Vasectomy


 

Illinois Urological Institute, S.C. offers the latest in No-Incision Vasectomy. Operative times average 10 minutes and a local anesthetic is used. A sedative may also be requested.

The following is detailed information for vasectomy patients, with frequently asked questions and post operative instructions:


What is a Vasectomy?

Bilateral vasectomy is an operation, which is performed to remove the sperm from the semen and results in sterilization in the male. The vas deferens (“vas”) is a tube that carries sperm from the testicle. It courses up through the groin and then down to the prostate gland at the bottom of the bladder. In a vasectomy, the vas from each testicle is divided near the upper portion of the scrotum. This prevents sperm from entering the semen during sex.


How is a Vasectomy performed?

We usually do this procedure in a licensed surgery center.

The upper portion of the scrotum is shaved on each side. Local anesthesia using Lidocaine (similar to Novocain) is injected into the skin of the upper scrotum with a very fine needle. The skin of the scrotum is not extremely sensitive and often there is very little or no discomfort with this injection, less than a dental injection. A mild sedative may be given if desired, but this is usually not needed. Once the Lidocaine has started going in, there usually is no more discomfort throughout the remainder of the procedure.

A tiny puncture is then made over the vas tube. The vas is divided, taking out a segment, which is sent to the pathologist. Each end is cauterized and tied with a permanent suture or clip. The two ends of the vas are separated by some of the surrounding tissue to minimize the risk of them growing back together on their own. An antibiotic ointment is applied to help prevent infection. No stitches are needed.

This procedure is repeated on the opposite side. The surgical time is usually a total of 20-40 minutes. However, total time in the surgery center is about an hour. Patients are requested to have a ride home.


How long does it take to recover?

As mentioned above, the procedure itself is fairly painless. Once the Lidocaine wears off, there is typically minimal or no discomfort. The main point is to avoid swelling. Although you may feel up to doing more, we ask that you lay on the couch, or in other words, remain horizontal, as much as possible the day of your surgery and follow the post-op instructions for the next week. This descreases venous pressure on your incision and will minimize swelling and hasten your recovery. Tylenol tablets and the use of gentle pressure and ice packs to the scrotum will help with any swelling or discomfort you may have.

This is a surgical procedure and needs to be respected and treated as such. Taking it easy initially will speed your recovery and avoid swelling and discomfort. Although individuals vary, most people feel comfortable enough to return to work the next day. If you have a very strenuous job, you may need a few more days to recover before returning to work. Marked swelling or severe discomfort is very unusual and should be brought to our attention.


When am I sterile?

Following a vasectomy, you are not sterile immediately and will need to continue using birth control measures until cleared in writing by us. In our experience, it takes a minimum of three months time and a minimum of 12-15 ejaculations to completely clear the sperm out of the tube beyond where the vasectomy was performed. It is not unusual for some patients to go 6-8 months until clear. There are also rare patients who demonstrate persistent rare non-motile sperm that never do completely clear. This is not due to recannulation and may be an acceptable end point under certain criteria.Routinely, a semen analysis is obtained each month until negative and then repeated until two consecutive samples show absolutely no sperm present. Most patients will have no sperm in their semen by the end of three months, and often the first two samples are negative. (However, it is not unusual for sperm to remain for a much longer period of time, even 6-8 months, depending on the individual.) Therefore, in some cases several semen samples are required as well as a bit of patience. Samples may be collected at home and brought into an approved lab within 48 hours.

The results of each semen analysis and further instructions are mailed to you within 7-10 days to prevent any possible confusion over the phone. There is a lab charge for each semen sample, which is usually reimbursed by your insurance company.


What are the risks?

Overall, vasectomy is a relatively safe procedure, and serious problems are unusual with proper care. This is mainly because major anesthesia is not required and the abdominal cavity is not entered (as in a tubal ligation).

The main problems that can occur initially are swelling or bleeding into the scrotum and infection in the incision. The scrotum is an elastic bag and can swell considerably if bleeding occurs. Although rare, if major swelling happens it may take a long time to return to normal. This is the reason we stress avoiding strenuous activity for the first few days even if you feel up to doing more.

Some long-term risks include chronic discomfort, shrinkage of the testicle (atrophy), possible formation of a small cyst containing sperm in the scrotum, and recannulation of the cut ends of the vas (see below). Probably the most bothersome of these would be chronic discomfort. A very small percentage (less than 1/1000) of patients report chronic discomfort in their scrotum or testicles after a vasectomy. This fortunately is quite rare and indeed may not be due to the vasectomy itself. Atrophy of a testicle, also extremely rare, may be more likely to occur if there has been recent surgery such as a varicocele or hernia repair around the vessels leading to the testicle. Formation of a cyst containing sperm (spermatocele or sperm granuloma) near the testicle may be more common after a vasectomy. This is also fairly common in men who have not had a vasectomy. They usually do not cause much trouble. If they do, a minor operation can remove them.

There have been conflicting reports of possible long-term adverse efforts on the other organ systems, such as heart disease, testis cancer or prostate cancer. These are controversial concerns and are not well established. It is generally felt that Vasectomy causes no long term health risks.

All forms of birth control except for total abstinence have some risk to them. Birth control pills, IUDs, and tubal ligation probably have more risk than vasectomy. You should discuss these matters in more detail at the time of your consultation if they are of concern to you.


Can the ends of the Vas grow back together? (Recannulation)

Yes. When this occurs it results in sperm getting into the semen and possibly an unwanted pregnancy. Recannulation is very unlikely, probably less than 1 in 1000, and results from your body simply trying to heal what it considers to be an injury. The extra step of separating the ends of the vas with tissue minimizes this risk.

An actual unplanned pregnancy from spontaneous recannulation of the vas is rare (about 1 in 10,000) and is less likely than a pregnancy from other methods of birth control including tubal ligation (1 in 800) and birth control pills (1 in 100). Nonetheless, no method of birth control, including vasectomy, is 100% effective.

Because of these low rates, once the semen analysis is negative we do not routinely test for sperm to detect recannulation of the vas.


Where does the sperm go?

We are frequently asked this question. The sperm are reabsorbed by the body. This may cause the body to develop antibodies to the sperm, which could interfere with fertility if you decide to have a vasectomy reversal. Vasectomy should be considered permanent sterilization before you elect to have the surgery.


Will a vasectomy affect my sexual activity?

No. The amount, appearance, and nature of the semen is unchanged following the vasectomy. The sperm cells themselves constitute less than 1% of the semen volume. Hormone levels and sex drive are not affected by a vasectomy. If anything, studies have shown some couples experience improved sex lives.


What about Vasectomy Reversal?

Reversal of the vasectomy is an operation that we do. Although vasectomy should be considered a permanent procedure, you need to be aware of your options.

Vasectomy reversal is a more difficult operation requiring microscopic technique. It is expensive and often is not covered by insurance companies, unlike vasectomy. Pregnancy rates after vasectomy reversal average 50% and decrease with time since the vasectomy was performed. These are important things to know if for some reason you had to consider vasectomy reversal.


What about other methods of birth control?

Other methods of birth control should certainly be considered. Bilateral tubal ligation, birth control pills, condoms, diaphragms, etc., are available. We can discuss these in more detail if you have questions. You should be aware of these alternatives to vasectomy for birth control before making your final decision. The main thing is that surgical birth control (vasectomy or tubal ligation) should be considered permanent.


Conclusion:

Vasectomy is a relatively safe procedure, which is usually done on an outpatient basis and results in permanent sterilization of the male (i.e., you will be unable to father children).

Vasectomy is an operation on an organ system and needs to be treated as such. Fortunately, serious complications are extremely rare. Usually there is very little discomfort, and taking good care of the operative site initially minimizes the chances of problems. Nonetheless, one should weigh the risks of surgery against the benefits of permanent sterilization.

Finally, it is important to stress that you are not sterile immediately and will need to continue other birth control measures following your vasectomy. We require two (2) consecutive negative semen analysis to confirm sterilization. Semen analysis reports and further instructions are mailed to you to avoid any confusion.

If you have further questions, we would be glad to answer them for you individually. Even if you have received this information sheet prior to an office visit, a consultation is required before your surgery. Please call us at: 630-690-6400.


Before Your Vasectomy:

Elective sterilization can be done in an Outpatient Hospital Ambulatory Surgical Center or in our office. Most insurance companies provide better benefit coverage in the office setting. Please check with your insurance carrier before scheduling.

You may schedule this with a receptionist by calling our Geneva office at (630) 232-7300 or our Winfield office at(630) 690-6400.
Our office will call you prior to your procedure to inform you of the time you need to arrive.
Since the procedure is done under a local anesthetic, you may eat and drink as you normally would on the evening prior to and day of your procedure.
On the morning of surgery, wash well with an antibacterial soap and shave your scrotal area.
Please wear tight-fitting briefs on the day of your procedure or bring an athletic supporter to wear.
Medications:
Most over-the-counter medicines for pain contain ingredients that promote bleeding (Naproxen, Aleve, Ibuprofen, and Anaprox). Please do not take these within 10 days of the planned procedure. However, Tylenol (acetaminophen) is okay.
If you take a blood thinner (Coumadin, Warfarin, or Heparin) please let us know, as special arrangements need to be made in preparation for surgery.
If you take aspirin, Plavix, Clopidogrel, Ticlid, Ticlopidine, Dipyridamole, Vitamin E, Aggrenox, Persantine, Pletal, or Cilostazol, please stop taking this medicine for ONE WEEK PRIOR to the surgery date. These medications will increase the risk of bleeding. We want to allow your body to return to normal prior to surgery.
We recommend you bring someone to drive you home as you may experience some fatigue, discomfort, and lightheadedness which may impair your ability to drive.


After Your Vasectomy:

Please follow the guidelines below carefully to minimize your chances of having post-operative problems.

  1. On the day of surgery, an ice pack may be applied to minimize swelling. Over the next 2-3 days, you can be up and about or return to work as comfortable, but do not do anything strenuous such as sports, yard work, heavy lifting, etc. Alternating Tylenol and ibuprofen (Motrin/Advil) tablets every 3 hours for the first 2-3 days helps prevent any swelling or discomfort. Apply antibiotic ointment to the sites 2-3 times daily for 2 days or as directed. Showering is okay, but avoid soaking or swimming for 2 days. Remember: this is a surgical procedure and needs to be respected and treated as such. Taking it easy initially will speed your recovery.
  2. Continue to avoid extremely heavy activity for 7-10 days to allow complete healing. You will have to pace yourself, and your body is your best indicator. Discomfort is your body’s signal that you are becoming too active too soon, and your activity level should be reduced for a few more days.
  3. It is not unusual to notice some black and blue discoloration or minor swelling. However, should you develop increasing pain, marked swelling or signs of infection (redness or tenderness in the scrotum or near the incisions), notify our office immediately. Someone is available to help you with any questions or problems you may have.
  4. CONTINUE USING BIRTH CONTROL MEASURES UNTIL RELEASED IN WRITING.Please follow the instructions for collecting a semen specimen outlined below. You may resume intercourse when you feel comfortable, usually in a few days. Be patient – sperm remain in the semen for an average of 3-6 months and even 8-9 months is not unusual.
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