Vasectomy
Definitions
• Vas: The tube that transports sperm from the testes.
• Vasectomy: Removal of a small portion of the vas.
• Testes: The egg shaped glands in the scrotum that make sperm and male hormones.
• Epididymis: A small gland, outside the testes, where sperm matures before entering the
vas.
• Prostate: The gland that makes the seminal fluid. When mixed with sperm from the
testes, semen is made.
Anatomy
Sperm is produced in the testes. From there, sperm travels into a small gland that is located
just outside the testes called the epididymis. It is here that the sperm stays as long as 6 weeks
to mature. The tubes of the epididymis join the vas or vas deferens. It is the vas that transports
the sperm into the body where it enters the prostate gland. The prostate gland is responsible
for making the seminal fluid that carries the sperm. The sperm from the testes, plus the seminal
fluid from the prostate, join together to make semen. The semen is then ejaculated through the
penis.
No Scalpel Vasectomy Procedure
A “no scalpel” vasectomy is started by anesthetizing a small area of the scrotum (the skin sac
that the testes are in) and then making a very small opening under the penis. We make the
small opening with a special tool that spreads the skin open rather that cutting the skin. The
technique allows quicker healing and less bleeding. We are then able to move each vas to the
opening, remove a small piece and then seal the end using heated cautery or a suture tie.
By removing a piece of the vas and obstructing the channel, sperm is no longer able to be
transported into the prostate and, therefore, results in infertility. The operation usually takes 20
minutes, and most patients can get up and walk out of the office soon afterwards.
Risks
The operation does have risks. As with any operation, simple or complicated, there is a chance
of bleeding, pain or infection.
We encourage men to stay off their feet after the operation for a few days and use ice packs to
keep swelling to a minimum. We encourage men to wear a scrotal support or jockey briefs to
provide some pressure to reduce bleeding. We also insist that patients not take aspirin for a
week or so before their procedure and for a short time afterwards, if there are no complications.
Despite precautions, complications from a vasectomy do occur. Some patients can have
bleeding or infection. Some patients will have discomfort in their incision, and some people will
have discomfort in their testes or around the vasectomy site for a period of time. This is due, in
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part, to the back pressure that builds up because the sperm cannot get out. For almost all of
these cases, the pressure in the testes, which causes sensitivity, eventually subsides.
Another possible cause of pain is called sperm granuloma. This is caused when the sperm find
their way out of the tied or cauterized end of the vas. This cannot be prevented in some
circumstances and the sperm that is released into the tissue is irritating and causes a small
nodule. These nodules usually resolve in time as the body seals them off, but can persist and
can be painful. On rare occasions, a sperm granuloma needs to be removed.
Fortunately, all of these complications are rare and in most cases the discomfort that occurs is
handled with a short course of anti-inflammatory drugs or pain medication with good resolution.
Another possibility is an infection or inflammation in the epididymis called epididymitis. This
again is rare and can be caused by the back pressure or infection or inflammation within the
epididymis. Epididymitis is treated with rest, elevation and antibiotics, and in most cases
resolves quickly.
Unique Risks of Vasectomy
Vasectomy has a few unique risks or complications. These include the possibility of
recanalization. Recanalization means that, despite removing a piece of the vas and sealing the
ends, the ends grow back together making the man fertile once again. This is extremely rare.
Since a fair amount of sperm is stored downstream from the portion of the vas that is removed,
the initial ejaculations always contain sperm. After the obligatory 1 week wait before engaging
in sexual activity, we encourage patients to become active sexually with protection. After at
least a dozen ejaculations, and 6 to 8 weeks, a semen specimen can be brought in for
microscopic examination. If that shows no signs of sperm, the vasectomy is considered
successful.
Some patients have very poor migration of sperm in the vas after the vasectomy, and cases of
persistence of sperm in the semen checks can be seen for several months. While this is rare
and even if the sperm counts are low, we do not consider you sterile until you have had a
completely negative sperm count. If, after a prolonged period of follow-up, sperm continue to
persist in the semen checks, particularly sperm that are active, we feel that recanalization has
occurred. While this occurs in only a small percentage of patients, it does necessitate a repeat
vasectomy on both sides.
The semen specimens that are needed for your checks do not have to be fresh. We are not
looking for sperm motility or action, and we consider any dead sperm as a potential pregnancy.
The semen specimens can be placed into a jar, such as a baby food jar, or one of the
containers that we give you. The easiest method of collection is to use a condom and dump the
contents of the condom (not the condom itself) into the jar. The jar does not have to be
refrigerated and the specimen can be a few hours old.
6005 244th St. SW, Ste. 111 !
Mountlake Terrace, WA 98043 !
t. 425.275.5555 !
f. 425.275.5590 !
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Long Term Effects of a Vasectomy
Another potential complication of a vasectomy is the long term effects of the procedure.
Controversies have existed for years about the possible side effects of a vasectomy. Large
studies have been done throughout the country looking at groups of patients who have and
have not had a vasectomy, and almost all of these studies have shown absolutely no difference
in any medical problems. We would be glad to discuss with you and your partner any of the
above risks or complications, and provide you an additional reading, if interested.
Vasectomy Requirements
There are 3 small requirements we have on the day of the vasectomy.
1. First, it is necessary to shave the hair off the scrotum. The shaving should be done on
the morning of the vasectomy and then you should take a shower to wash away all of
the cut hair. We strongly urge you not to consider the use of any depilatory creams to
remove the hair.
2. The second requirement is that you bring a pair of tight jockey shorts or a jock strap to
provide scrotal support and for us to be able to place bandages in the underwear for
security. Boxer shorts don!t provide support and will not hold any bandages that are
placed without tape.
3. Third, we suggest you bring someone to drive you home. While this may be logistically
difficult in some circumstances, a small number of men feel somewhat uneasy after the
operation because of stress. While there should be no discomfort for 1 to 2 hours after
the vasectomy, we would rather see the patient be able to lie down comfortably in his
automobile without having to drive home and fight traffic.
After the Vasectomy
After the vasectomy, we recommend that you go home immediately and get off your feet. It is
not absolutely essential to say bedridden for the next 2 days, but the more motion and
movement creates increased chance for swelling of the scrotum and incision. Once you get
home, ice packs for the first 36 hours are very helpful, for both pain relief and reducing swelling.
Frozen zip lock bags of peas and corn can be thawed and refrozen and provide a very soft,
pliable method of applying ice packs to the incision. Usually 15 minutes on and 15 minutes off
works very nicely and does truly keep down the amount of swelling that is present.
For discomfort, we also recommend the use of Tylenol or acetaminophen. 2 extra-strength
Tylenol (500 mg) tablets can be taken every 4 hours as needed for pain. Narcotics are rarely
indicated or needed for a vasectomy. If you are not moving around, it should not be too
uncomfortable, and Tylenol should be more than adequate pain relief. We encourage you not to
use aspirin in the postoperative period. Non-steroidal anti-inflammatories such as Advil,
ibuprofen, Naprosyn, etc., are excellent pain medications as well.
Questions?
If you have any further questions about the procedure, please don!t hesitate to ask us by calling
our office at 425.275.5555.
6005 244th St. SW, Ste. 111 !
Mountlake Terrace, WA 98043 !
t. 425.275.5555 !
f. 425.275.5590 !
www.urologynorthwest.com
6005 244th St. SW, Ste. 111
Mountlake Terrace, WA 98043
425-275-5555
www.urologynorthwest.com
Vasectomy Payment/cancellation Policy
Urology Northwest, PS verifies insurance coverage and benefits prior to
procedures. Many insurance companies do not cover sterilization procedures.
The total cost for the surgeon is $1000.00.
The surgeon reserves 1 hour for this procedure, therefore, we require a deposit
on the day the procedure is scheduled. If the patient has insurance, a deposit of
$150.00 is required upon scheduling. Any remaining patient pay portion must be
cleared within 30 days for the insurance payment. If the patient does not have
insurance a deposit of $250.00 is required at time of scheduling and the balance
of $750.00 is required on the day of the procedure.
The procedure will be cancelled if the patient does not come prepared to pay the
balance.
Failure to cancel your procedure within two business days or failure to show up
for your appointment will result in the loss of the deposit. Urology Northwest
does not offer post procedure payment plans.
I have read and understand the above payment policy.
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