No-Needle No-Scalpel Vasectomy

A vasectomy surgically blocks the vas deferens, thin tubes carrying sperm from the scrotum, and prevents sperm from becoming part of the seminal fluid that leaves the body at sexual climax. The most popular type of vasectomy is the No Needle, No-Scalpel Vasectomy (NNNSV).

BEFORE THE VASECTOMY

• To prevent the possibility of increased bleeding, do not take aspirin or other blood thinners for 10 days before the procedure. May take Ibuprofen 3-4 tabs 1 hour before vasectomy.
• Trim the hair as short as possible in the front of scrotum with a scissor (do not shave)
• Shower and bring an athletic supporter on the day of the procedure.
• Think of any questions you may want to ask your doctor.
• You are able to drive home by yourself after the surgery.

DURING THE VASECTOMY

• You will lie on the exam table, and the procedure site will be prepped with the Betadine solution. Sterile drapes will be placed over you to guard against infection.
• Under local anesthesia given by jet spray (no needle technique), a tiny puncture is made in the middle of scrotum. Either right or left vas deferens is lifted through this hole and then dissected, and a section is removed. The two ends of the vas are heat sealed and the distal ends are buried under the fascia with metal clips before placed back into the scrotum (metal clips are left in the scrotum without any harm). The same procedure is repeated for the opposite vas deferens. The small puncture that was made earlier can naturally heal by itself; there are no stitches in the NNNSV.

AFTER THE PROCEDURE

• Discomfort should be mild, may take Tylenol or Ibuprofen as needed, normally strong pain relievers are not necessary. Get plenty of rest and stay off your feet. Don’t need to use ice packs.
• Read your doctor’s written instructions
• You should wear a new scrotal support immediately after the vasectomy and for a few days afterward.
• Contact us immediately if you experience severe swelling or a growing mass related to bleeding, any sudden fever, chills, increasing pain, swelling or drainage, and lasting pain.
• You should be able to take showers after a day or two. Do not take baths or submerge your body in water for a few days after surgery.
• You should be able to return to work after three days. No strenuous activities or heavy lifting for 1-2 weeks.
• It is recommended that you abstain from sex 1-2 weeks after the surgery. Keep in mind that until your doctor confirms that you are sterile, use an alternate form of birth control.
• You will be expected to collect your specimen after 3 months (at least ejaculate 20 times before collecting). You can do this at home and bring the container into the clinic. You are considered sterile only after your doctor confirms it.

How long does the No-Needle No-Scalpel procedure and recovery take?

The procedure itself takes only 20 minutes in the doctor's office, but the entire process including paperwork may take up to 40 minutes. The vasectomy may cause tenderness, discomfort, and swelling the first few days after the procedure, but patients typically return to normal activities within a week.

How effective is a No-Needle No-Scalpel vasectomy?

It is nearly 100% effective. However, until the sample of ejaculation are sperm free, you must use some form of contraception.

Does it work immediately?

No, it may take several weeks before your semen is totally free of sperm. Therefore, couples are advised to use another form of contraceptive until the doctor can confirm that the man's semen no longer contains sperm.

How much does a No-Needle No-Scalpel Vasectomy cost?

It ranges from $700 to $1,000, if your health insurance program covers the cost so there may be little or no cost to you.

What happens to the sperm after the surgery?

Sperm continue to be produced in the testicles after the procedure. The sperm continue to be stored in the epididymis and are eventually dissolved and absorbed by the body.

Will the vasectomy affect my enjoyment of sex?

No. Erections, climaxes, and ejaculations should continue after vasectomy. Normal hormones are still produced. Some men may experience difficulty with erections or ejaculations, but this is usually a psychological problem rather than a surgical complication.

What are the complications of the surgery?

Infections and small blood clots are very rare. A small, tender nodule can develop at the cut end of the vas, and chronic aching in the scrotum can occur, but both go away with time. Most physicians believe that there is no substantial risk of cancer associated with vasectomy.

Is the surgery reversible?

You can choose to reconnect the cut ends of the vas, but it doesn't guarantee restored fertility. Current techniques for reversal are only about 60% effective.

Vasectomy Facts

• A vasectomy is one of the most popular forms of contraception in the United States and worldwide. Each year, more than half million men choose to get a vasectomy.
• The No Scalpel Vasectomy procedure was developed in the early 1970s in China. Almost 20 million No-Scalpel Vasectomies have been performed around the world.
• Sterilization for a man (vasectomy) is significantly less expensive than for a woman (tubal ligation), which may be up to five times more costly.
• Vasectomies are nearly 100 percent effective and safe. They don't reduce a man's sexual drive, virility, or ability to have or enjoy sex.
• Most vasectomies are done in the doctors' offices. A No-Scalpel Vasectomy takes only about 20 minutes.
• Most patients can go back to work in three days.
• There may be little or no cost to you since most health care insurance programs cover vasectomies.

Risk and Complications

Although a vasectomy is one of the safest procedures, there are still chances of minor complications, such as infection, bleeding or transient bruising, temporary swelling or fluid accumulation. Some patients experience a dull ache in the scrotal region, but this can be treated with medication.

The potential risks and complications:

• Bleeding under the skin that may cause scrotum area to look bruised. Hematoma (collection of blood) in the scrotum that should be reported immediately
• Infection occurs in the wound or inside scrotum, more common if there is a hematoma (blood collecting) beneath the skin, can be treated with antibiotics, hematoma evacuation, I&D drainage, and antimicrobial creams.
• Postoperative acute pain (mild) for a few days or occasional chronic dull ache (congestion) in the testicles, usually disappears within six months.
• Epididymitis, when the larger tube behind the testicle becomes inflamed and swollen, can be treated with heat application and medication
• Failure if the man has sex before all the sperm is confirmed to be gone
• Prostate cancer, the recent study showed there is no increased risk of prostate cancer if a vasectomy is done
• Sexual difficulties for the man due to psychological and emotional responses to a vasectomy
• Sperm granulomas, a rare sperm collection from the testicular cut end of the vas, producing harmless lump.

Psychological issue related to vasectomy

Almost all men fear the idea of having surgery anywhere near their genital regions. However, it is important to understand that vasectomies are generally less painful than surgical options for the woman, and they are also less expensive with fewer complications. Patients are recommended to ask questions and consult doctors about any risks and concerns in order to relieve anxiety. Vasectomies are often the best option that benefit the man as well as his loved ones. Many men have the following common fears:

• Pain – Local anesthetic completely numbs the area, so there should not be any discomfort or sensations during the procedure. If patients feel mild discomfort the first couple days after the anesthetic wears off, medications or ice packs can be used.
• Sexual dysfunction – A vasectomy does not reduce a man's sexual drive or his ability to have an erection or enjoy sex. The procedure only blocks sperm and simply prevents the possibility of conceiving a child. There's no effect on "masculinity," The man's body continues to produce hormones as before; testosterone continues to be produced and released into the bloodstream.
• Procedure failure – Vasectomies are almost 100 percent effect and very reliable. The risk of failure is under 0.1% in the literature. There is no single case report from hundreds of vasectomies performed in Dr. Shu's office over the past 10 years.
• Complications – There are few risks involved with vasectomies. These include infection or swelling around the incision or inside the scrotum, bruising or inflammation and the development of a small lump due to a sperm leak.
• Absence from work – Patients typically return to work in three days of surgery, they are advised to avoid strenuous activities and heavy lifting for 1-2 weeks.

OTHER CONTRACEPTION OPTIONS

• Abstinence – both the man and the woman choose not to have sex.
• Cervical Cap/Diaphragm/ Vaginal Pouch – barrier devices placed over the cervix and vagina and stops sperm from entering.
• Condom – the most common form of contraception; risk of tearing, breaking, slipping or leaking, any of which can lead to conception.
• Depo-Provera® – a progesterone injection administered every 12 weeks that stops ovulation, highly effective but may cause significant side effects such as weight gain or depression. No menstruation with
• Depo-Provera, but it returns after stopping the injection.
• Intrauterine Device (IUD) – a small T-shaped plastic device placed in the uterus that creates a low-grade inflammation, preventing sperm and fertilized egg from settling in uterus.
• Norplant® – a long-term contraceptive system that involves small pellets being surgically inserted under the skin of the upper arm, and a progesterone-like hormone (levonorgestrel) is released gradually over time, blocking ovulation.
• Oral Contraceptives – estrogen tablet that is fairly effective.
• Rhythm Method – couples abstain from having sex for five to 15 days per month in order to avoid the most fertile days in the woman's menstrual cycle. However, this is not a precise method.
• Spermicides – chemical contraceptives, such as foam, cream or jellies that kill sperm on contact in the vagina.
• Tubal Ligation – permanent surgical sterilization for women, involves tying, cutting or cauterizing fallopian tubes to permanently block egg passage from the ovaries to the uterus.
• Withdrawal method – the man withdraws from intercourse before ejaculation, not reliable since sperm may enter the vagina before ejaculation.