What is a vasectomy? A vasectomy is a procedure that blocks both sperm ducts called the vas deferens (see diagram) which transport the sperm from the epididymis (where the sperm are stored) up through the prostate to the back of the urethra during an ejaculation. Ninety seven percent of the fluid that comes out during an ejaculation is made in the prostate and seminal vesicles, only 3% of the fluid comes from the testicle and epididymis but this contains all the sperm. The easiest way of eliminating the sperm but leaving everything else the same is to interrupt the vas deferens. The easiest place to do this is in the scrotum because the vas is directly under the skin.

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Contraception can be divided into several categories: male or female and permanent or temporary. Ideally, only men who are sure that they are finished having their family or men who are positive that they do not want children should consider permanent sterilization. Even though most vasectomies can be successfully reversed, vasectomy should still be considered permanent because the chances of conceiving after a reversal are not 100%.

Vasectomy is the easiest and most reliable form of permanent sterilization. At The Center for Male Reproductive Medicine vasectomy is performed as an office procedure that takes about 10-15 minutes to complete. This is much easier then the standard vasectomy and certainly less risky than female sterilization (tubal ligation) which needs to be performed in an operating room under general or epidural anesthesia and runs the risk of injury to the abdominal organs including the intestines and major blood vessels. Because of this risk, many couples choose vasectomy as their form of permanent contraception. Vasectomy is also usually less expensive then tubal ligation.

Conventional versus No-Scalpel Vasectomy

The standard technique of performing a vasectomy required the doctor to make an incision (cut) in the scrotal skin, find the vas and separate it from the other structures in the spermatic cord. The vas was then tied off with sutures, cut and the ends separated. The skin incision was then stitched back together. This procedure took longer, was more painful and resulted in a longer recovery time and more complications then the no-scalpel vasectomy. So what is a no-scalpel vasectomy? This is a technique developed in China approximately 20 years ago. In China, men must be sterilized after they father a child in order to qualify for government assistance. This led to a need for a quick and simple method of vasectomy with a short recovery time since almost every man gets sterilized at some point for population control.

The technique of no-scalpel vasectomy uses a special instrument to grasp the vas through the scrotal skin and hold it in place directly under the skin. Another instrument is used to make a small puncture in the skin over the vas and spread the tissue. The vas is then pulled up and all the tissue around it is cleaned off. This is an important step because all the nerves must be moved away from the vas before it is clipped. Once the vas is clear then titanium clips are placed to block the vas. The vas is cut and cauterized between the clips and then separated. A small segment is removed to prevent the vas from growing back together. The vas is then dunked back into the scrotum and the poke hole is sealed without the need for sutures. A sterile dressing, ice pack and jock strap are then placed on the scrotum.

Anesthesia
We perform the no scalpel vasectomy with local anesthesia much like the dentist uses to fill a cavity. The anesthetic is injected into the skin and the vas, not the testicle as many people incorrectly think. The injection lasts for 10 seconds and works immediately. Patients are offered valium prior to the procedure but many men chose not to take the valium. The valium is not for pain control but rather to “take the nervous edge off” that most men have prior to the vasectomy.

Recovery
After the procedure it is best to go home and rest for 24 hours off your feet. An ice pack or bag of “frozen peas” should be used intermittently for 24-48 hours. This will minimize any pain, swelling or bleeding. We recommend no heavy lifting and no ejaculation for a week after the vasectomy. You should be able to resume all normal activity after this point. Doing too much activity too soon could result in a longer recovery time or a complication. While it is OK to shower the day after the vasectomy, bathing or swimming or surfing should be avoided for at least 1 week to make sure the tiny puncture wounds are sealed completely. Most importantly, you should not play Golf the day after the vasectomy, despite what your friends tell you!

Follow Up
It is very important to follow up after the vasectomy. The reason for follow up is that you are not sterile immediately after the procedure. Sperm live in the reproductive tract upstream from where the vasectomy is performed and it can take from six weeks to three months for these sperm to be flushed out of the system or die off. We recommend that you have a minimum of 2 semen analysis starting around six weeks after the vasectomy or after 20 ejaculations. You must have 2 consecutive semen analysis that show no sperm in order to be considered sterile and you must use some form of birth control until that time.

Sperm Banking
An option to consider prior to having your vasectomy is sperm banking. Some men chose to have their sperm frozen and stored just in case they change their mind and want more children in the future. Having frozen sperm would mean that they would not necessarily need a vasectomy reversal or have to do in-vitro fertilization both of which can be costly. Sperm can be stored indefinitely and used at any time with an artificial insemination procedure. We recommend that our patients store their sperm at The California Cryobank, the world’s largest and most reputable sperm bank. We will help make all the arrangements for you should you chose this option.

Risks and Complications
As with any surgical procedure a vasectomy carries with it the potential for risks and complications. You need to be aware of these to help you consider the choice you are about to make. Any time a surgeon makes a cut or poke anywhere on the body, there exists the possibility for pain, bleeding, swelling or infection. The complications specific to vasectomy include failure of the procedure, sperm granuloma formation, injury to the blood supply of the testicle resulting in the testicle getting smaller (atrophy) and chronic testicular or epididymal pain (post vasectomy pain syndrome). Fortunately these complications are rare when we perform the no-scalpel vasectomy using our technique. While the reported complication rates for vasectomy vary between 5%-10%, our complication rate has been much lower, under 1%. In the last 1000 vasectomies that Dr. Werthman has performed, the complications were as follows:

What do we do differently at The Center for Male Reproductive Medicine then general urologists?
Dr. Werthman’s practice is limited to surgery of the scrotum and vas. He is one of the few urologic surgeons in the United States who don’t practice general urology but only specialize in Andrology full time. Because he only operates on the vas, he has a unique understanding of the anatomy and has refined his techniques and procedures to be as painless as possible. Dr. Werthman pays great attention to the nuances of vasectomy that come with the experience of performing over one thousand no-scalpel vasectomy procedures. This is also why he has such a low complication rate. Dr. Werthman also specializes in treating post-vasectomy pain syndrome and understands its causes. He has improved on the technique of no-scalpel vasectomy to avoid this dreaded complication. Some of the new techniques Dr. Werthman pioneered and exclusively practices include performing the vasectomy high up on the vas to reduce chance of back-pressure build-up, injecting the inner channel of the vas with long-acting anesthesia to avoid stimulating pain receptors, and giving patients an injection of a powerful anti-inflammatory medication to prevent inflammation before it starts. To our knowledge, no other center incorporates these measures routinely during a vasectomy. We are so confident in our technique that we are the only center that shows a video of the surgical procedure for all to see.

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