No-Scalpel Vasectomy


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Quick jump:

Sterilisation or contraception
Steriliastion, him or her?
Vasectomy and effects on the body
How vasectomy works
What happens to the sperms after vasectomy?
What'ts so special about NSV
Preparing for vasectomy
About the procedure
Post Vasectomy complications
Changing your mind!

Sterilisation or contraception

Because sterilization is so difficult to reverse, it is essential to be as sure as one can be that you really do want sterilization rather than contraception. If there is any possibility that you may want to have more family then do visit your GP for contraceptive advice. There may be contraceptive methods that will suit you as a couple and leave your options open fir the future. For example, modern coils (IUCD – intra-uterine contraceptive devices) are very effective and well tolerated. Couples who attend for vasectomy usually go through the process of contemplating vasectomy then put this to the back of the mind for some months or years. Then, an event, usually a late period! concentrates the mind and crystallizes the decision to seek vasectomy.

Sterilisation, him or her?

The couple contemplating sterilization will usually think that vasectomy is the best way forward and they are correct. The pros and cons of his and hers sterilization are set out in this table

Tubal tie (female)
Local clinic
Time to discharge
30 mins
½ day
Failure rate
Time off work / away from family
1 day
3 days
Complications- infection/haematoma

Vasectomy wins which ever way you look at it.

Vasectomy and possible effects on the body

Over the last twenty years vasectomy has been linked with a rise in the incidence of heart attacks, testicular and prostate cancer. Fortunately none of these alleged links has been proven indeed a very large study of nurses and their husbands in the USA showed that vasectomised husbands lived longer! It is true however that prostate cancer is becoming more common in the whole population so routine checking particularly in the over 50s and vigilance in all men who have a change in urinary flow is recommended.

How vasectomy works

‘Vas’ ‘ectomy’ means literally removal of part of the vas as shown in the diagram below. Sperms are generated in the testis and spend at least 2 months making their way along the epididymis, maturing as they go and acquiring a tail and motility. The sperms and their fluid comprise only 3% of the fluid ejaculated, the remaining 97% being transport medium containing nutrients for the journey such as fructose. It is because the sperms form such a tiny proportion of the ejaculate that there is no noticeable change in the fluid passed during intercourse after vasectomy.

What happens to the sperms after vasectomy?

After vasectomy sperms carry on being produced just as normal. They swim along the epididymis and up the vas to the site of the vasectomy blockage where they survive for some days then die off. The dead sperms are broken up and absorbed by the body’s white cells which enter the vas through the blood supply to this tube.

What’s so special about no-scalpel vasectomy (NSV)?

NSV patients are pain and discomfort free after just 12-24 hours whereas after conventional vasectomy pain and discomfort typically lasts for 3 days or so. So why the difference ?

NSV= keyhole surgery.

With NSV the surgeon locates and holds the vas directly under the skin with a pair of special forceps so and with the other hand makes a puncture through the overlying skin right through into the center of the vas. He then lifts the vas up through the puncture hole and leaves in place all the tissues surrounding the vas. The vessels supplying blood to the vas are gently pushed back from the vas and preserved rather than cut as in conventional vasectomy. All pain sensitive tissues are covering the vas are gently removed and the vas then occluded with application of heat, a Titanium clip and removal of a 1cm segment. The ends then return to the scrotum without the need to stitch the skin. As in all the best keyhole surgery minimal disruption of tissues leads to quickest and complication free recovery. In summary NSV
• Preserves the blood supply to the vas
• Avoids damage to pain sensitive tissues
• Avoids cutting and stitching
Large scale trials have shown that the incidence of complications after NSV are a fraction of those following conventional vasectomy. Infection and swelling due to bleeding into the tissues occur in approximately 1/500 patients. This is because the blood vessels are not cut in the NSV procedure as the following diagrams show:

Preparing for vasectomy

Relax. The NSV procedure really is as near to painless and possible, yet many patients are irrationally scared of the operation. Usually once the office or workmates hear that you are going for ‘the snip’ the horror stories start pouring out. Ignore these! If true at all they refer to vasectomy performed years ago and not by the NSV method. Infection and swelling are almost unheard of with NSV.
Shaving. We ask patients to remove the hair on the scrotum and up towards the base of the penis. Depilatory creams such as Immac Sensitive can be used but check that you do not react to this by trying some on a non sensitive area first.
Bring an escort. In this clinic we administer a small dose of very welcome pre-med sedative a few minutes prior to the vasectomy. We see the patients face relax, even smile about 10 seconds after giving this. This treatment also relaxes the skin of the scrotum and makes the vasectomy even easier. BUT you will not be able to drive or make decisions until the next day so make sure you are accompanied to the clinic. Most wives join husbands in the operating room, we welcome this.

The No-Scalpel Vasectomy procedure

There many sites on the net that show pictures of the NSV being performed of which is one of best. After administering anaesthetic, special ring forceps are used to hold the vas directly under the skin. Then, using another specially sharpened pair of forceps, a puncture hole is made through the skin and into the vas. This exposes the bare vas which is hooked upwards and brought through the skin. Thereafter the vas is cut and sealed as shown above. The ends retract through the skin leaving a tiny puncture wound that is almost invisible. It takes usually 10-15 minutes at most.

Recovering from NSV – back to work the next day.

Immediately afterwards. We offer our patients strong coffee or tea and biscuits and advise a few minutes rest in the waiting room before leaving for home.
At home. Patients vary, but most will put the feet up for a couple of hours then will feel able to leave the house in the evening and return to all but the most physical job the next day. Bruising is minimal and all aching is usually gone by the next day.
Pain relief. If needed, use Ibuprofen or Paracetamol.
Sex.We recommend no sex for 7 days after NSV. This is to allow the vas to heal completely after the heat sealing treatment. Ejaculation leads to a pressure rise equal to that of your blood pressure and if the vas is not fully healed this can cause a tender swelling called a granuloma. After 7 days we recommend frequent sex – around three times per week until the post vasectomy samples are submitted. This is to clear away all the millions of sperms that remain in the tubes after vasectomy. Approximately 25-30 ejaculations are required to clear all sperms in most cases although some patients require more than this.
Better sex. Almost all couples report better sex after vasectomy with the lifting of the worry of unwanted pregnancy. Couples should not seek vasectomy to improve their sex life however.

Post vasectomy complications

There has not yet been devised any operation that does not carry some risk of some kind of complication. The advanced NSV procedure performed by skilled hands has all but abolished the complications of bleeding and infection.
Mild ache.Probably the commonest reported effect of vasectomy (probably 2-3%) is a mild aching sensation in the testes that appears maybe one to three weeks after vasectomy. This may be accompanied by a feeling of swelling in the epididymis (see diagram above). This sensation is caused by a slight pressure rise in the vas and mild distension of the epididymis following the blockage of the vas. The discomfort rapidly settles down as the body readjusts. The surgeon has a part to play in minimizing this. By choosing to perform the vasectomy in the upper third of the scrotal vas we minimize the pressure rise in the system thus reducing the chance of post vasectomy ache.
Granuloma. This is a firm lollipop shaped swelling on the cut testicular end of vas. Sometimes caused by returning to sex too soon before the vasectomy has fully healed. Usually goes unnoticed. Very occasionally causes discomfort and can be cured by merely trimming off the affected end in a further minor procedure.
Early recanalisation. This is the formation of a minute track between the ends of the vas which is microscopic in size but can allow a tiny number of sperms to re-appear in the semen. Occurs in approximately one per thousand patients and is detected by the post vasectomy semen tests. The remedy is simply to re-do the vasectomy.
Late recanalisation is the extremely rare process of microscopic rejoining of the ends of vas after the all clear has been given by passing two clear semen samples. We have never had one case of this in 8000 cases in this clinic but it has been reported.

Changing your mind!(

It is a fact that in the UK 1-2 % of patients will change their minds and in the USA up to 6% do so. Of course there is counseling from the GP, friends, family and colleagues and ourselves, but life often takes an unexpected turn. (Incidentally, approximately 15% of reversal requests arise because couples made the vasectomy decision when they were knee deep in nappies and probably tired and struggling financially. When the children are ‘grown-up’ and going to school and parents perhaps better off and less sleep deprived, they turn to a vasectomy reversal request. The remaining 85% of reversal requests come from couples who are in a second relationship and wish to enrich their lives with further family).
Vasectomy reversal is a lot more likely to succeed where the vasectomy has been performed without using diathermy and where care has been taken to operate on the vas in the correct area. A large part of my practice consists of vasectomy reversal, so I know!

I hope you enjoy browsing this site. I would be delighted to hear comments from interested parties, professional colleagues and patients.
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Dr Andrew Dawson