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New Methods of Vasectomy

Close to half a million vasectomies  are done per year in this country. Worldwide, it is considerably less common than female sterilization. The Chinese have develop the "no scalpel" vasectomy technique, and now they now have a male/female sterilization ratio of vasectomy.  They are also working on a totally percutaneous technique. The idea is that they actually cannulate the lumen of the vas with a #24 gauge needle. Now, that has got to take a little practice to do that. They inject red dye into the right vas, blue dye into the left vas and then they inject their sclerosing solution which is a mixture of phenol and cyanoacrylate into the lumen. After the procedure, they have the patient void and, of course, that dye would go down through the vas into the ejaculatory ducts and reflux into the bladder.

The no scalpel method is currently the best method. The next consideration is how you are going to occlude that vas. There is pretty good evidence that cauterization of the vas lumen with a little battery-operated cautery. It is probably not necessary to remove a segment of vas. We still do it. I was taught to do that and I kind of canít bring myself not to remove a segment of vas. Of course, one reason that is cited for doing that is the medical-legal reasons.

The no scalpel method. Iíd like to point out that it does require special instruments. You will see there is a little ring forceps and there is a special hemostat. So donít try to do it unless you have those instruments. One suggestion I would have for you is I really like to have a second one of those little ring forceps available. There are times when you might have it a little bit tenuously in one ring forceps and you just want to reach in and grab it without letting go with the original forceps.

Is it really any better? Yes. I donít think itís a revolutionary procedure. I think itís an evolutionary procedure. There is less postoperative pain. They do require less analgesics, there are fewer infections and this is nice because we get fewer phone calls.

What about complications of vasectomy? Hematoma in about 1-2% of patients and obviously that can be a real distressing problem for the patient. Itís not usually serious but they are pretty uncomfortable for quite awhile until it resorbs. What about more serious things? In the late 1970s there was a report out of a primate lab that suggested that vasectomy may lead to acceleration of atherosclerosis. This was based on some studies in monkeys. Theyíve now looked at. There has been at least 11 studies looking at 30,000 men with vasectomies that have not shown any correlation between vasectomy and atherosclerosis.

How do we follow patients after vasectomy? Again, we really emphasize the importance of getting a semen analysis afterwards although it is surprising that studies have shown that as many as 30% of men never come in for their followup semen analysis. They should wait at least four to six weeks. We have tended to stretch that out partly because of our staff. As you might imagine, the semen analyses are not the favorite part of their day so by increasing that to eight or even twelve weeks, that just cuts down on the number.

It is fairly common. If you do a lot of these youíre going to get some guy, usually the guy that lives across the street or one of your doctor friends or something, who keeps having 1 to 2 sperm in their specimen, non-motile. They were able to get good follow-up on 50 of those patients. All but one eventually did become azoospermic and no pregnancies resulted. So I think as long as you know your patient and they are reliable, I think it is reasonable to adapt that policy. For that matter, even if you did redo them, if the sperm.

We talked a minute ago about the prostate cancer issue. This was based on a study done four or five years ago now. They looked at 24,000 men. They found that vasectomized patients had about a 1.5 fold increase in their risk of developing prostate cancer and if their vasectomy had been done greater than 20 years earlier, it was almost double. However, no one has, then or since, come up with any kind of biological mechanism of how this might cause prostate cancer.

We feel that with the current state of knowledge, it is our responsibility if we are going to do vasectomies to tell our patients about this. As youíll note, that is included in our handout. But beyond that, it is pretty much up to the patient and what his level of anxiety.