Vasectomy in review.

ABSTRACT

PIP: Improvements in vasectomy techniques which increase the possibility of successful reversal and speed the testing for sterility are discussed. Open ended vasectomy where the testicular end of the vas is open to the scrotal cavity is described. The advantages of the technique include: less damage to the epididymis in the presence of a sperm granuloma on the testicular end and therefore increased chances for a successful reversal, and reduced post vasectomy epididymal pain, inflammation or orchalagia. In 4330 open-ended vasectomies the rate of epididymal congestion was significantly less than in 3867 standard vasectomies and the rate of painful sperm granuloma was reduced, while spontaneous recanalization was rare in both groups. Reducing the time the man must wait for a negative sperm test is accomplished by washing the sperm from the prostatic or distal end of the vas with a small volume of 1% lignocaine hydrochloride. With this procedure 95% of the patients are clear of sperm within 4 to 6 weeks. Washing out the proximal vas induces a feeling of burning or wetting or some other prostatic urethra sensation in the patient which immediately confirms that the physician is operating on the correct structure. The most common patient questions about vasectomies relate to the cost and the safety of the procedure. Studies to date have shown no harmful effects to be associated with vasectomies.