Vasectomy

A vasectomy (Pic. 1) is an operation designed to sterilise a man by cutting the tubes that allow sperm to leave the testicles. During the procedure, the male vas deferens (a tiny muscular tube in the male reproductive system that carries sperm from the epididymis to the ejaculatory duct) are severed and then tied/sealed. 

There are several methods by which a surgeon might complete a vasectomy procedure, all of which occlude (i.e. "seal") at least one side of each vas deferens. 

These types of surgery are performed:

• Fascial interposition: Recanalization (the process of restoring flow of a bodily tube) of the vas deferens is a known cause of vasectomy failure(s). Fascial interposition ("FI"), in which a tissue barrier is placed between the cut ends of the vas by suturing, may help to prevent this type of failure, increasing the overall success rate of vasectomy while leaving the testicular end within the confines of the fascia (a band of connective tissue).
• No-needle anesthesia: A method of local anesthesia was introduced for vasectomy which allows the surgeon to apply it painlessly with a special jet-injection tool, as opposed to traditional needle application. The numbing agent is forced/pushed onto and deep enough into the scrotal tissue to allow for a virtually pain-free surgery. 
• No-scalpel vasectomy (NSV): Also known as a "key-hole" vasectomy, is a vasectomy in which a sharp hemostat is used to puncture the scrotum. This method has come into widespread use as the resulting smaller "incision" or puncture wound typically limits bleeding and hematomas. Also the smaller wound has less chance of infection, resulting in faster healing times compared to the larger/longer incisions made with a scalpel. The surgical wound created by the no-scalpel method usually does not require stitches. 
• Open-ended vasectomy: In this procedure the testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This method may avoid testicular pain resulting from increased back-pressure in the epididymis. 
• Vas irrigation: Injections of sterile water or euflavine (which kills sperm) are put into the distal portion of the vas at the time of surgery. The use of euflavine does however, tend to decrease time (or, number of) ejaculations to azoospermia (semen contains no sperm) vs. the water irrigation by itself. 

Due to the simplicity of the surgery, a vasectomy usually takes less than thirty minutes to complete. After a short recovery at the doctor's office (usually less than an hour), the patient is sent home to rest. Because the procedure is minimally invasive (Pic. 2), many vasectomy patients find that they can resume their typical sexual behavior within a week, and do so with little or no discomfort.

Associated diseases

There are no associated diseases for this procedure.

Symptoms

• infertility

Complications 

Short-term possible complications include infection, bruising and bleeding into the scrotum resulting in a collection of blood known as a hematoma. 

The primary long-term complications are chronic pain conditions or syndromes that can affect any of the scrotal, pelvic and/or lower-abdominal regions, collectively known as post-vasectomy pain syndrome. 

Long-term postvasectomy pain is experienced at a frequency which ranges between 15% and 33% of vasectomy patients. Post-vasectomy pain syndrome is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore efforts focus on mitigating/relieving the individual patient's specific pain. 

Risk factors 

There is no risk factor for this condition. Men undergo this procedure on his own will and should think carefully if it is neccessary. This procedure is not irreversible, but reversal surgery has several complications.

Prevention

Vsectomy is a procedure, which is required by the patient. If men is considering to have a child in the future, he should think about other options of contraception. 

There is possibility of vasectomy reversal surgery to restore the ability to concieve.

Vasectomy is a procedure, which is used to prevent sperms to enter the ejaculate by cutting the tubes that allow sperms to leave the testicles. After the procedure, there are no sperms, which can be delivered to female genital tract, so the conception is not possible.

It is advised that all men having a vasectomy consider freezing some sperm before the procedure.
The cost of cryopreservation (sperm banking) itself may also be substantially less (approximately every five years) than alternative vaso-vasectomy procedure(s).

Vasectomy reversal is a term used for surgical procedures that reconnect the male reproductive tract after interruption by a vasectomy. Two procedures are possible at the time of vasectomy reversal: vasovasostomy (vas deferens to vas deferens connection) and vasoepididymostomy (epididymis to vas deferens connection). The procedures remain technically demanding and expensive, and may not restore the pre-vasectomy condition.

Vasectomy success is usually assumed when one or two post-vasectomy semen analyses show azoospermia or when only very rare non-motile sperm are observed, otherwise failure of adequate vas occlusion is implied. Failure can be attributed to surgical errors such as cutting a structure other than the vas, repeating the vasectomy twice on the same vas, or, very rarely, by overlooking a congenital duplication of the vas. However, most vasectomy failures are presumed to result from recanalization of the severed vas. 

Vasectomy reversal is an option for couples interested in fertility after vasectomy. Vasectomy reversal has been reported to have some cost-benefits related to use of assisted reproductive technology (ART). There are, however, additional factors that must be considered prior to vasectomy reversal. The availability of a trained microsurgeon must certainly be taken into consideration. Without a microsurgeon skilled in both vasovasostomy as well as vasoepididymostomy available to perform the procedure, vasectomy reversal should not be undertaken and couples may be better served with sperm retrieval and in vitro fertilization (IVF). 

It can take up to two years for sperm to return to the ejaculate after vasectomy reversal, at least this much time must be factored into the equation that determines a couple's likelihood of pregnancy through natural conception. The not inconsequential number of couples who fail their initial attempt at vasectomy reversal and require a reoperation will also have more years of waiting added to their reproductive timelines, as will the couples who have secondary stricture of the anastomosis (a connection between two structures in the body) who then require revision. 

Every advantage that a vasectomy reversal provides couples relies on the female partner having normal fertility potential; therefore, a vasectomy reversal should only be performed after female reproductive capacity is confirmed.

Vasectomy reversal has a pregnancy rate of 26% after 3 years. IVF has a pregnancy rate of 44% in each cycle, with cycles repeatable within 2 months. The cumulative pregnancy rate within 6 months will easily be more than 90%. 

Although the urge to satisfy a couple's request for a vasectomy reversal is understandable, blindly performing the procedure first without the appropriate evaluation or consideration of the option of sperm retrieval/IVF is not appropriate. For the male fertility expert counseling a couple interested in fertility after vasectomy, sperm retrieval with IVF is the preferred option. Even if vasectomy reversal is initially attempted, the vast majority of couples will require IVF.