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Vasectomy In Male

What is Vasectomy?

Vasectomy is derived from the latin word 'Vas' stands for vas deferens and 'ectomy' means cutting. It is a permanent method of male contraception or birth control. Male vasectomy is a surgical sterilization procedure performed on adult males that is intended to obstruct or remove a portion of both vas deferens, thereby preventing sperm from moving from the testes to the ejaculatory ducts. The semen no longer contains sperm and so conception cannot occur. 
During the procedure, the vas deferens are cut and tied or sealed to prevent sperm from entering into the seminal stream and thereby preventing fertilization. The effectiveness of it is 99.85%.
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Methods of Vasectomy:


There are several methods of vasectomy,different types of procedures that are available can be categorized into two main types- Conventional and No-scalpel procedures.

Conventional vasectomy:

Prior to the procedure, the scrotum area is cleaned with antibacterial scrub and injected with local anaesthesia.The process of injecting anaesthesia can be painful but it can be avoided by applying anaesthetic cream.The vas deferens are located by making a small incision on either side of the scrotum.Vas deferens is taken out followed by fitting with two clamps.The segment between the clamps is removed and the two open ends are sealed with sutures and cauterized.The vas deferens is gently placed back into the scrotum and the same process is repeated on the other vas deferens as well.The main disadvantage of this procedure is that risk of surgical complications are there.

No-Scalpel Vasectomy (NSV):

No-Scalpel Vasectomy is the most widely adopted vasectomy procedure as it is considered as the safest among all other methods. This method reduces the risk of surgical complications. It was originally developed in china and first introduced in US in 1984. It is different from the conventional technique in that the tubes under the skin are felt and they are held in place using a small ring-like forceps so that only a minimal amount of tissue is present in the ring. Near the vas deferens tubes a small puncture is made in the ring forceps.The tubes are stretched and pulled out from this puncture. This process is known as ‘supination manoeuvre.The tubes are ligated and a small segment is excised.The ends are sutured and then cauterized.At the end of the procedure a tiny puncture hole remains, which doesn’t require any closure and that can heal naturally.In comparison to other methods, less bleeding, no scar post vasectomy,less pain are some of the advantages. It can be performed usually within 10-15 minutes.

Other methods are as follows:

Open- Ended Vasectomy:

In open-ended technique,only one end of the vas deferens is sutured and the other end is left open. The end leading to the prostate is tied and the end connected to the testis is left open allowing to maintain decompression.It is one of the more popular types of vasectomy, as it involves less risk of any complication before, during and after the procedure.The amount of discomfort and pain that is associated with this method is low in comparison to other procedures. Also, there are higher chances of success with vasectomy reversal. 

Closed- ended Vasectomy:

Unlike open ended technique,both the open ends of the vas deferens that are cut are sealed or tied in this procedure.

Vasclip Implantation:

Vasclip is a rice-sized plastic clip,which is used to lock the vas deferens in order to prevent sperm from moving through the ejaculation duct.In this process vas deferens tubes are not sealed.It is only the vasclip that locks the vas deferens.Although there are no complications involved in this process, but the birth control option is not as effective as seen with other vasectomy procedures.

Vasectomy combining cautery and fascial interposition:

It is the most effective method of occlusion of vas with minimal risk of failure.In this method, the vas deferens is exposed first with no-scalpel approach.The lumen of the vas is then cauterized.The two cut ends of the vas are then separated by fascial interposition.It results in maximum effectiveness.

Surgical procedure:

It is performed in two distinct steps: delivering and exposing the vas deferens out of the scrotum (isolation), and occluding the vas.

Preparation: 

Pre and perioperative anti-inflammatory treatment with celecoxib, started the night before the procedure may help to prevent postoperative pain.

Antimicrobial application:

After positioning, the skin on the testicles and scrotum is prepared with antimicrobial surgical scrubs eg chlorhexidine.

Anaesthesia:

Local anaesthesia is given prior to the procedure, in which the needle is advanced along the vas deferens to provide a cord block. A newer non-needle approach can also be used in which the anaesthetic is delivered via a pressurized jet injection.The technique is nearly painless. 

Access to the vas deferens:

The vas deferens is brought up to the skin, a ring-tipped clamp is used to secure the vas through the skin.Tissue adherent to the vasal sheath is cleared away with the mosquito hemostat using the same spreading motion of its blades, and the vasal sheath is further cleared of adventitia.It is important to achieve a segment of vasal sheath completely free from adherent tissue.

Occluding the vas deferens:

The vas deferens is hemi-transected with the cautery, exposing the lumen of it. The tip of the device is inserted into each end of the vas deferens to cauterize both the openings.Care should be taken properly to avoid full-thickness cautery of the vas to prevent necrosis.Cautery is done just to obliterate the luminal lining of the vas deferens.
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Advantages of Vasectomy:


• It is an effective and permanent way to prevent pregnancy.
• It doesn’t have any lasting effects on sexual performance and it doesn't affect hormone levels or sex drive.
• It is easier to perform and less expensive than female sterilization as well as it is more reliable alternative.
• It is best for those who are certain that they don’t want children and it also doesn't require daily attention.

Disadvantages and complications of Vasectomy:

• The main disadvantage of this procedure is that it doesn’t protect against sexually transmitted infections such as HIV infection.
• However,reversal of this procedure may be possible but it is more complicated than the initial procedure.
• Chances of early complications eg hematoma and infection are there.
• Chronic testicular pain is one of the most vexing postoperative complication.
• Pain with intercourse or ejaculation, physical exertion can occur after the procedure.
• Epididymitis and sperm granulomas can also occur after the procedure.


Are male vasectomy reversible?


Although vasectomy is intended for permanent sterilization, but it can be reversed for those who seek to restore their fertility due to reproductive goals.Vasovasostomy is the surgical procedure in which vasectomies are partially reversed. It means connection of the vas to the vas.
This procedure is costly and success of the procedure is not guaranteed.


Average cost of vasectomy:


The cost of a vasectomy ranges between 4000- 5000/- INR in private hospitals whereas it is done free of cost in Government hospitals in India.In government hospitals of India, reward is also given to motivate. 
Cost ranges from $400- $1200 in US. 


Precautions after vasectomy in male:


Pre-operative instructions
• Consult physician and stop taking anti-coagulants such as aspirin etc.
• Shave all the hair from the scrotum carefully before the procedure.
• Wear close-fitting underwear supporting the scrotum.
Post-operative instructions
• Keep the dressing dry and in place for atleast 48 hours.
• Putting ice packs on the scrotum after operation may help decrease pain and swelling.
• Wear close fitting briefs to reduce pain and swelling.
• Take all the medications properly as prescribed by the doctor.
• Keep the genital area dry and clean to avoid infections.
• No sex or ejaculation for atleast 1 week.
• Avoid heavy lifting and other strenuous physical activity until it heals properly.
• Avoid sports and contact sports for a couple of days.

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