No-Scalpel Vasectomy – Alaska Urology

The procedure is performed under local anesthesia in the outpatient surgery room. The surgeon feels for the sperm-carrying tubes, or vas deferens, under the skin of the scrotum and holds them in place (one at a time). Injection of a local anesthetic using either a tiny needle (similar to the one used for a TB test) or other injector completely anesthetizes the surgical site. The anesthetic is effective immediately, so the instruments should not be felt after that point. A special instrument is then used to make a small puncture in the skin and stretch the opening so the vas deferens can grasped, cut, cauterized and clipped with two sterile titanium clips on either end. The clips remain permanently, but rarely can be felt through the skin and will not be picked up by metal detectors. There is little discomfort, though some men feel a slight “tugging” sensation. This approach produces very little bleeding and no stitches are needed to close the incision. Generally, the procedure takes 15 to 30 minutes.

What happens to sperm after vasectomy?

After vasectomy, the testes continue to make sperm. When the sperm cells die, they disintegrate and are absorbed by the body. This is the same way the body handles other types of cells that die and are replaced on a daily basis. 

Can I discontinue other birth control methods right away? 

Sperm can remain in the vas deferens above the operative site for weeks or even months after vasectomy. You will not be considered sterile until postsurgical semen analysis (usually performed 12 weeks post-vasectomy) shows that no live sperm remain. This test must be repeated monthly until clear. Until then, you must continue to use other birth control to prevent pregnancy. You will receive a letter from your doctor confirming your sterility. Only at this time is it safe to discontinue birth control.

What are the risks?

Although complications such as inflammation, bleeding or infection may occur, they are relatively uncommon and not serious. A major benefit of the percutaneous no-scalpel vasectomy is that the opening in the scrotum is so small that the blood vessels are less likely to be affected. Minor risks include: 

Sperm Granuloma

A hard, sometimes painful lump about the size of a pea may form as a result of sperm leaking from the cut vas deferens. The lump is not dangerous and is almost always resolved by the body. Typically, scrotal support and mild pain relievers help relieve symptoms. 

Congestion

A sense of pressure caused by sperm in the testes, epididymis and lower vas deferens may cause discomfort for two to 12 weeks after vasectomy. Like granuloma, congestion usually resolves itself over time. 

Pain

Any surgical procedure can affect nerves and, rarely, there can be residual “phantom” pain. The testicles are sensitive organs, so such pain is common in men whether they have had vasectomy or not. It is not clear whether vasectomy increases this risk.

Is a vasectomy 100% effective? 

Other than total abstinence, no method of birth control is 100-percent effective. In rare cases, it is possible for sperm to find its way across the void between the two blocked ends of the vas deferens. Called recanalization, this generally occurs within the first few months following vasectomy. However, the failure rate of vasectomy is very low, as shown in the previous table. Vasectomy has been used for many years as a means of sterilization and has a long track record as a safe and effective method of contraception. If live sperm continue to appear in the semen samples, or if sperm are discovered after a period of time, a repeat vasectomy will be necessary. Medical research shows that this only happens approximately once in every 1,000 cases, a failure rate far lower than any other form of birth control 

Can I have it reversed later if I choose? 

Vasectomy should be considered a permanent means of birth control. Reversing a vasectomy is difficult, expensive and often unsuccessful. The decision should be discussed with a professional counselor. Men who are married or in a serious relationship also should discuss this issue with their partners.  If you’re thinking about a reversal now, perhaps you should take more time to decide whether vasectomy is right for you at this time. Because people often feel differently as they age, most men under 30 who are without children would be wise to wait in case they desire fatherhood later. An exception might be the man whose spouse or partner cannot have children for health reasons.