No-Scalpel Vasectomy Procedure
If you are considering having a vasectomy you are not alone. Every year, about half a million men in the U.S. choose vasectomy as a permanent contraception. Even though vasectomy is a minor surgical procedure performed under local anesthesia, it is recommended to choose a urologist who is performing the procedure on a routine basis. Board certified Dr. Turek, one of the “Best Doctors in America”, is the leading expert in vasectomies in California, treating patients in the San Francisco Bay area and Los Angeles.
The procedure takes approximately 10-20 minutes to perform. The goal of the procedure is to render the ejaculate free of sperm. This prevents the sperm from entering the semen (ejaculate) so that the female egg cannot be fertilized after intercourse. Remarkably, sperm continue to be produced within the testis but disintegrate and are reabsorbed by the body.
In clinical use for over 100 years, a vasectomy can be performed by making small surgical incisions or through the No-Scalpel technique that uses no incisions. Dr Turek much prefers the latter and offers it whenever possible to his patients.
To learn more about No-Scalpel Vasectomies, please select one of the following topics. If you are ready to schedule a consultation for your vasectomy, please request a consultation here.
About the No-Scalpel Vasectomy Procedure
There are 2 muscular tubes (the vas deferens), one from each testicle, that travel from the testicles in the scrotum up into the abdomen and end behind the prostate. During ejaculation, live sperm is conducted through these tubes to fill the ejaculate with sperm. The goal of vasectomy is to interrupt this flow of sperm. The procedure is performed in the scrotum. Before the procedure starts, men are offered (and encouraged to take) a sedative pill to help them relax. This is especially helpful if this is the first procedure that they have ever had.
With the patient lying down, the scrotum is cleaned with soap and water. Dr. Turek will then begin the procedure by gently finding the vas deferens on one side and bringing it to a position immediately under the scrotal skin (Figure 1).
Then, a small amount of local anesthesia is placed into the scrotal skin (by fine needle or needleless injector) above and around the vas deferens (Figure 2). A remarkably small amount of anesthesia is needed if it is placed precisely.
A small puncture is then made in the numbed area of scrotal skin directly over the vas deferens. The bare vas deferens is then secured and delivered cleanly away from its cover of nerves and blood vessels and into view with the help of 2 special instruments developed for the technique (figure).
The bare vas deferens is then treated in a variety of ways. Dr. Turek uses 3 methods to insure complete occlusion: he cuts the vas deferens in half, treats the hole in the tube on each with cautery to scar it, and places small titanium clips (or a permanent suture) across each face of the opened vas deferens (Figure 3). The vas deferens is then placed back into the scrotum in its normal anatomic position within its cover (“in-line” vasectomy). He prefers not to leave the testicular end open (“open-ended” vasectomy), nor does he remove a long segment of vas deferens, or send a segment for review by a pathologist.
A similar procedure is performed on the opposite vas deferens through the same puncture hole to complete the vasectomy. A single absorbable suture may or may not be placed across the puncture site to close it. A scrotal support is applied and the patient can then leave the office. The local anesthesia will keep the area numb from 2-4 hours after the procedure.
Benefits of the No-Scalpel Vasectomy
Vasectomy is a relatively simple, quick and safe method to prevent unwanted pregnancy. The recovery period is short, and patients can return to work and their regular lifestyle fairly quickly. Sexual activity, penile sensitivity and male hormone production are not affected by vasectomy, and there is no appreciable decrease (less than 5%) in how much ejaculate is made. After a vasectomy, the testicles continue to produce sperm, which then disintegrate and, like other dead cells within the body, are reabsorbed. Male hormone levels (also produced by the testicle) remain the same. One strong argument for choosing vasectomy in many couples is the simple fact that once the procedure is done, there is no need to constantly think about contraception, as is true with most other contraceptives. Examples of methods that require constant attention (“user compliance”) are: taking a birth control pill daily, using a diaphragm or condom, and timing the sex during non-fertile time of month. In other words, after vasectomy, couples can stop thinking, worrying or reminding themselves about this issue. Some patients find that freedom from the fear of producing an unwanted child improves the mutual enjoyment of sexual relations, sometimes making it more spontaneous and frequent.
How Permanent is a Vasectomy?
Practically speaking, vasectomy should be considered a permanent birth control procedure. Having said this, however, vasectomy can be reversed if absolutely necessary. In addition, the success rates of vasectomy reversal can be extremely high. The best (most convenience and cheapest) method to “preserve” fertility in the setting of vasectomy is to bank ejaculated sperm before the actual vasectomy procedure. Sperm cryopreservation or banking relies on the fact that sperm survive and recover remarkably well after freezing and thawing. Semen samples can be given at intervals of every 2-3 days for banking in Dr. Turek’s clinic for this purpose. As a rough guide, fertile men with normal semen quality will need 2-3 semen samples to provide enough sperm for 6 monthly tries to conceive after thawing with the use of low technology procedures such as low technology assisted reproductive procedures such as intrauterine insemination (IUI). To complete this process, patients will need to:
- Choose whether they want to bank for 1 year or 5 years.
- Sign a sperm banking consent form and make a payment to open the account.
- Undergo a blood test (by California law) for 5 sexually transmitted diseases (HIV; HTLV I, II; RPR; Hepatitis B surface antigen; Hepatitis C antibody).
- Drop off the semen samples for freezing.
Importantly, The Turek Clinic will ask the patient to consider how he wants the banked sperm handled in the rare event that he cannot decide for himself (due to illness or death) on the fate of the frozen samples. Although not suitable for all couples, sperm banking may be appropriate for some couples, including those with children harboring a serious illness. Men considering vasectomy should feel free to further discuss the issue of sperm banking with Dr. Turek or his staff at their consultation visit to have all their questions answered.
A third option for fertility after vasectomy is to have a sperm retrieval procedure performed behind the vasectomy site under local anesthesia with sedation. Since a vasectomy generally does not alter sperm production, usable sperm from the testicle or epididymis can be obtained by several methods, many of which have been pioneered by Dr. Turek. Things to consider with this option are: a) another procedure will need to be performed on the vasectomized man to obtain sperm, b) retrieved sperm is generally “immature” and requires high levels of assisted reproduction for success, which can be costly. Again, this option is not for everyone but has become very popular among men who desire more children after vasectomy, but want to preserve their vasectomy.