Normal Male Anatomy and Function:
The male reproductive system has functionally three parts: the factory (testicles and epididymis) where sperm are made, the transport system (the vas deferens), and the storage/ejaculatory system (the seminal glands and prostate). Sperm are made in the testicles, and then transported via the vas deferens to the seminal glands where they are stored for ejaculation. The ejaculate is comprised of prostate secretions (which makes up 85 % of the volume)
and sperm. The goal of a vasectomy is to cut the vas deferens, severing the supply route from the testicle to the seminal glands. After a vasectomy, the testicles continue to produce sperm but in reduced numbers. The sperm then leave the testicle and enter the epididymis, coming to a dead end at the point where the vas deferens is cut. They then die after a few weeks, degrade, and are reabsorbed into the blood stream where they are recycled by the body. After a vasectomy, you continue to have a normal appearing ejaculate, it simply lacks sperm.
No-scalpel Vasectomy Procedure:
The no scalpel vasectomy is done with regular skin anesthetic (freezing), and does not require a general anesthetic.
- The vas deferens is isolated in the fingers, and then the skin is infiltrated with plain lidocaine. Then the vas deferens is clasped with a small instrument called a ring clamp.
- The skin is then opened by poking with a sharp instrument called vasectomy forceps.
- The vas deferens is pulled through the poke hole, and one end is clipped with two small titanium clips.
- The vas deferens is then cut, and the end is cauterized, it is then cut again removing a small segment.
- The end closest to the testicle is then returned to the tissue sheath in which it normally lies, and the sheath is wrapped around the end of the vas deferens.
- The tissue is then clipped closed with two titanium clips over the end of the vas deferens.
- The process is then repeated on the other side through the same poke hole.
A small amount of bleeding from the skin edge, swelling, and bruising of the skin is common. It is generally not painful, and resolves relatively quickly.
Less common, infection may occur in the small skin puncture, but occurs in less than 1% of procedures. As well, a hematoma, a large blood blister, can form in the scrotum following vasectomy. This happens in less than 0.5 % of cases, and usually responds spontaneously over several weeks. A scar known as a granuloma may form in up to 50% of cases, and results from an immune response against the small number of sperm that leak out of the severed end of the vas deferens. The body forms a hard, pea sized scar around the sperm, which under normal circumstances has no symptoms. There is, however, approximately a 1% chance of tenderness in the scar following the procedure, which may last for years afterward. There is also a 1 % chance of developing a recurring moderate aching in the testicles. The condition is often referred to as post vasectomy syndrome, and usually is not incapacitating, although may at times be uncomfortable. Generally granuloma and post vasectomy syndrome can be successfully managed with mild analgesics and anti-inflammatories.