H.T. Kurkjian, M.D.        Vasectomy
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Vasectomy


 A Vasectomy is a minor surgical procedure.  It is done to remove segments of the vas for the purpose of contraception.  This surgery is usually performed in the clinic under local anesthesia.  However, it can also be done under general anesthesia in the hospital.

Complications From Surgery

Swelling:  A small amount of swelling is not unusual.  However, if the scrotum reaches about two to three inches in diameter, it can be problematic because the swelling is mostly in the spongy tissue of the scrotum and not easily drained. This makes it even more important for the patient to follow the directions very carefully.  Proper rest will help prevent the swelling.

Infections: Infections are very rare but may occur.  If this happens, it may cause chills and fever.  A prescription for antibiotics may be needed.

Epididymitis: Epididymitis is a swelling of the epididymis.  The epididymis is a structure that drains the testicles and acts as a conduit for the sperm to travel to the vas.  In some patients it gets inflamed a few months to a few years after the vasectomy.  Most of the time antibiotics, heat and rest will eliminate it.  However, in some cases, it becomes necessary to do a minor surgical procedure to remove the epididymis. 

Although it has not been proven to be true it has been mentioned in some articles that after a vasectomy patients are more prone to have coronary heart disease or prostate cancer.  Also, there is a rare form of infection that may set in after a vasectomy called narcotizing fasciitis that may cause death.  Narcotizing fasciitis is usually associated with immunocompromised patients such as patients with AIDS.

Procedure

The patient is seen initially in consultation at least 48 hours before the vasectomy.  This gives the physician a chance to talk to the patient and his wife and explain the different aspects of the vasectomy.

He will also discuss recuperation time as well as different complications.  He will then do a Physical Exam.  it is extremely important to have this initial interview.  Our statistics show that 10% to 15% of the patients do not proceed after the initial interview.  On the day of the vasectomy, the patient will arrive at the clinic about an hour before the actual time of surgery.  He will be given a tranquilizer, which will relax him as well as as his muscles which will make surgery much easier.  It is imperative that the patient's wife or friend be available to take him home after the surgery.

About 45 minutes to an hour after the medication, the patient is taken to surgery.   After being scrubbed with a special surgical solution, two incisions are made on the front part of the scrotum.  The incisions average about 1/4 inch in length.   Part of the vas is removed to prevent the two ends from reconnecting.  Then each end is tied twice.  The skin is sutured on each side.  The sutures are absorbable and within ten days will have fallen off.  Therefore, there is no need to remove the sutures later.  After surgery, a tight dressing is applied as well as a scrotal support.  The patient is sent home to rest for three days as instructed.   Pain pills are prescribed if Tylenol is not enough.

Care After the Procedure

  1. The patient should be off work at least for two days (48 hours) following a vasectomy.   It is important that he stay off his feet for that period of time and not use a recliner.
  2. The patient should not drive for long distances for at least two weeks following the surgery.
  3. The patient should not strain or lift heavy objects for these two weeks (five pound limit).
  4. The patient should use an ice pack for the first 24 hours.  Please discontinue using the ice pack after 24 hours.
  5. The patient should use an athletic supporter for at least two weeks following the vasectomy.
  6. The patient should not take showers or baths for 48 hours.
  7. The patient may have intercourse after 1 week.
  8. If the wounds heal with some drainage, cleanse with hydrogen peroxide solution daily, cover with Neosporin ointment, and dress with gauze.
  9. No driving or riding long distances for 2 weeks following the vasectomy.
  10. The patient will need to take at least two separate semen specimens to the hospital out-patient laboratory for a sperm count.  The first should be taken 1 month or approximately 15 ejaculations after the surgery.  The second taken in two month or 30 ejaculations.   These specimens must be collected in a rigid container.  Remember, during this time, precautions should still be taken against pregnancy until after the specimens show no sperm.  We also recommend a yearly semen analysis to make sure the vas have not recanalized (1% chance).

Before the Procedure

  1. The patient must bring his scrotal support with him on the day of surgery.
  2. The patient should shave his scrotum before he come.

Charges

The receptionist will explain the charges for the procedure.  It is our policy that we receive payment at the time the surgery is done.  Parts of the vas are sent to Pathology for conformation of the diagnosis and to check for pathology.  Therefore a separate charge should be expected from the Pathologist.  You will receive this in the mail after the vasectomy.  The lab where the sperm count will be done will also charge you separately for the service.

The success rate for prevention of pregnancy after a vasectomy is 99%.

Reversal of a vasectomy can be done.  The success rate is about 90%.  However the best results are obtained within 5 years after the vasectomy.

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