Vasectomy refers to voluntary or “elective” surgical sterilization in men. Vasectomy may be reversible, but is considered a permanent form of sterilization. Reversal is technically difficult, has a moderate to low success rate, and is quite costly.
The vas deferens are small tubes that transport sperm from each testicle to the urethra where the sperm combines with the remainder of the contents (made in other glands) of ejaculation. After vasectomy, the ejaculate fluid should appear unchanged in amount and consistency to the naked eye, but it will contain no sperm. Only under a microscope is the change perceptible. The sensation of orgasm and ejaculation are unaffected, and the operation does not affect libido (sex-drive) or erections.
Preparation
Please refer to the detailed information provided with your booking papers. For your convenience, this information is also available on this website.
Procedure
A vasectomy typically takes less than 30 minutes. Variations in time will depend on your particular anatomy. The procedure may be performed under general anaesthetic, sedation or local anaesthetic. We strongly recommend a brief general anaesthetic to ensure patient comfort.
In most instances, very small incision (one centimeter or less) are made on the left and right side of the scrotum respectively. Each vas deferens is located, separated from surrounding tissue, and divided. A short segment of the tube may be removed as well. This is sent for histological analysis to confirm that the vas deferens has been successfully divided. This will incur a separate expense from the pathology service. The ends of the vas are tied, cauterized and looped to prevent the vas from rejoining through the natural healing process. The ends of the vas are placed back into the sac and the incisions are closed. The suture material used on the skin is self-dissolving and will just fall out on their own after one to two weeks.
Post Procedure
After the vasectomy, you will have one to three small sutures on each side. They will dissolve over the following one to two weeks and need not be removed. Every patient has some degree of swelling and discomfort, and it is not possible to predict who might have minimal versus significant swelling. We strongly encourage you to take the following day off work and perhaps more if your occupation requires strenuous activity or heavy lifting. Severe pain is unlikely but possible. We may provide you with a prescription for pain medication but you certainly may take an over the counter medication to which you are not allergic. Just like variation in swelling, the scrotum and surrounding areas can have a variation of bruising. This will typically resolve with time. You may shower the following day.
Expectations of Outcome
The effects of a vasectomy at resulting in sterilization are not immediate. Despite a successful procedure you are not considered sterile until a semen analysis (under the microscope) demonstrate no evidence of sperm. This usually occurs after 20-30 ejaculation. Do not make the assumption that you are sterile just because time has elapsed or because the above number of ejaculations have occurred. You must wait for us to tell you, following the semen analysis, that it is safe for you to have unprotected intercourse. Sometimes, it can take months for you to clear all of the sperm out of your tracts. Please make sure to keep all follow up appointments as they are scheduled. While rare, a vasectomy can fail.
Possible Complications of the Procedure
The majority of patients will not experience any major problem after a vasectomy. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
- Failure
As mentioned, a vasectomy may fail. This is rare and probably only occurs 1-2% of the time by national average. In immediate failure, the patient never has a semen analysis that demonstrates “no sperm”. A delayed failure would mean that at one time, there were no, or few sperm but subsequently there were increased sperm again in the ejaculate. There are different reasons for each. Failure requires that the procedure be repeated. Vasectomy failure has many causes. It may be because of “recanalization” where the cut ends of the vas join one another via small channels. This reflects the body’s incredible powers of healing and regeneration. Another cause is the presence of an extra, thin, vas deferens that was not divided. This reflects an anatomical variation that is rare but has been described.It is theoretically possibly in very rare cases that even after a zero sperm count viable sperm may reappear in the ejaculate. This may be due to delayed recanalization. This may lead to pregnancy.Remember that the only way to be 100% sure of not conceiving is to abstain from intercourse!
- Sperm Granuloma
Our sperm cells are seen as “foreign” by our immune system. After a vasectomy, tiny volumes of sperm may leak out of the cut ends of the vas, despite it having been tied securely. These sperm cells will stimulate an immune response that may lead to the formation of a small inflammatory mass known as a granuloma. These may be tender, but are often not.
- Haematoma
This is when a small blood vessel continues to ooze or bleed after the procedure is over. The result is greater swelling and bruising. Intervention (opening the incision to evacuate the blood) is very rarely necessary and it almost always resolves over time with compresses…much like any bad bruising or swelling. If this happens, it is usually in the first day after the procedure.
- Infection
Infection is possible in any procedure. Usually, local wound care and antibiotics are all that is necessary.
- Chronic Pain
As with any procedure, a patient can develop chronic pain in an area that has undergone surgery. This is rare and would tend to disappear with time. If persistent, further evaluation may be necessary.
- Testicular Ischemia/Loss
This is very unlikely but could theoretically occur due to interference with the tiny artery that supplies blood flow to the testicle. If the testicle has inadequate blood supply, it would shrink and lose ability to function.
Follow-up
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. Do not hesitate to call at any time if you have any concerns. You may see him in his offices at RPA, Bankstown or Strathfield Private Hospital. Remember that you cannot assume that the procedure has been successful until a semen analysis is obtained. This will be requested after 25-30 ejaculations.