NO SCALPEL VASECTOMY

Choosing a method of contraception is a very personal and important decision. It is almost always filled with emotion, fear and even excitement. In order to make important choices regarding your health and family planning, you must have accurate and easily understandable information. Dr. Werthman is ae trained urologists who has dedicated his practice to Andrology, that portion of urology that deals exclusively with male fertility, hormone and sexual function, sterilization and microsurgery. Dr. Werthman has performed more than 1000 vasectomies. This website was created to aid you in the decision-making process, present the most up to date information available as well as our extensive clinical experience, and address the most common questions and concerns that men and women have asked us over the years regarding male contraception. Vasectomy is the most common male sterilization procedure with about 500,000 being performed in the United States each year. We will explain everything you need to know, show you how we perform a no scalpel vasectomy, and tell you why you should have your vasectomy at the Center for Male Reproductive Medicine. We have also included a video clip of the actual procedure so you can see how quick and easy it is in our hands.

What is a vasectomy?

A vasectomy is a procedure that blocks both sperm ducts called the vas deferens (see diagram) which transport the sperm from the epididymis (where the sperm are stored) up through the prostate to the back of the urethra during an ejaculation. Ninety seven percent of the fluid that comes out during an ejaculation is made in the prostate and seminal vesicles, only 3% of the fluid comes from the testicle and epididymis but this contains all the sperm. The easiest way of eliminating the sperm but leaving everything else the same is to interrupt the vas deferens. The easiest place to do this is in the scrotum because the vas is directly under the skin.

Contraception can be divided into several categories: male or female and permanent or temporary. Ideally, only men who are sure that they are finished having their family or men who are positive that they do not want children should consider permanent sterilization. Even though most vasectomies can be successfully reversed, vasectomy should still be considered permanent because the chances of conceiving after a reversal are not 100%.

Vasectomy is the easiest and most reliable form of permanent sterilization. At The Center for Male Reproductive Medicine vasectomy is performed as an office procedure that takes about 10-15 minutes to complete. This is much easier then the standard vasectomy and certainly less risky than female sterilization (tubal ligation) which needs to be performed in an operating room under general or epidural anesthesia and runs the risk of injury to the abdominal organs including the intestines and major blood vessels. Because of this risk, many couples choose vasectomy as their form of permanent contraception. Vasectomy is also usually less expensive then tubal ligation.

Conventional versus No-Scalpel Vasectomy

The standard technique of performing a vasectomy required the doctor to make an incision (cut) in the scrotal skin, find the vas and separate it from the other structures in the spermatic cord. The vas was then tied off with sutures, cut and the ends separated. The skin incision was then stitched back together. This procedure took longer, was more painful and resulted in a longer recovery time and more complications then the no-scalpel vasectomy. So what is a no-scalpel vasectomy? This is a technique developed in China approximately 20 years ago. In China, men must be sterilized after they father a child in order to qualify for government assistance. This led to a need for a quick and simple method of vasectomy with a short recovery time since almost every man gets sterilized at some point for population control.

The technique of no-scalpel vasectomy uses a special instrument to grasp the vas through the scrotal skin and hold it in place directly under the skin. Another instrument is used to make a small puncture in the skin over the vas and spread the tissue. The vas is then pulled up and all the tissue around it is cleaned off. This is an important step because all the nerves must be moved away from the vas before it is clipped. Once the vas is clear then titanium clips are placed to block the vas. The vas is cut and cauterized between the clips and then separated. A small segment is removed to prevent the vas from growing back together. The vas is then dunked back into the scrotum and the poke hole is sealed without the need for sutures. A sterile dressing, ice pack and jock strap are then placed on the scrotum.

Anesthesia

We perform the no scalpel vasectomy with local anesthesia much like the dentist uses to fill a cavity. The anesthetic is injected into the skin and the vas, not the testicle as many people incorrectly think. The injection lasts for 10 seconds and works immediately. Patients are offered valium prior to the procedure but many men chose not to take the valium. The valium is not for pain control but rather to “take the nervous edge off” that most men have prior to the vasectomy.
Recovery

After the procedure it is best to go home and rest for 24 hours off your feet. An ice pack or bag of “frozen peas” should be used intermittently for 24-48 hours. This will minimize any pain, swelling or bleeding. We recommend no heavy lifting and no ejaculation for a week after the vasectomy. You should be able to resume all normal activity after this point. Doing too much activity too soon could result in a longer recovery time or a complication. While it is OK to shower the day after the vasectomy, bathing or swimming or surfing should be avoided for at least 1 week to make sure the tiny puncture wounds are sealed completely. Most importantly, you should not play Golf the day after the vasectomy, despite what your friends tell you!

Follow Up

It is very important to follow up after the vasectomy. The reason for follow up is that you are not sterile immediately after the procedure. Sperm live in the reproductive tract upstream from where the vasectomy is performed and it can take from six weeks to three months for these sperm to be flushed out of the system or die off. We recommend that you have a minimum of 2 semen analysis starting around six weeks after the vasectomy or after 20 ejaculations. You must have 2 consecutive semen analysis that show no sperm in order to be considered sterile and you must use some form of birth control until that time.

Sperm Banking

An option to consider prior to having your vasectomy is sperm banking. Some men chose to have their sperm frozen and stored just in case they change their mind and want more children in the future. Having frozen sperm would mean that they would not necessarily need a vasectomy reversal or have to do in-vitro fertilization both of which can be costly. Sperm can be stored indefinitely and used at any time with an artificial insemination procedure. We recommend that our patients store their sperm at The California Cryobank, the world’s largest and most reputable sperm bank. We will help make all the arrangements for you should you chose this option.

Risks and Complications

As with any surgical procedure a vasectomy carries with it the potential for risks and complications. You need to be aware of these to help you consider the choice you are about to make. Any time a surgeon makes a cut or poke anywhere on the body, there exists the possibility for pain, bleeding, swelling or infection. The complications specific to vasectomy include failure of the procedure, sperm granuloma formation, injury to the blood supply of the testicle resulting in the testicle getting smaller (atrophy) and chronic testicular or epididymal pain (post vasectomy pain syndrome). Fortunately these complications are rare when we perform the no-scalpel vasectomy using our technique. While the reported complication rates for vasectomy vary between 5%-10%, our complication rate has been much lower, under 1%. In the last 1000 vasectomies that Dr. Werthman has performed, the complications were as follows:

Failure of procedure	1
Infection	2
Sperm granuloma requiring treatment	1
Hematoma (bleeding)	2
Chronic pain	1
Testicular injury/atrophy	0
Total complications	7/1000 or 0.7%

What do we do differently at The Center for Male Reproductive Medicine then general urologists?

Dr. Werthman’s practice is limited to surgery of the scrotum and vas. He is one of the few urologic surgeons in the United States who don’t practice general urology but only specialize in Andrology full time. Because he only operates on the vas, he has a unique understanding of the anatomy and has refined his techniques and procedures to be as painless as possible. Dr. Werthman pays great attention to the nuances of vasectomy that come with the experience of performing over one thousand no-scalpel vasectomy procedures. This is also why he has such a low complication rate. Dr. Werthman also specializes in treating post-vasectomy pain syndrome and understands its causes. He has improved on the technique of no-scalpel vasectomy to avoid this dreaded complication. Some of the new techniques Dr. Werthman pioneered and exclusively practices include performing the vasectomy high up on the vas to reduce chance of back-pressure build-up, injecting the inner channel of the vas with long-acting anesthesia to avoid stimulating pain receptors, and giving patients an injection of a powerful anti-inflammatory medication to prevent inflammation before it starts. To our knowledge, no other center incorporates these measures routinely during a vasectomy. We are so confident in our technique that we are the only center that shows a video of the surgical procedure for all to see.

FAQ about Vasectomy

What happens to sperm after a vasectomy?

A vasectomy creates a blockage or “dead end” in the scrotal portion of the vas. The sperm get to the point of blockage and can go no further. They age and then die. The sperm degenerate and the body breaks the sperm down into component protein molecules as it does for dead cells elsewhere in the body. These protein molecules are then reabsorbed in the bloodstream and are eliminated.

When am I considered sterile?

Sperm can still live in the vas upstream from the vasectomy site (in the scrotum) for weeks to months. It could easily take between 6 weeks to three months for these sperm to die off of get flushed out of the reproductive tract. Men are not sterile immediately after a vasectomy therefore you must practice contraception until there are 2 consecutive semen analyses that have no motile sperm in them. We begin checking semen specimens after 20 ejaculations post vasectomy.

Can a vasectomy be reversed?

While vasectomy is considered permanent sterilization it can certainly be reversed. Roughly 5% of men who have had vasectomies change their mind each year and want to re-establish their fertility. Options available include vasovasostomy, reconnecting the vas at the vasectomy site and sperm harvesting from the epididymis or testicle combined with in-vitro fertilization. Neither of these techniques are 100% effective so those men who may still want more children should not have a vasectomy. For more information regarding vasectomy reversal and to view a video of the procedure click on VASECTOMY REVERSAL.

Will a vasectomy cause me to have problems with erection or libido?

Having a vasectomy should not cause any problem with erections or libido from a physiological standpoint barring any complications. It is possible for some men to have a psychological reaction to having their vasectomy as they might to having any surgical procedure and that can affect libido. This is a very uncommon scenario that I have not encountered in any patient in whom we have performed a vasectomy.

Is there an increased risk of prostate or testicular cancer because I had a vasectomy?

In the early 1990’s a concern was raised that men who had a vasectomy were at greater risk for getting prostate cancer, a disease that will affect 1 out of 6 American men. This concern sparked great interest and research that concluded that vasectomy is not a risk factor for prostate or testicular cancer or any other disease.

What are anti-sperm antibodies and what do they have to do with a vasectomy?

Antibodies are molecules produced by the immune system to fight off anything that the immune system perceives as being foreign. After a vasectomy many men begin making antibodies to their sperm that can be detected in their bloodstream. When present, antibodies can attach to the sperm and prevent them from moving (decrease motility) or from penetrating an egg. It has become clear that only antibodies present on the sperm may cause a problem in certain situations. Very few men actually have antibodies detected on their sperm after vasectomy reversal.

What is the Post Vasectomy Pain Syndrome?

Most men who undergo vasectomy have no difficulties but a small group of men develop chronic testicular or epididymal pain after the procedure. This pain can start immediately after surgery and is usually due to a sperm granuloma (inflammation at the vasectomy site) or infection and most cases resolve with the appropriate medical therapy. Occasionally, pain may develop years after the vasectomy and be exacerbated by ejaculation. This pain is thought to be the result of back pressure building up in the epididymis and is known as an ” epididymal blowout” or “post vasectomy pain syndrome” While it must be stressed that these are fairly uncommon occurrences after vasectomy, they are frustrating and difficult to deal with for both the patient and the physician. We offer a range of treatments for these syndromes including non-surgical treatments, vasectomy reversal, open-ended vasectomy, and chemical sterilization. Most patients with this problem, which has been ignored for so long, need not suffer.

What is an open-ended vasectomy?

An open-ended vasectomy is a vasectomy that is performed in the exact same fashion as a standard vasectomy other than leaving the testicular end of the vas unclipped. By leaving the proximal end open, it is thought to reduce the back pressure build up on the epididymis and testicle thus making a future vasectomy reversal easier and possibly reducing the already low chance of developing post-vasectomy pain syndrome. The problem with the open-ended vasectomy is that there is a greater likelihood of the vasectomy not working and because the end is open, sperm can leak out and cause a granuloma (inflammatory mass) to form at the end of this vas. The granuloma can sometimes be the cause of pain after a vasectomy. We do not routinely recommend open-ended vasectomy but will certainly perform one if requested.

What are the alternatives to vasectomy?

The alternatives to permanent male sterilization include permanent female sterilization by tubal ligation or tubal blockage and reversible contraception with condoms, birth control pills or IUD. Many researchers have been working on a “male pill” but none of the current formulations are very effective or consistent.

Fees and Billing

The Center for Male Reproductive Medicine is not contracted with any insurance company or provider. Fees are payable at the time service is rendered. While the patient is responsible for the total charge, it does not mean that your insurance company will not cover the vasectomy in portion or in total. We will check your coverage to see if your company will pay for a portion of the vasectomy and we will give you the appropriate paperwork for you to submit so your insurance carrier will reimburse you directly. We realize that many patients will only have procedures performed by physicians who are contracted providers, we could not perform the same quality of service and devote to you the time and skill you deserve while accepting insurance contacted rates. Those men who wish to entrust their care to us for this important and sensitive area of the body will find our fees for vasectomy very reasonable. To receive information regarding fees and billing please call the office at 310-277-2873.

Message from Dr. Phil Werthman

I believe that medicine and surgery should be practiced the “old-fashioned” way by giving personal, individualized attention to each patient and spending as much time as needed educating you as patients as to all the possible options, procedures, alternatives and risks regarding vasectomies and reversals every year, we are not “running a mill” and will only schedule a limited number of procedures a day so those patients will get my complete attention. I personally perform your surgery myself. I have no interest in using your vasectomy to train resident physicians, junior partners, or passing your care off to a less experienced associate because I am too busy. All my patients receive both my home and cellular phone numbers after surgery so you can reach me anytime.

This approach has worked very well for our patients and has resulted in our being one of the premiere places on the West Coast to have a vasectomy. We routinely care for many movie and television celebrities, rock stars and professional athletes, CEO’s of Fortune 500 companies and physicians and their families. People who can get their care anywhere come from around the world and trust us with their most personal and important problems because of the environment and success we create combining Skill, Service, and Compassion. We have consciously made an effort to keep the surgical fees reasonable even though there are surgeons with much less experience and success charging more than twice as much for a vasectomy. I want the opportunity of high quality no-scalpel vasectomy to be affordable to most couples.

We hope that you find the presented information valuable and we look forward to meeting you and to the privilege of taking care of you. If you have any questions or would like to speak with me directly, please don’t hesitate to call.