotal skin at the base of the penis will be numbed with novacaine gently through the skinniest of needles. Once that area is numb, further anesthetic will be given to numb each vas. By using his method of giving novacaine - always working through an area that was previously numbed - the only thing you'll really actually feel is the first pinch with the skinny, skinny needle. The "novacaine and valium" combination is the best that I have found. Even the bravest guys become increasingly nervous in the final minutes before their vasectomy. Anxiety / tenseness unnecessarily lengthens the procedure. The valium/ novacaine combination works wonders in comforting, calming and relaxing patients. Under those conditions, the procedure takes only 10 minutes! I do highly recommend you take the valium in addition to the novacaine. This means you can't drive, so you have to arrange to have someone drive you. Sorry if that's inconvenient, but do it! It's worth it. Valium makes the vasectomy easier and nicer for you (and me).

On occasion, guys are so uncontrollably anxious, that valium and novacaine aren't enough. This will usually be obvious during the first office visit. We (the patient and I ) agree they should be put to sleep for their procedure. If that were the case, we would alter these instructions slightly as needed.

No-Scalpel, Incisionless Vasectomy Procedure

The no-scalpel, incision -less vasectomy is done through a self-sealing puncture. Once the area is numb, a tiny instrument is passed to make a single puncture on the scrotum one half inch below the base of the penis. Both the right and left vas are sealed through this one puncture. The first vas is brought to the surface, exposed, cut and cauterized (sealed with electric heat- which you won't feel) and then returned to its place in the scrotum. The second vas is brought to the surface through the same puncture, and is similarly exposed, cut, sealed and returned to its place.

There is no bleeding. No stitches are required. A band aid is applied to the puncture site, which can be removed in 24 hours.

Immediate Post Op

Use prescription pain pills as needed. The novacaine lasts for several hours.

When it wears off, you'll feel like you pulled a muscle several days ago - nothing bad. At the end of the procedure, I will give you a prescription for pain pills (usually percocet or lortab). This will cover any discomfort you have over the next few days

Many patients report never feeling the need to take any post-op pain meds, but its good to have them if needed. Usually, patients expect the worst and are pleasantly surprised just how painless their vasectomy was. This can sometimes lead to other problems, stemming from them not feeling they need to rest afterward.

See the section VERY IMPORTANT ADVICE below.

Finish your antibiotics. At this point, after your vasectomy, you'll still have two days of antibiotics left. Take one the day after the vas and one more the day after that (for the total of 4 days).

To prevent swelling:
1) Use icepack as much as possible for 24 hours
2) No lifting straining or sex for 48 hours

Patients usually have vasectomies on a Friday, relax the weekend, and return to work on Monday. Some patients work weekends and have weekdays off. You can have a vasectomy any day that suits your schedule as long as you give yourself time to rest afterward.. Generally, patients would return to work after 48 hours, depending on the individual and the amount of exertion involved in his usual day's work.

Keep the area dry.

The puncture usually seals in 24 hours. You can remove the band-aid and shower the day after the vas. Except for showers, keep the area dry. Do not apply cream or powder. Do not soak (swim, hot tub) until there is a dry scab sealing the site.

The post-vas sperm count.

The day of the procedure you will also get a slip for a post -vas sperm count. It will be dated for four months after the procedure. Your semen won't ever look different, so you can't tell if your sperm count is zero afterward by just looking with the naked eye. A zero count must be documented by taking a specimen to a lab. So plan to continue birth control for several months after your vas. Then, 4 months post-op, take the lab slip and your specimen to lab for a sperm count. Call our office one week after that. Do not stop current birth control measures until you call our office and we tell you your sperm count has gone to zero.

Why wait four months to check a sperm count?

Every Urologist has his own thoughts on when (and how) to best check/ confirm the procedure worked. You need to get a sperm count showing "zero sperm seen" to document success. Any count that shows sperm still present means the test must be repeated until the count reads absolutely zero.

I personally started my urology career checking post-vas sperm counts at 2 months and found very many still had sperm showing. I found that 4 months was the best time to start checking the first count, and that almost all patient's counts were zero when done at 4 months. Four months also happens to be the lifespan of the sperm in the body, so that by 4 months, whatever sperm you haven’t shot out as ejaculate should have completed its lifespan and disintegrated.  Either way, your count should be zero at 4 months. My experience shows this to be true. 

A failure would be indicated by a persistently elevated sperm count months after a vasectomy. The accepted rate of failure for a vasectomy is 2%. My failure rate is much less.( no failures since 1993). If a vasectomy has failed , the smartest simplest thing to do is repeat the same procedure. The failure rate of a second vasectomy is 2% of 2% , or .04%. Insurance carriers accept that occasionally a repeat vasectomy will need to be performed, and they will cover the procedure.

Very Important Advice

You do not want to strain, lift anything heavier than 10 pounds, or have sex for 48 hours after the procedure. These may cause a sudden dramatic increase in swelling at the site of surgery. The tiny blood vessels in the scrotum aren't normally well supported, and can easily break open and bleed with even minimal activity or straining after a vasectomy. Either generalized swelling or an internal bleed will make you very uncomfortable for two weeks and wish you had taken it easy for 48 hours. Patient's who do get this will usually admit to doing something they shouldn’t have - usually, because they "felt good". I have seen three cases. One was carrying a laundry basket full of fresh laundry up two flights of steps the night of his vasectomy. Another pushed twins in a stroller up and down Christiana Mall several times the day after. The third attempted to play nine holes of golf the day after (and quickly found it was a bad idea). All of these people thought these activities sounded reasonable. Two weeks of swelling and discomfort made them wish they had not lifted, strained, or had sex for 48 hours.

Some patients ask if they should refrain from exercise for even longer than 48 hours.  Even with very active, athletic patients, this has not been necessary.

Post-Op Follow-Up

After your vasectomy you should call me if you have:

• 1) swelling or redness that increases over what you notice after the first day or two.
• 2) fever of 101.5 degrees or higher.
• 3) pain not relieved by the medications provided.
• 4) drug reactions such as hives , a rash, nausea or vomiting

If all this pre- and post -op advice is closely followed, patients usually do not have any problems at all. So, we usually don’t see them or hear from patients again until after they have gotten their 4 month sperm count, when they call for results. If patients do have a question, concern or post-op problem, they should call our office. They will be given the first available appointment and seen promptly. I have found that most patients can't really describe what’s going on, so its best to have a "medical eye" examine them. Most have absolutely no problems after a vasectomy and aren't seen post-op. Of the patients that do call, and are seen in the office, the most common finding is mild persistent post -op swelling that wasn't significant, but just didn't resolve as quickly as they thought it should. In this case, after being examined, the patient is reassured, and no further treatment is usually needed. Their swelling resolves on its own over time. Again, patients don't have medical backgrounds and couldn’t possibly be expected to tell this from a true infection on their own, so I have absolutely no problem with a patient coming in for a quick post-op check for reassurance. Personally, I share your desire to make sure everything's all right.

The Cost Of a Vas Reversal

A vasectomy is intended to be permanent, and you should not have it done unless you are reasonably certain you do not want any more children.

Vas reversals are very expensive because they require several hours use of anesthesia, operating and recovery rooms. (They are much more expensive than vasectomies.) Insurance companies encourage you to get a vasectomy because it makes economic sense for them. They would spend much more money on your family if you continue to have children. They discourage your ever getting a vasectomy-reversal by not considering it a "covered" service. A vasectomy should be considered permanent and may not be able to be reversed later.

Slow To Zero Sperm Counts

Every two or three years we will see someone with a sperm count that lingers at some low ( but not zero ) number for 6- 8 months before going to zero. This is rare, but does happen. These patients get a monthly count after the first 4 month count, until it comes back "zero".

My Experience

I perform 150 -200 vasectomies per year. I haven't had a failure since 1993 when I still used clips. I then switched to cautery and haven't had a failure since. I last calculated that, in training and practice, I have performed a total of more than 5,000 vasectomies.

If this pre- and post- op advice is closely followed, patients usually do not have any problems at all. Because it is low risk, minimally invasive and highly effective, vasectomy is the most popular method of male birth control.