Vasectomy

 

 

Vasectomies provide men with a permanent contraceptive solution. Vasectomy surgery is a minor operation typically performed in the doctor’s office under local anesthesia. Vasectomy involves blocking the flow of sperm from the testicles by cutting the vas deferens (the muscular duct that carries sperm from the testicles to the seminal vesicles.). Vasectomies are performed in a variety of ways depending on the technique chosen by the individual surgeon. 

Surgeons generally attempt to occlude the vas deferens using a combination of excision (removal of a segment of the vas deferens), cauterization (burning of the cut ends of the vas deferens or sometimes the inner lumens of the cut ends), ligation (closing of the lumen of the vas deferens using either sutures or metal clips), fascial interposition (sewing one end, typically the testicular end, of the vas deferens outside of the vasal sheath or fascia thus isolating the two ends). 
Some surgeons advocate leaving the testicular end of the vas deferens open to reduced the likelihood of congestive epdidymitis or epididymal back pressure that can lead to epididymal sperm granuloma both of which have been associated with chronic post-vasectomy pain syndrome.  
No-Scalpel vasectomy involves the use of pointed forceps to create the scrotal opening instead of a scalpel and involves an more efficient way of exposing the vas deferens. No-scalpel vasectomy has been found to result in less pain both during and after the procedure and also reduced incidence of complications.
Up to a third of men experience testicular discomfort post-vasectomy. For up to 15% this discomfort can become bothersome.[1]  Vasectomies provide high effectiveness reported at 97% to 99.8% effective.

[1] Br J Urol 1992 Feb;69(2): 188-91

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