Both of these complications may lead to spontaneous recanalization and late failure. Proximal fascial interposition involves the closure of the fascial sheath over the prostatic cut end of the vas in a purse-string fashion Figure This technique in combination with luminal fulguration of both ends of the vas was shown to be effective and to cause few postoperative complications in a study of over 6, patients.
An open-ended technique first reported in 22 has been investigated as a method for preventing painful side effects and allowing easier reversibility of vasectomy.
With the open-ended technique, the testicular end of the vas is left open and the prostatic end is managed with cautery and fascial interposition. In two separate studies, 22 , 23 a marked decrease in epididymal congestion was observed along with fewer instances of symptomatic sperm granuloma and failure.
Following removal of the vasal segment and management of the ends, the wound is then inspected for active bleeding, and hemostasis is ensured.
The incision is closed with absorbable suture Figure The no-scalpel, or Li, technique was developed in China in in the hope of improving the acceptance of vasectomy in that country. This technique differs from conventional vasectomy techniques primarily by the unique method of incision and delivery of the vas. A ringed extracutaneous vas clamp Figure 13 is used to fixate the vas to the overlying skin, and a single midline incision is made by means of a sharpened clamp. Compared with other vasectomy techniques, the benefits of no-scalpel vasectomy include a shorter operating time, 24 less pain and swelling, and faster recovery.
After the procedure is completed, postoperative instructions should be reviewed with the patient. Appropriate recommendations include intermittent ice applications to the scrotum for eight hours, bed rest and scrotal support for 48 hours, and avoidance of heavy exertion for one week. Acetaminophen usually provides sufficient analgesia, although occasionally narcotic analgesics are necessary.
Sexual activity should be avoided for one week. Another method of contraception should be used until semen analysis has confirmed azoospermia. A telephone call 48 to 72 hours after surgery and a one-week follow-up office visit provide opportunities for the physician to assess the patient's condition and reemphasize the postoperative instructions.
Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. He recently completed a residency in family practice at the Naval Hospital, Jacksonville, Fla. He graduated from the University of South Florida, Tampa. Address correspondence to Timothy L. Reprints are not available from the authors.
The authors thank Robert F. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense.
Vasectomy in the United States, Am J Public Health. American Academy of Family Physicians. Office practice characteristics survey, May Kansas City, Mo. Family physician perception of economic incentives for the provision of office procedures. Fam Med. A national survey of vasectomy training in family practice residency programs. Tubal sterilization or vasectomy: how do married couples make the choice?
Fertil Steril. Vasectomy: an appraisal for the obstetrician-gynecologist. Obstet Gynecol. The choice of sterilization procedure among married couples. J Fam Pract. Postvasectomy semen analysis: why patients don't follow-up. J Am Board Fam Pract. Alderman PM. The lurking sperm: a review of failures in vasectomies performed by one physician.
Temporary reappearance of sperm 12 months after vasectomy clearance. Br J Urol. No-scalpel vasectomy. Prim Care. Standards of care for vasectomy. Contemp Urol. No-scalpel vasectomy: a technique for family physicians. Am Fam Physician. Use of EMLA during local anaesthetic vasectomy. A clinical study of vasectomy failure and recanalization.
J Urol. Vasectomy: how much is enough? Reynolds RD. Vas deferens occlusion during no-scalpel vasectomy. Denniston GC. Vasectomy by electrocautery: outcomes in a series of 2, patients. The vas after vasectomy: comparison of cauterization techniques.
Schmidt SS. Vasectomy by section, luminal fulguration and fascial interposition: results from cases. Open-ended vasectomy: an assessment. Denniston GC, Kuehl L. Open-ended vasectomy: approaching the ideal technique. The procedure was quick and I went back to work for a little while. The only pain I experienced was soreness beginning about 4 hours post procedure, lasting for 24 hours, then subsiding rapidly.
I was fine by Monday. The office checked on me twice, no problems. I would recommend Dr. Monteith to anyone. Your questions about our services will be answered directly and promptly by our staff or Dr.
We will not respond to general medical questions or if you are a patient of another practice and are contacting us because you are not getting answers from your physician. If you have been a patient at our center and have specific questions about your medical care you should contact the staff directly at Different Types of Vasectomy Conventional vasectomy with two incisions There are three main different types of vasectomy: conventional vasectomy no-scalpel vasectomy minimally invasive vasectomy Although all three types of vasectomy procedures cause permanent blockage of the vas deferentia there are minor variations in the techniques used to perform each type of vasectomy.
Some vasectomy procedures have been associated with higher rates of complication. Conventional vasectomy Conventional vasectomy is performed using a scalpel to make incisions in the scrotum. No-scalpel vasectomy No-scalpel vasectomy NSV is a minimally invasive vasectomy that uses specially designed instruments to make smaller sized openings in the scrotal skin.
Minimally invasive vasectomy with one incision The NSV incision is usually less than 10mm and no skin sutures are required to close these smaller incisions. Technically, No-scalpel vasectomy only refers to how an opening is made in the scrotal skin. Minimally invasive vasectomy Minimally invasive vasectomy uses the same instruments as No-scalpel vasectomy.
Which vasectomy technique is better? What should you do if your doctor only performs conventional vasectomy? I never want to discourage a guy from getting a vasectomy if he feels that is the best choice for him. Run Forrest Run…!!! Monteith performs minimally invasive vasectomy. Ask Us A Question! Enter Email Confirm Email. Complications are rare.
If they do occur, they can include:. Another post-vasectomy complication can be a buildup of sperm that forms a lump in your testicles. This is called a sperm granuloma. Granulomas usually disappear on their own, though an injection of a steroid may be needed to speed up the process. Likewise, hematomas tend to dissolve without any treatment. But if you experience pain or swelling in the weeks following your procedure, schedule a follow-up appointment soon with your doctor.
One other important consideration is the possibility of remaining fertile during the first several weeks after a vasectomy. Your doctor may advise you to ejaculate several times in the first couple of months after a vasectomy and then bring in a semen sample for analysis. Some insurance companies, as well as Medicaid and other government-sponsored programs, may cover the cost entirely.
Check with your insurance company or with your local public health office to learn more about options to pay for the procedure. Reversing a vasectomy to restore fertility is possible for many men who have undergone the procedure. A vasectomy reversal involves the reattachment of the severed vas deferens. Sometimes a couple changes their minds about having children and seek a reversal. A no-scalpel vasectomy can be an effective and safe form of long-term birth control.
When performed by surgeons with experience, the failure rate can be as low as 0. Sexual function is usually unaffected by a vasectomy.
Intercourse and masturbation should feel the same. Your testicles will continue to produce sperm, but those cells will die and be absorbed into your body like any other cells that die and get replaced. If you have questions or concerns about a no-scalpel vasectomy, talk with your urologist. A vasectomy is performed on an especially sensitive part of the body, but it doesn't cause a lot of pain or lingering discomfort.
Learn more about…. A vasectomy is generally an effective birth control method for avoiding pregnancy. However, many men wonder about vasectomy side effects and even long-. A vasectomy is a birth control method that prevents the release of sperm during ejaculation. Chemical castration is the use of drugs to lower the production of hormones in your testicles. Learn how it works, and more. Scrotox refers to injecting Botox in the scrotum. While there are medical reasons to have this done, it's becoming a popular procedure for appearance….
Penis splitting, known clinically as penile bisection or genital bifurcation, is a type of body modification.
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