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Monday 21 October 2019
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Is vasectomy right for you?

SATYENDRA PERSAUD

What is vasectomy?

Vasectomy involves blocking off the tubes (vas deferens) which transport sperm from the testicles to the penis. This usually involves cutting the tubes, burning the edges, and possibly tying them off. The aim is to make the man sterile, meaning he can no longer have children. It is usually done when you have completed your family.

What to do if you want a vasectomy

You should see a urologist who can discuss the procedure in detail and help you to decide if vasectomy is right for you. He will also conduct a thorough examination to ensure your vas deferens, the sperm pipe being cut, is easily felt.

During a vasectomy both tubes are cut, burnt and separated.

What does the procedure entail?

This is done as a same day operation. Most times, this procedure is done under local anaesthetic but rarely, if your tubes are difficult to feel, you may require general anaesthetic. Once the surgeon has injected the anaesthesia he will make tiny incisions on each side, one at a time, over the tubes. Each tube is then pulled out, cut, and the edges burnt and tied. The edges are then replaced in the scrotum in separate layers. The small skin incision is closed with one or two stitches and a dressing is applied. Some surgeons prefer to operate on both sides through a single cut in the midline.

What happens after the operation?

You will need to use alternative forms of contraception until your urologist is sure that your tubes are completely blocked and there are no sperm in your semen. He will do this by doing a sperm test in a few months. Some sperm are stored up in your system and these have to be cleared out via ejaculation over several weeks – this is why it is important to verify that all sperm have been cleared out before you can stop using contraceptives.

What are the risks or vasectomy?

You may experience some bruising and swelling of the scrotum which usually goes away on its own except in a few rare cases. There is a small risk of infection or inflammation of the testicle. You may see some blood in your first few ejaculates. A few men complain of chronic scrotal pain and in very few instances this may affect daily activities. The risk of early failure, meaning failure to achieve sterility, is around one in 250 or less. Late failure, meaning rejoining of the cut ends, happens in one in 2,000 cases. There is no evidence that vasectomy increases the risk of prostate cancer.

What is a no scalpel vasectomy?

In the no scalpel technique, local anaesthetic is injected using a special injector, avoiding needles. The incision in the skin is made using very sharp scissors, rather than a scalpel. This minimises the size of the cut. Otherwise, the principles of the vasectomy remain the same as do the outcomes. It does result in faster recovery following the procedure.

Is vasectomy reversible?

The answer is yes but this requires specialised skill and is done using a microscope which is not available locally. It is therefore important that you ensure vasectomy is right for you before choosing the procedure. Please discuss this with your doctor who should refer you to a urologist. Vasectomy services are offered by the Department of Urology at San Fernando General Hospital upon referral.

Dr Persaud is a consultant urologist at San Fernando General Hospital. He is a lecturer in Urology at the University of the West Indies and is responsible for urology training at UWI.

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