Vasectomy

Ellen Sowa ** Vasectomy ** **Vasectomy** is a form of male birth control that cuts the supply of sperm to your semen. It's done by cutting and sealing the tubes that carry sperm. Vasectomy is considered a permanent form of male birth control. (Mayo Clinic, 2011) All birth control methods have a risk of failure, but vasectomy is the most reliable of all the methods available. According to the UK national sterilization guidelines, the failure rate of vasectomy should be quoted as approximately 1 in 2000 (0.05%) after clearance has been given (RCOG, 2004).

In a conventional vasectomy, after the scrotum has been numbed with a local anesthetic, the doctor makes two small cuts in the skin of the scrotum and lifts out each tube. The tubes are cut and blocked so the sperm cannot reach the penis. The doctor then stitches them closed. (Mostowfi, 2011) Conventional vasectomy, also known as "incisional" or "scalpel" vasectomy, is the original surgical method or technique used to perform vasectomies in North America. mmonly today, many people choose a no-scalpel vasectomy, in which the doctor numbs the skin and the nerves to the vas deferens ("the tubes"). Instead of making two incisions, the doctor usually makes only a single tiny opening with a special instrument. The same instrument is then used to gently stretch the opening so the tubes can be easily reached. The tubes are then blocked by cutting, cauterizing (sealing them shut) and then tying off each end. There is very little bleeding with the no-scalpel technique. With this gentle technique, there are no stitches needed to close the tiny opening. (Mostowfi, 2011) With conventional or scalpel vasectomy, the same end result is obtained as with the no-scalpel method. The main differentiation between the two methods is the way the doctor locates the vas deferens. The success rates of both approaches are no different, because the success rate is related to how the vas tubes are blocked, not how the doctor gets to the tubes (Goldstein and Girardi, 1998).
 * Procedure**

Side effects right after surgery can include swelling, bruising of your scrotum, bleeding or a blood clot (hematoma) inside the scrotum, blood in your semen, and infection of the surgery site. Delayed complications can include fluid buildup in the testicle, which can cause a dull ache that gets worse with ejaculation, inflammation caused by leaking sperm (granuloma), pregnancy, in the event that your vasectomy fails, and chronic pain (Mayo Clinic, 2011). Spontaneous recanalization is where the vas deferens manages to "grow back" and reverse the vasectomy making a man fertile again. According to Harvard Medical School, "Vasectomy can reverse itself, but it is a very rare event. It develops in only about .025% or one in 4,000 vasectomies" (HMS, 2001). Statistically, 5% to 10% of the approximately 600,000 men in North America who annually undergo vasectomy look to get their vasectomy reversed, at some point. Surgery is performed first on one side of the scrotum and then on the other. The surgeon will identify the right and left vas tubes. He will then make incisions, beginning at the top of the scrotum extending up into the abdomen a number of inches on both the right and left side. Once the tissue is cleared off the first vas tube, the surgeon must make a decision regarding what will be required to re-establish sperm flow, a vasovasotomy or a vasoepididymostomy. He makes his decision after opening up the testicular end of the blocked vas and checking the fluid from that blocked end. (Goldstein and Girardi, 1998)
 * Complications and Vasectomy Reversal**

Men decide to have a vasectomy based on the fact that they are absolutely sure they do not want to have any or any more children. Most men make the choice when in a committed relationship, so the choice should be best decided as a couple. Some additional reasons for a man to choose a vasectomy include enjoying sex without the worry of pregnancy every time, avoid health risks being passed on to children, inability to use other forms of birth control, and it is less painful and less expensive than a woman getting her tubes tied (Mostowfi, 2011). This is often an emotional decision for men to make, and open communication with both their partner and their doctor is essential. Some considerations that men should take before undergoing a vasectomy include their age as many life changes may be ahead, pressure from a partner, unstable relationship, stress or depression or difficulty making important life decisions, or planning to reverse the procedure later. Because reversing a vasectomy can be complex and success is variable, men need to carefully consider the pros and cons before proceeding with a vasectomy (Mostowfi, 2011). In recent years, some urologists are trying to get men’s attention by marketing March Madness as a great time to get a vasectomy. For a growing number of urology practices, tournament time has become key to marketing a procedure that many men put off or avoid out of sensitivity. This marketing ploy has been instilled by practices from Oregon to Texas, Illinois to Georgia. One urologist claimed, "We find patients who tend to plan their vasectomy surgeries around times where there are good things on TV to watch” and with days full of basketball on television, and nothing to do but sit around and recover, this time period is a great opportunity (Cook, 2010).
 * Making the Decision**

The no-needle vasectomy is an alternative method for anesthetizing which was introduced in 2001 by a pioneering doctor who reported successful results. During past three years, the no-needle vasectomy or no-needle, no scalpel vasectomy (NNNSV) has gained greater acceptance and name recognition. General acceptance for the jet anesthetic began when a case study was published in the May 2005 edition of the Journal of Urology, followed by a presentation in the same month during the annual meeting of the American Urological Association (AUA). The no needle jet anesthetic technique show-cased findings involving 465 patients who underwent a vasectomy using the no-needle jet anesthetic technique. The anesthetic is delivered via a jet anesthetic into the target area with a no needle jet injection. The study’s findings suggest this form of anesthetic is reducing of patients' fear of needles, less painful, less invasive, the technique is simplified for the surgeon. Today many vasectomy doctors have adopted the no-needle technique and show-case it as an advantage offered (Goldstein, Li, Matthews, 1998).
 * Advancements**

**References**
Goldstein, Marc and Philip Shihua Li and Gerald J. Matthews. (1998) //Microsurgical Vasovasostomy: The Microdot Technique of Precision Suture Placement.// __The Journal of Urology__, 159 pp. 188-190. Mayo Clinic staff. (2011). //Vasectomy.// Retrieved from: [] Drugs and Information Online. (2011). Vasectomy. Retrieved from: [] Goldstein, Marc and Sarah K. Girardi. (1998). //Vasectomy and Vasectomy Reversal.// __Current Therapy in Endocrinology and Metabolism__, pp. 371-380 Mostowfi, Kiu. (2011). //Vasectomy Clinics of Chicago.// Retrieved from: [] Cook, Bob. (2010). //NCAA tournament perfect time for a vasectomy, urologists say//. __American Medical News__. Retrieved from: [] Royal College of Obstetricians and Gynecologists (RCOG). (2004). //UK// //national sterilization guidelines//. Retrieved from: [] Harvard Medical School (HMS). (2001). //Well connected//. Retrieved from: http://www.vasectomy-information.com/pages/wellconn2001.pdf