ST LUKE’S SURGICAL SERVICES 

Can a No-Scalpel vasectomy be reversed?

No more than any other vasectomy procedure. Remember that vasectomy especially the no-scalpel method is quick, convenient and causes very little discomfort, but vasectomies should be considered permanent. Reversal operations are expensive and often unsuccessful. If you are thinking about reversal, perhaps vasectomy may not be the best option for you

What is Different about a No-Scalpel Vasectomy?

No-scalpel vasectomy is different from a conventional vasectomy in the way the doctor gets to the tubes. This makes the procedure much less painful.

In a conventional vasectomy, after the scrotum has been numbed with a local anaesthetic the doctor makes one or two cuts in the skin with a scalpel and lifts out each tube in turn, cutting and blocking it so the sperm cannot reach the semen sac. Then the doctor stitches the cuts closed.

In a no-scalpel vasectomy, the doctor feels for the tubes under the skin and holds them in place with a small clamp after numbing the area. Instead of making two incisions, the doctor makes one tiny puncture wound opening with a special instrument so the tubes can be reached. The tubes are then blocked using a cautery method. There is very little bleeding with the no-scalpel technique. No stitches are needed to close the tiny opening, which heals quickly.

The no-scalpel vasectomy was invented by a Chinese surgeon, and is used throughout China. It was introduced in the United States in 1988, and  in the UK much later. The Royal Colleges now recommend it as the standard method of Vasectomy.

 

Is No-scalpel vasectomy safe?

Vasectomy in general is safe and simple. Vasectomy is an operation and all surgery has some risks, such as bleeding, bruising, infection or scarring. But serious problems are rare; less than 1 in 100 cases have even minor problems.

Does No-scalpel vasectomy work?

Yes. It Is estimated that after a vasectomy there is less than a 1 in 2000 chance that a man’s partner will become pregnant. Unfortunately No method is 100 % fool proof, but Vasectomy is ‘the best a man can get’.

Will vasectomy change me sexually?

The only thing that will change is that you will not be able to make your partner pregnant. Your body will continue to produce the hormones that make you a man. You will have the same amount of semen. Vasectomy won’t change your beard, your muscles, your sex drive, your erections, or your climaxes. And you won’t sing soprano. Some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex is more relaxed and enjoyable than before. 

How long will the No-scalpel vasectomy procedure take?

You can come to see us for a consultation at which we explain the procedure and answer your questions. Your partner does not have to attend with you but it may be helpful if she does. You can then book in for the procedure to be done on another day. On average the procedure takes about 15 minutes but you will be at the surgery about 30 minutes in all. You should bring someone with you to drive you home afterwards.

One Stop Shop: Same day consultation and operation is the norm these days with all the information sent to you electronically before hand.

Will it hurt?

Before the vasectomy we can give you a mild sedative, to be taken an hour and half before hand, to relax you. When the local anaesthetic is injected into the skin of the scrotum, you will feel some discomfort, but as soon as it takes effect, you should feel no pain. Afterwards you may be sore for a couple of days and you might want to take a mild painkiller. But the discomfort is usually much less with the no-scalpel technique, because there is less injury to the tissues. Also, there are no stitches. You will be provided with complete instructions about what to do after surgery.

How soon can I go back to work?

You should take it easy for at least 48 hours after your vasectomy. If your job doesn’t involve heavy work, you can then go back. If it does you should take a full week off. (People have come, had the operation and then went back to their work in the office!, but this is not generally recommended.)

Do I need a referral?

Many men consult their GP first and are referred to us. If you choose to book an appointment with us without seeing your GP first, we will ask your consent to contact your GP so he can let us know if there is any medical reason that would make it unwise or unsafe for you to have a vasectomy.

Will I be sterile Right away?

No. After a vasectomy, there are always some active sperm left in your sperm sacs. It takes about 20 ejaculations to clear them. You and your partner should use some other form of birth control until a 16  week sample of your semen have been tested and confirmed free of sperm. It is very important that you wait for the results before stopping using the other method of birth control

Complications

This one of the safest operations with very few serious complications. However, no operation is without complication and NSV is no exception. There is a small chance of infection, bleeding and post-operative pain. Infection is usually controlled with antibiotics. However, in extremely rare occasions it can go out of control and result in Septicaemia, loss of the testicle and even death. A small blood clot about the size of the testicle and feels almost like another tender testicle can rarely happen. It resolves in a few weeks. Bigger blood clots can take longer to resolve and cause discomfort. There have been reports of large haematoma to the size of a melon, which can take 6 months to go down. Usually post-operative pain is mild. Occasionally it can last a week. Rarely chronic testicular pain can occur and be a troublesome prolonged pain and result in loss of enjoyment of life. Occasionally sperm can extrude from the cut tube and cause a local reaction resulting in a tender swelling called sperm granuloma. Extremely rare still, are complications like damage to the blood vessel resulting in loss of the testicle, or urine tube damage  during operation, burns from the cautery and anaesthetic reactions like low BP, anaphylactic shock which can be life-threatening.

Operation Failure 

No contraception method is 100% failure proof, but Vasectomy is the best available. Early re-joining of the tube occurs 1 in 1000 patients after NSV. Late re-joining can occur even after 2 years and the chance of this is 1 in 2000.

Post-Operative Course 

After operation take it easy for a couple of days, take ibuprofen /paracetamol if pain dictates it. Can return to desk job the same day, sedentary job in 2 days and heavy work in about a week. At about 16 weeks (and 20 ejaculations), you should do a semen test. If it shows no sperms in the seminal fluid you can stop contraception. If it shows sperms, even if dead,  you need to repeat the test evey 6 to 8 weeks until it is clear.

In some people, dead sperms keep appearing in the semen. This is due to dead sperms at the bottom of the semen sac which is not all ejected out. It is not due to failure of operation. In this situation if there are less than 10000 dead sperms in 1ml of semen, at 7 months after operation, you can consider the operation a success and stop contraception. This is called special clearance to stop contraception. 

Failure of Operation

If live and kicking sperms are there in the semen after 4 to 6 months, the operation is a failure. In this situation, a reoperation is needed. If the re-operation also fails, you should resort to alternate methods of contraception. The reason for failure could be variations in the anatomy.

A Comparison Published in Lancet.

Kings Birthday Vasectomy Festival, Bankok 1988	CONVENTIONAL VASECTOMY	NO-SCALPEL VASECTOMY
CASE	523	680
INFECTION(%)	1.4	0.1
BLEEDING(%)	1.7	0.3
COMPLICATIONS	3.1/100	0.4/100
Lancet:336 894-990