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Disruption of the deferens (sterilisation)

What does this procedure entail?

The principle of this procedure is to interrupt both vasa deferentia, most often in the scrotum. After the wound is healed, this procedure permanently prevents the sperm from entering the ejaculate. It is an effective and permanent form of male "contraception". Compared to surgical sterilisation of a woman, this is a faster, simpler and, above all, safer method. The vasectomy is only suitable for men who no longer want children now or in the future. The main reason is the fact that it is a method of permanent contraception (reconnection of vas deferens is complicated and usually unsuccessful).

Is vasectomy reliable?

This is an almost 100% fail-safe method – failure occurs in 0.1% of cases. For comparison, daily use of contraceptive tablets is associated with a failure rate of up to 8% (pregnancy in the first year of application of the relevant contraceptive method is considered to be failure), barrier protection fails in up to 15% of cases. Spermicides cannot prevent up to 30% of unwanted conceptions.

What are the alternatives to this procedure?

Other forms of contraception

What should I expect before this procedure?

If you regularly use Anopyrin, Clopidogrel, Warfarin, etc., you must tell your doctor. These medications can be associated with increased risk of bleeding during and after the surgery if they are not stopped in time. In some cases, it is necessary to replace these drugs with injection preparations. It is necessary to consult your general practitioner or cardiologist about this approach.

Usually, at the request of the ordering physician, a preoperative examination will be arranged, where any required laboratory examinations are evaluated.

Due to the fact that the procedure is performed under local anaesthesia, we recommend that you eat and drink something small before the procedure.

Remember to inform your physician about the following possible facts before the surgery:

  • artificial heart valve
  • coronary artery stent
  • pacemaker
  • artificial joint
  • artificial vascular graft
  • neurosurgical bypass
  • other implanted foreign body
  • use of the following prescription drugs: Acylpyrin, Anopyrin, Aspirin, Godasal, Clopidogrel, Plavix, Kardegic, Aspegic, Micristin, Ibustrin,Ticlid, Tagren, Ipaton Apo-Tic, Plavix, Persantin, Curantyl, Anturan, Aggrenox, Vessel due F.
  • drug and other allergies
  • any abnormalities or eventualities

 It is NECESSARY to inform the physician about your use of drugs affecting blood clotting before scheduling the procedure.

The procedure is performed on an outpatient basis and as standard under local anaesthesia. You will arrive at the outpatient office at the designated time. We will check whether you meet the conditions (statutory but also medical) for the procedure and you will be issued an invoice for the procedure (not covered by health insurance). After paying the amount at the reception (cash / credit card), you will be referred to the operating room. It is necessary to shave the lower abdomen and the entire scrotum.

What will happen during the surgery?

In the vast majority of cases, it is performed under local anaesthesia. The anaesthetic (Lidocaine, Mesocaine) is injected subcutaneously into the groin and scrotum on both sides. Subsequently, a very small incision opens the skin cover at the point where the vas deferens run just below the skin. The vas deferens is freed and then interrupted. The lumen of the upper end is closed via electrocoagulation and each end is inserted into a different layer of the subcutaneous tissue to increase the effect. The whole procedure takes about 20-30 minutes (according to local conditions – accessibility of the vas deferens). Scrotal wounds are closed with 1-2 absorbable sutures.

What will happen immediately after the procedure?

Increased sensitivity or a small haematoma (bruising) or swelling may appear in the scrotum and groin area in the following days. This problem may be prevented by wearing firm underwear for at least one week after the procedure. Patients are advised to avoid increased physical load for at least one week.

To keep you and your healthcare providers informed, you should:

  • ask if the planned outcome was achieved
  • inform the medical staff about any problems
  • ask what you can and cannot do
  • ask all the questions you have for the healthcare professionals and members of the medical team.
  • remember (and understand) why the surgery was performed, how it turned out, and what will follow

What are the postoperative risks or complications?

Common (10% of procedures of this type)

  • A small haematoma in the subcutaneous tissue, swelling of the scrotum – may take several days
  • Little yellowish discharge from the wound – may take several days
  • Blood in semen during the first few ejaculations
  • The procedure must be considered irreversible – even if the patency of the vas deferens could be restored, such step is not always able to achieve fertility, especially if more than 7 years have passed since the vasectomy.
  • There must be a sufficient number of ejaculations after the surgery until motile sperm are no longer detected in two consecutive samples.
  • Until then, contraception must be used
  • Chronic scrotal pain (10-30%) or sperm granuloma (soft nodule at the site of surgery)

Occasional (2-10% of procedures of this type)

  • Significant bleeding or haemorrhage requiring surgical revision
  • Inflammation of the wound or inflammation of the testis, epididymis requiring antibiotic treatment

Rare (may occur in 2% of procedures of this type)

  • Early failure of the method to achieve sterility (1 case out of 250-500)
  • Reconnection of both ends of the vas deferens after already negative tests for sperm presence, resulting in fertilisation/pregnancy in a later period (1 case out of 4,000)
  • Vasectomy has not been shown to be a long-term health risk (e.g. for testicular or prostate cancer)
  • Infection or bleeding at the site of surgery requiring surgical revision

Hospital infections

  • MRSA colonisation (0.9% – 1 of 110)
  • Intestinal infection by clostridium difficile (0.01% – 1 of 10,000)
  • MRSA blood infection (0.02% – 1 of 5,000)

Hospital infection rates may be higher in high-risk patients, such as in cases requiring long-term drainage, after a previous infection, after prolonged hospitalisation or after multiple hospitalisations.

What should I expect when I return home?

When you leave the hospital, you should:

  • Get recommendations on recovery at home
  • Ask when you can return to normal activities such as work, exercise, driving, housework
  • Get a contact number for further questions after returning home or in case of trouble
  • Ask about the date and place of subsequent check-ups (hospital or your doctor)
  • Make sure you are aware of the reason, course and outcome of the surgery, the results of examinations or the removal of tissues or organs
  • The wound should be clean and dry for a full 24 hours. If clothes stick to it, they can be removed after a short bath or shower. You should not bathe or shower until the area has healed, as this could lead to quick dissolution of the sutures and infection and poor healing. The scrotum and groin may be slightly insensitive and swollen for the first few days, or conversely, there may be increased sensitivity in the scrotum and groin, or a small haematoma or bruising. This problem may be prevented by wearing firm underwear for at least one week after the procedure. Patients are advised to avoid increased physical load for at least one week.
  • You should avoid sexual intercourse for about 14 days, or until all eventual problems improve.

What else should I watch out for?

If you experience more frequent problems, fever, redness, pulsation or discharge from the wound, see your attending physician.

Important information?

How do I know that the procedure was successful?

We recommend that patients use the barrier or another relatively reliable contraception method, optimally combined, for three months after the surgery. The ejaculate is checked under a microscope 8 and 12 weeks after the surgery, and if no sperm cells are present, the desired effect of the operation is confirmed.

What are the benefits of a vasectomy?

You no longer have to think about other contraceptive methods. Among other things, sterilisation of a woman is a much more difficult procedure, with a higher incidence of more serious complications.

What are the disadvantages of a vasectomy?

Above all, it is a period of about 3 months when the presence of sperm in the ejaculate cannot be completely ruled out.

Exceptionally, the greatest benefit of vasectomy can become the biggest problem. For example, in case of life partner or life situation changes. Discomfort in the scrotum cannot be completely ruled out after the procedure. In questionnaire surveys (data obtained in this way is very biased), 12-52% of men who underwent a vasectomy in the past reported occasional discomfort in the scrotum, and 97% of these men had no symptoms affecting their quality of life.

Will a vasectomy affect my libido and my sex life?

Absolutely not. The sex hormone testosterone, which is formed in the testicles, gets into the blood as like before surgery in unchanged amounts. (Some professional publications exceptionally report slow scarring of testicular tissue, which could theoretically lead to a decrease in testosterone production. This hypothesis has not yet been confirmed.) The amount of ejaculate also does not change significantly, but there are known cases where men reported a 30% decrease in the volume of ejaculate after the procedure. (It is necessary to realise that the amount of ejaculate varies depending on the frequency of intercourse, or according to the intensity of sexual climax; diet and other factors also have an effect.) It is similar to the variability in the intensity of sexual experience, which can be affected by basically anything that precedes or takes place during intercourse.

Where do the sperm cells go?

Sperm cells are very sensitive to environmental conditions and quickly die in the blinded vas deferens, disintegrate and are then absorbed.

What else should I know about vasectomy?

Above all, you must be aware that this is a method of permanent and irreversible sterilisation (or reversible with very poor results). Even though the consent of the partner is not required by law, it is appropriate, or even ethical, for your partner to be supportive of your procedure. Since the inability to have more offspring will affect both of you, you should make a decision together, after considering all the pros and cons.

 

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