Treatment

Sperm are made in the testis and travel via muscular tubes called the vas deferens, which enter the pelvis and pass behind the bladder and through the prostate gland to open just below the neck of the bladder. The vas deferens are joined by ducts from other glands, which lie behind the bladder known as the seminal vesicles. When a man ejaculates the semen produced is made up of three components. The majority of the fluid is produced by the seminal vesicles (approximately 60%) and secretions from the prostate gland (approximately 30%). The remaining 10% comprise sperm-rich fluid from the testicle delivered through the vas deferens.

The operation of vasectomy involves removing approximately 1cm of the vas just above the testicle and sealing the two free ends by internal cauterisation. This prevents sperm passing beyond this point and after all the sperm stored up-stream in the vas deferens are used up, the semen will only comprise fluid from the prostate and seminal vesicles. Because the sperm make up such a small percentage of the total volume, a man does not usually notice any difference to his ejaculation after a vasectomy.

Following a vasectomy, the testicle continues to make sperm, which is stored in a structure attached to the testes, the epididymis. As sperm break down and are removed, new sperm are produced to replace them.

Generally, we carry out a so-called ‘no scalpel vasectomy’, avoiding the need to make incisions in the scrotum and there's no sutures. Occasionally, where the scrotal skin is very thick or tight, a traditional scalpel vasectomy will need to be carried out but this happens rarely.

On arrival at the surgery, you will be escorted to the procedure room and the groin area is shaved by a nurse. The position of the vas is then marked out on each side with a small marker pen, Emla cream applied and covered with a dressing. This cream is absorbed into the skin numbing it to quite a reasonable depth. Although this takes approximately 30-40 minutes to become effective it results in virtually no sensation at all during the injection of local anaesthetic, the part of the operation most men dread. After the local anaesthetic is injected and the area numb the vas is manoeuvred to just under the skin and held in position by a special clamp. The vas is then delivered through a tiny split in the skin and the 1cm segment removed. The two ends of the vas are cauterised internally thereby sealing them off and reducing the chance of sperm leaking or re-joining. After carefully checking for any bleeding, the ends of the vas are released and they drop back into the scrotum.

The tiny split is too small to require sutures and because no skin or muscle fibres were cut the area will heal over very quickly.

Whilst the no scalpel vasectomy is technically a more difficult operation than the standard procedure and takes a little longer, it results in much less discomfort post- operatively.

Like any operation there are complications associated with vasectomy and it is extremely important you are aware of these and accept the possibility that they may occur in your case. In our practice, less than one in a hundred men would experience complications.

Complications

1. Infection: If an infection occurs in the cut you will notice this wil become red, tender and possibly swollen and you will require antibiotics. By carrying out the pre-operative instructions involving a shower as described later, the chances of infection are extremely small.

2. Heamatoma: Haematoma is the medical term for the collection of blood in tissue. Following the vasectomy some of the small thin walled veins around the vas may start bleeding, although every care will be taken to seal these off during the procedure. Because the area is so elastic, quite a large blood clot can build up before the bleeding stops. This will result in anything up to a large egg-like swelling above the testicle, which is extremely painful if you try to work or walk around with it. If you are unfortunate enough to have a haematoma, and the chances are approximately <1%, you will probably be required to take three or four days off work and rest up. The body will reabsorb the haematoma over a period of about 7 - 10 days and you will not be left with any long-term problems.

   1. In addition bleeding can occur into the skin layers itself which will leave a black looking bruise, but this is painless and therefore of no consequence. Bleeding can also occur from the cut itself, but this simply requires a dressing and usually stops within half an hour of surgery.

   2. Fairly commonly there is some residual haematoma in the vas itself and this can cause blood to appear in the ejaculate. This always resolves and is of no consequence. (Though it can look alarming!)

3. Granuloma: This is another rare complication comprising of a lump of scar tissue that forms between the two cut ends of the vas and is usually about the size of a pea or small grape. It is usually a reaction to the sperm that have spilled out during the procedure into the tissues, and will only persist if there continues to be a sperm leak. In all the cases of granuloma we have seen, the lump has disappeared over a period of months, but theoretically it is possible you may have to go back and have a minor procedure to remove the granuloma and reseal off the vas. Granulomata were much more common in the days when the vas was tied off with a silk stitch, which in many cases use to irritate the tissues for years.

4. Testicular Pain: Whilst it is normal (as you would expect) to have pain following this operation, this usually lasts only a few days and is a dull ache. However, many men experience occasional dull aches in their testicles, often just on one side or the other for many months or even a year following vasectomy. This pain is thought to be due to the congestion of the epididymis, the structure attached to the testis where the sperm is stored. The pain is usually only a very minor nuisance, occurs only on occasions and in our experience has always resolved after, at the very latest, 18 months. It is very rare, but must be mentioned as a possibility. In more severe cases, an occasional anti- inflammatory tablet will quickly resolve the problem.

5. Failure of the Operation (your wife or partner gets pregnant): This could be considered the most serious complication and, of course is a permanent one! It can occur if men do not wait sufficient time to use up all the sperm still in the vas above the level of the operation and which usually takes anything from six to eight weeks. In addition, a canal can develop between the two ends of the vas through which sperm can travel (re-canalisation). If this is going to occur it usually does so in the first few weeks after the operation. Therefore, to avoid this unfortunate event you should undergo a sperm count approximately six to eight weeks after the operation. If this is zero, you know that (a) you have used up all the stored sperm and (b) the ends have not re-joined. Although it is theoretically possible that the ends may  re-join years after the operation, this is very rare.

To reduce the chance of re-canalisation one could remove much more of the vas but if your circumstances change it would be impossible to reverse the operation whilst haematomas would be more common. If the sperm count is still positive at six weeks, we merely repeat this every two weeks until it becomes negative. Very occasionally, a vasectomy needed to be done again, because of persisting low sperm count, not that there was much chance of a pregnancy, but whilst there is a single sperm in the ejaculate, there is always a theoretical possibility. It goes without saying that if you are unfortunate enough to require the second procedure, there would be no additional charge!

Your Consent

You will have an appointment to see your Urologist to give you the opportunity to discuss any aspects of this information sheet and the operation itself. During that appointment you will be asked to sign a consent form and you will be given an appointment and some tablets for your pre-medication (Diazepam 20mg).

Your Operation

One hour before your scheduled surgery time, you should take a shower. During this shower you should thoroughly soap up your penis, scrotum, groins and particularly around the anus, rinse off and repeat this procedure a total of three times. This will greatly reduce the bacterial count, which could cause infection. Dry yourself with a clean towel and put on a clean pair of underpants. As soon as you are out of the shower take the two 10mg Diazepam tablets, then sit down, and relax until it is time to come in to the rooms.

It is most important that you do not drive yourself to or from the surgery. Following surgery, we will make the necessary arrangements for the post-operative sperm count.

After Surgery

You should go straight home after the operation and lie down for 4-6 hours. In the event you are unfortunate enough to have a complication, you should phone our rooms and your Urologist will arrange to see you. Overall, we do not make routine follow-up appointments, because it is so rare to have problems post-operatively.

We recommend you take two days off from your normal employment, during which you should take it very easy. This is particularly important on the night of the surgery and the day following. You can resume sexual intercourse as soon as you feel comfortable, but preferably not within 48 hours of surgery.

Once Home

You should go straight home and lie on your bed or couch for the next four to six hours. Use the Maxigesic tablets provided if you feel an ache developing as the local wears off and we recommend taking some before you go to sleep that night. The normal dose is two tablets, four hourly.

For the next 1-2 days, depending on progress, you should avoid exercise and lifting and you should return to normal activity over a period of days depending on how comfortable you feel.

You should use contraception until you have had a clear sperm count. Your first sperm count should be about 8 weeks post operation. Semen should be collected, preferably by masturbation in the container provided which should be delivered to any Pathlab facility within approximately one to one and a half hours. Be sure to also hand in the form with the sample.

Please phone the Rooms (07) 579 0466 for the results after two working days. If the sperm count is not clear you will need to repeat the test after two weeks. Some people suggest a second clear count one month later but that is up to you. If you live out of Tauranga check with you nearest laboratory about the best time to drop off the sample.

Sperm Storage

If you have any doubt about the permanence of vasectomy, you may choose to store sperm in a sperm bank. You will need to sign various consent forms and in particular decide in advance what should happen to your sperm in the event you no longer wish it to be stored or in the event you died. The options are for the sperm to be destroyed or they can be made available for artificial insemination for infertile couples. We normally utilise the services of Fertility Associates in Auckland or Hamilton.  They can be contacted on Auckland 09 5209520 or Hamilton 07 839 2603 for further information.

Vasectomy Reversal

This operation involves removing the blocked and scarred portions of vas and mobilising the two ends sufficiently for them to be re-joined using micro-surgical techniques. Because of the fine nature of the surgery and the equipment required, this operation on average takes 2 hours. In approximately 85% of men, sperm will return to the ejaculate. However, only 50% will father a child successfully. The operation is expensive, costing in the order of $9,000 and the bottom line is that if you are not really sure whether you want to have more children in the future then vasectomy is not the operation for you.

While you are in hospital, we will do everything we can to make your stay as comfortable as possible. The nursing and medical staff are always available to help with whatever needs you have. If you are worried about anything before or after your surgery, or if you have any further questions or would like more information, please do not hesitate to ask your nurse who will be more than happy to help.