Urology Procedures at False Creek Surgical Centre:

• Vasectomy
• Vasectomy Reversal

What is a Vasectomy?

Vasectomy is a safe, simple and effective birth control method.

A vasectomy is a minor surgical procedure used for male contraception. It is one of the most popular forms of contraception worldwide (as many as 30 million men), and is regarded as safe, simple and highly effective. A vasectomy is performed by cutting the vas deferens (the small tube that carries sperm from the testicles and mixes with prostatic fluid to become semen). Although the patient may continue to have sexual intercourse and climax as before, the semen does not contain sperm and a child cannot be fathered following a vasectomy.

It is a popular means of birth control for couples that have decided that their family is complete. It is nearly 100 % effective and is intended to be permanent but may be reversed.

There may be some swelling and minor pain in the scrotum for several days after the surgery. Most men can return to work in 1 or 2 days, unless their work is strenuous. They should avoid heavy lifting for a week.

A vasectomy does not interfere with a man's sex drive, ability to have erections, sensation of orgasm, or ability to ejaculate. Some men have occasional mild aching in the testicles during sexual arousal for a few months after the surgery.

Vasectomy Surgery:

A no scalpel vasectomy is offered. A vasectomy is performed on an outpatient basis, frequently in the office. The procedure takes about 15-30 minutes.

The scrotum is cleaned with an antiseptic; a small area of the scrotal skin is shaved. The scrotum is anaesthetized with local anaesthetic using a tiny needle and the vas deferens is gathered under the skin of the scrotum. A single small incision (usually 4-5mm) is made. The vas deferens is then brought through the incision, cut in two places, a 1-centimeter segment is removed and electrocautery is used to seal the ends. Each end of the vas deferens is surgically tied off and then placed back in the scrotum. The incision may need a single, dissolvable suture. A small dressing is applied.

Vasectomy Summary:

• A vasectomy is a safe, simple, fast and highly effective procedure. Complications are uncommon.
• It is one of the most common means for contraception.
• The procedure is over 99 % effective and intended to be permanent.
• Discomfort following the procedure is often mild and easily relieved; this normally decreases and disappears within days.
• Strenuous physical activity should be avoided for 4-5 days after. Return to a sedentary job may be on the same or next day.
• Although it is a simple, safe and common surgical procedure, any surgical procedure includes some risk.

Vasectomy Reversal

A urology surgeon performs vasectomy reversal when a man has had a vasectomy, and now wants to have children. Vasectomy reversal reconnects the tubes ( vas deferens ) that were cut during a vasectomy .

Vasectomy reversal is done as an outpatient procedure - without an overnight stay. General anaesthesia (or spinal) is commonly used to ensure the patient remains completely still during the surgery.

Vasectomy reversal usually requires approximately 2 to 4 hours, followed by a few more hours for recovery from the anaesthetic. You can expect to go home on the same day as a routine vasectomy reversal.

Pain is mild to moderate and similar to a vasectomy. You should be able to resume normal physical activities, including sex, within 3 weeks.

Chances for success depend on many factors. These include the microsurgical skill and experience of the surgeon, the method of vasectomy that was done and most importantly the length of time since the vasectomy was performed.

Within 5 years of the vasectomy, pregnancy rates are up to 75%. At 10 years or longer following the vasectomy, the pregnancy rates are less than 35%. A sperm count of more than 90% can be expected if the vasectomy has been done within 5 years and over 80% after 10 years. The formation of anti-sperm antibodies will often prevent pregnancy from occurring despite a good sperm count after the vasectomy. Conception will usually occur a year or so after the reversal.

Vasectomy Reversal Surgery:

Most patients request a general anaesthetic for their comfort, but the procedure can also be performed under regional or local anesthesia with sedation. Generous us of local anaesthetic combined with general anaesthesia makes for a very light general anaesthetic, which makes the procedure very safe. A small incision is made in the scrotal skin over the old vasectomy site. The two ends of the vas deferens are identified and freed from the surrounding scar tissue. 

A drop of fluid from the testicular end of the vas deferens is placed on a glass slide and examined using a light microscope. This is a crucial part of the operation because the information obtained is used to decide what type of microsurgical reconstruction needs to be performed to re-establish sperm flow, a vasovasotomy or a vasoepididymostomy .

• Vasovasostomy , which is for the simpler cases, reconnects the two cut and blocked ends of each vas deferens.
• Vasoepididymostomy is performed for more complex cases (when a large portion of the vas has been removed at vasectomy or when a portion of the epididymis has become blocked) connecting the vas deferens to the epididymis.

Typically, a two-layer anastamosis is performed. At least 6 sutures are used for the first layer followed by a similar number for the outer layers providing a “watertight” join.

Vasectomy Reversal Summary:

• Vasectomy reversal procedures are considered safe with low risk for complications.
• Reconnecting the cut ends of the vas deferens is delicate microsurgery.
• Compared to prior vasectomy experience, a reversal usually produces a slightly longer period of discomfort and recovery.
• The procedure can require two to four hours, usually with a general anesthesia.
• Some discomfort is to be expected, but most signs and symptoms diminish within the first few days.
• You can expect a gradual return to normal activities, typically within two - five weeks as indicated by your doctor.
• Individual cases will vary and it's important to discuss success factors with a doctor.
• Success factors include: the skill of the surgeon, the condition of tissue and the time that has passed since the original vasectomy.
• Results are not immediate; it may be months or more before fertility and a normal sperm count is restored.
• A successful reversal can lead to conception, typically, within 12 to 24 months.