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Vasectomy & Reversal (N1710 & N1750)

Vasectomy is an operation design to produce sterility in a man.  The vas is a muscular tube which conducts sperm from the testicular to the penis prior to ejaculation.  It is about 6mm in diameter and can be felt as a taut cord in the scrotum (the best time to do this is in a warm bath).

Why this procedure
It is the most effective form of contraception for men.

What is the procedure
During a vasectomy a piece of the vas between 1cm and 2cm long is removed from both the right and left sides of the scrotum.  This interrupts the flow of sperm and after a period of time no sperm is found in the semen you are then considered sterile.  The operation can be performed using a local or general anaesthetic.  If local anesthetic is used patient may feel some pulling on the testicular which is said to feel like having been kicked in the testiculars.  Two self-dissolving stitches are used to close the wound.

Before, during and afterwards
The operation is always performed as a day case.  

Most patients have only a small amount of bruising.  The pain and swelling usually subsides in a week or so and is controlled easily by taking paracetamol.

About 1% of patients develop a haematoma all large bruise in the scrotum which can make the scrotum swell rather alarmingly.  This is rare but not surprisingly causes pain and distress.  If the large haematoma develops as a second procedure maybe required to evacuate the blood from the scrotum.  

Longer term there is a slight risk of developing testicular aching or pain, which can be quite distressing.

There is also a slight risk of developing a tender lump at the site of the division of the vas.  This is probably due to leakage of sperm from the cut end of the vas and the reaction of the bodies immune system to these sperm that produces inflammation and pain.

There is no good evidence that having a vasectomy is associated with the development of tumours, prostate or testicular cancer.

You will not be sterile immediately following a vasectomy, it can take 3-6 months for the sperm to clear from the ejaculate.  The more times a patient ejaculates in the three months following the procedure the more likely it is that they will be clear on checking.  Patients are advised to produce two semen samples, 1 week apart approximately 3 months post-surgery and if these show no sperm in them then the patient can be considered sterile.  If the samples are not clear they are repeated monthly until they are.

Your sexual performance should not be affected by have a vasectomy.  The ability to have an erection, ejaculate and the volume of ejaculate should not be affected.

Although vasectomy is reliable it is not full proof, however the risk is rare and around 1 and 3000.  In a small number of men, the tubes may re-join spontaneously and sperm may appear in the ejaculate.

If you are uncertain about fathering children in the future, are under 30, have a very young child/children or have experienced any pain in the testes previously, you may be advised against a vasectomy.

Vasectomy Reversal
An operation can be performed to re-join the severed tubes with the aim to restore continuity to the tubes and allow sperm to flow into the ejaculate again.

A vasectomy reversal is a much more complex procedure than a vasectomy and is always performed under general anaesthesia.  The operation takes about two hours and is technically demanding.  The ends are usually re-joined under magnification and some surgeons use an operating microscope to allow the accurate placement of the very fine stitches.

The success of the operation depends on the skill of the surgeon and the length of time that has elapsed since the vasectomy.  If the reversal takes place within three years of the vasectomy then sperm will usually be found in the ejaculate after the reversal, and 75& of couples will achieve a pregnancy.  If between three and eight years have elapsed around 50% of couple achieve a pregnancy.  Only around a third of couples will achieve a pregnancy if more than 10 years has elapsed since the vasectomy.

If the operation fails, a pregnancy can still sometimes be achieved using techniques of in vitro fertilisation (IVF) using sperm harvested from the epididymis, testis or vas.  We sometimes collect sperm for deep frozen storage at the time of the reversal operation then, if the reversal operation is unsuccessful, the frozen sperm can be used for IVF.  This means that the patient does not have to undergo a separate operation at some point in the future to have sperm harvested.


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