19 Frequently Asked Questions (FAQ) About the No-Scalpel Vasectomy
- What is a Vasectomy?
- What is special about the "No-Scalpel Vasectomy" technique?
- Can hemoclips cause a problem?
- What about the "open ended technique"?
- What type of anesthesia does Dr. Silverstein utilize and what about the use of the "No-needle" method or use of IV sedation and being "put out"?
- Does the No-scalpel vasectomy utilize a laser?
- What happens to the sperm cells after a vasectomy?
- Is No-Scalpel Vasectomy painful?
- Does vasectomy affect one's sex drive/performance?
- Are there any long-term health risks of vasectomy?
- Will a No-Scalpel Vasectomy prevent the spread of Sexually transmitted diseases?
- What are some risks of having a No-Scalpel Vasectomy?
- What should I do before the procedure?
- What should I do after the procedure and when should I get post Vas semen check?
- Is a No-Scalpel Vasectomy reversible?
- What about pre-vasectomy sperm banking?
- What are other alternative forms of birth control?
- Why do I need a consult before the procedure?
- Again, what are the advantages of vasectomy care at the Center for No-Scalpel Vasectomy?
What is a Vasectomy?
Vasectomy is a minor surgical procedure. It involves the surgical disconnection of the tubes (vas deferens) that carry sperm from the testicles to the ejaculatory ducts. After a vasectomy men still have ejaculatory fluid (semen) but there are no sperm cells and thus can no longer make a women pregnant. After the procedure there is no noticeable decrease in ejaculate volume. Vasectomy is one of the most effective forms of birth control for men who are sure that they do not want to have any more children. A vasectomy performed by an experienced physician is simple, safe and more than 99% effective as a male contraceptive method. About 1 in 6 men over age 35 in the United States have had a vasectomy. More than 500,000 Americans undergo this procedure each year.
What is special about the "No-Scalpel Vasectomy" technique?
Newer methods of vasectomy, such as the "no-scalpel" vasectomy (NSV), have greatly reduced the side effects and complications of the procedure. NSV was developed in China, and introduced in the United States in 1988. Dr. Silverstein has perfected the technique over the last 20 years such that his technique is uniquely his own.
Men can now feel comfortable, relaxed and confident with this simple procedure. With NSV there is no knife and no cutting incision. Instead of a scalpel, two special instruments are used. The vas deferens is gently guided up through a tiny midline puncture in the scrotal skin. This tiny hole is stretched just enough to lift out the vas deferens. The blood vessels and nerves are pushed aside instead of cutting across them. The chances of bleeding, pain, infection and all other complications are significantly reduced.
Our Vasectomy practice is structured to assure maximum patient convenience, minimum cost, and decreased time away from work. Dr. Silverstein’s technique is designed to be in-office, thus obviating the need for to do the procedure in a hospital or surgi-center.
Can hemoclips cause a problem?
Dr. Silverstein believes redundancy is the key to assuring long term success of vasectomy. The vasal interruption / occlusion technique he utilizes involves triple protection; segment of vas is removed, then each end of the vas is sealed with cautery and an applied hemoclip. The clips used in vasectomy are very small and cannot be felt. They are made of medical grade titanium, and will not interfere with MRI studies, nor will they set off metal detector alarms.
What about the "open ended technique"?
The "open-ended" method refers to a vasectomy technique in which the testicular end of the divided vas is not closed off with a stitch, hemoclip, or electrocautery. The theory is that by not closing off the testicular end of the vas there is no increased backpressure on the epididymis compared to the conventional vasectomy technique of occluding the vas. The proponents of the open-ended technique assert that this decreased backpressure decreases the chance of inflammation and pain. Dr. Silverstein does not do the "open ended technique" for three important reasons. First, as our doctor performs the vasal occlusion well away from the epididymis, in his experience the "post vasectomy inflammatory syndrome/chronic pain" is rare even with his “closed technique”. The second reason is that with an open ended technique, 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. The final and most important reason against the open-ended technique is that it may be associated with an increases risk of vasectomy failure.
What type of anesthesia does Dr. Silverstein utilize and what about the use of the "No-needle" method or use of IV sedation and being "put out"?
The "no-needle" anesthesia method has been promoted by some as a way to avoid the use of a needle to administer the local lidocaine anesthetic. The No needle technique utilizes a multiuse nozzle "jet injection" device that uses pressure generated by a spring mechanism to push an anesthetic solution through the skin. A small 'pop' is felt; the feeling is similar to releasing a small rubber band against the skin.
Dr. Silverstein does not utilize the no-needle technique as there is strong evidence that the design of currently available jet injectors are inherently unsafe. There are documented concerns regarding the ability to maintain sterility of the anesthesia fluid and other components of the "jet injector" device, and thus there is a risk of blood-borne transmission of infectious agents between consecutive patients.
The device includes a reservoir of lidocaine that, unlike standard disposable needles and syringes, is part of a fluid pathway that is used more than once. The entire fluid pathway is not sterilized between each patient use, and the reservoir typically is filled and then used for several patients in a row.
The high-pressure of injector devices have been reported to cause a "splash-back" of blood onto or into the device. This splash-back can contaminate the device nozzle, the fluid pathway, and/or the lidocaine medication reservoir. In 1985, the dangers of jet injectors came to the limelight when a huge outbreak of Hepatitis B infection was linked to a jet injector used at a weight loss center. See CDC MMWR.
The current devices marketed for No-needle vasectomy procedures were designed in the 1970-1980's. The devices were grandfathered onto the market by virtue of preceding the FDA 1976 cutoff date for medical device regulation, or were "cleared for sale" on the basis of being similar to the grandfathered devices ("substantial equivalence”). They continue to be used despite safety concerns that appeared back in the 1980's and that continue to proliferate today. The FDA, CDC, DoD, AND WHO continue to be very concerned about the dangers of these devices. Clinical, laboratory, and epidemiological studies have continued to highlight the risk of viral transmission and blood borne disease by use of multiuse nozzle jet injectors. By 2005 various manufacturers had attempted to decrease the risk of cross contamination and the spread of blood Borne illness by modifying the patient contacting components. These modifications involved use of caps, spacers, and sheaths. However, testing in China had revealed spacers had failed to prevent hepatitis cross transmission. See 1. FDA Guidance 2. FDA Device Panel 3. Vaccines, 6th Edition By Stanley A. Plotkin, MD, etal; Chap 61, pp 1212-1221.
Primarily because of their utility for administration of vaccines, the Bill & Melinda Gates Foundation is currently funding the design and engineering of safer injectors. Once available, I will be an early adopter of the improved technology. Until then I feel it is safer to avoid the injectors and will follow the Hippocrates credo, Primum non nocere, first do no harm!
Thus, our Center for No-Scalpel Vasectomy does not use the "No-needle" injector. We use a standard single use needle and syringe to administer numbing medication. We utilize an advanced technique to anesthetize the scrotum effectively and with minimal discomfort. A local anesthetic is injected into the skin and alongside each vas tube with a very fine needle. There is no injection into the testicle itself. The patient feels a tiny poke in the skin, and then a bit of a squeeze as the anesthetic is applied.
Some doctors use IV sedation or general anesthesia for vasectomy procedures. This type of anesthesia is totally unnecessary. Local anesthesia (numbing medication) is all that is needed. IV sedation or general anesthesia for vasectomy only adds to inconvenience, time away from work, complications, length of recovery, and to out of pocket cost ($) to the patient. If you are told by your vasectomy doctor that you are going to be "put out", given IV sedation, "twilight", or general anesthesia I recommend getting a second opinion! Caveat (patientes!) emptor!
Does the No-scalpel vasectomy utilize a laser?
No. Although lasers have many uses in surgery today, there is no benefit to using a laser in Vasectomy. Dr. Silverstein had done research on the use of laser for vasectomy, and for vasovasostomy (vasectomy reversals), and had found no advantage to using the technology for either procedure.
What happens to the sperm cells after vasectomy?
A vasectomy prevents sperm from traveling from the testicle to the ejaculatory duct. Restricted in their movement, the sperm degenerate and are broken down into proteins and reabsorbed into the bloodstream.
Is No-Scalpel Vasectomy painful?
Since we use a special nerve block anesthetic technique, the No-Scalpel Vasectomy is an almost painless procedure. You may experience mild discomfort when the local anesthesia is administered. However, once it takes effect you should feel no pain. Some men feel a slight "tugging" sensation as the vasa are manipulated.
Before the vasectomy, you can request an Rx for a mild sedative such as Valium to relax you. Most of Dr. Silverstein's patients, however, do not require any sedative. If you do opt for Valium you need to have someone drive you to and from your vasectomy appointment.
After the procedure you may be a little sore for a few days. The discomfort is usually less with the no-scalpel technique as there is less injury to the tissues. The numbing medication wears off two to three hours after the procedure and most of the time no pain medication is needed. Post procedure you may feel a pulling sensation, but usually no pain. If you have any discomfort post procedure usually all that is required is ice packs (do not place directly on skin, wrap in towel or over the underwear), and/or Advil, Motrin, or ibuprofen. You may shower the evening of the procedure. The day after the procedure you may return to work and resume light activities. No strenuous activity for four days. Avoid sexual relations and any type of ejaculation for seven days. An alternative form of birth control must be used until the post vasectomy semen specimen at ten weeks confirms no sperm present.
Does vasectomy affect one's sex drive/performance?
Vasectomy does not affect sex drive, erections, or the sensation of orgasm. Additionally, there is no noticeable change in the volume of the ejaculation fluid. Male sex hormones are not affected by a vasectomy. This means there will be no changes in your beard, muscles, voice, or sex drive. Some men even report that without the constant worry of an unwanted pregnancy and the hassle of other birth control measures, they are able to relax and enjoy sex more than ever.
Are there any long-term health risks of vasectomy?
Epidemiologists, scientists, and clinicians have thoughtfully reviewed available literature and research and have concluded that vasectomy does not increase the risk of prostate cancer, coronary heart disease, stroke, hypertension, dementia or testicular cancer.
Will a No-Scalpel Vasectomy prevent the spread of Sexually transmitted diseases?
No. Vasectomy can only prevent pregnancy. Only abstinence or barrier contraceptives such as condoms can offer protection against the transmission of sexually transmitted infections.
What are some risks of having a No-Scalpel Vasectomy?
While vasectomy itself is a relatively safe and simple procedure, No-Scalpel Vasectomy has fewer complications. A few postoperative complications of vasectomy include:
- Swelling and/or tenderness of the scrotum
- Pain at the site of incision
These problems are usually minor, subside within 1-2 weeks and can be treated with mild non-aspirin painkillers, sitz baths, and ice application. Severe cases of postoperative pain are uncommon.
Significant complications are extremely rare, but may include:
- Infection or Bleeding (hematoma) formation. Studies indicated that NSV has a lower incidence of infection and hematoma. A prospective, randomized study in Thailand comparing the side effects of two vasectomy techniques showed that of 523 men, 1.34% developed an infection and 1.72% developed hematoma or bleeding after traditional vasectomy procedure. Of 680 men who underwent NSV, 0.15% developed an infection and 0.3% developed hematoma or bleeding. Overall percentage of complications after NSV is 0.4% versus 3.1% for conventional vasectomy.
- Sperm granulomas (small lumps, the size of a pea, caused by sperm leaking from the vas into the surrounding tissue). Most sperm granulomas do not produce any symptoms, rarely require treatment, and almost always resolves over time. If they cause tenderness anti-inflammatory medications like Advil usually resolves this.
- Failure of the procedure. Vasectomy does not produce immediate sterility. Thus, after vasectomy the couple must use other contraceptive methods until vasectomy success is confirmed by post vasectomy semen analysis (PVSA). This test is brought to a lab (Lab Corp, Quest, etc.) ten weeks after the procedure. Specimen is obtained at home and brought to Lab within three hours after ejaculation. Patients may stop using other methods of contraception when examination of the PVSA shows azoospermia or in some circumstances only rare non-motile sperm.
Patients considering vasectomy must be aware that even after vas occlusion is confirmed by PVSA (i.e. no sperm seen in the 10 week specimen), vasectomy still cannot be considered 100% guaranteed in preventing pregnancy. Even when the procedure is performed perfectly, recanalization, (sperm finding their way across the blocked ends of the vas deferens), can occur. In extremely rare cases, recanalization has been reported to occur even years after vasectomy.
- Post vasectomy pain syndrome/chronic pain. Temporary or chronic testicular pain may be secondary to a congestive process in the epididymis and testicular portion of the transected vas deferens. Nationally, episodic or recurrent epididymitis/ tenderness of the epididymis has been reported to occur in 0.3-6% of men who undergo vasectomy. A trial of antibiotics may be indicated but usually these cases respond to anti-inflammatory agents like Motrin or Advil. Resolution of the symptoms usually occurs but chronic testicular pain has been reported in some studies.
- In Dr. Silverstein's practice the incidence of this chronic pain syndrome is extremely low compared to rates reported in published series. This is likely due to Dr. Silverstein's experience and also due his "high" vasectomy technique. In this "high" vasectomy technique, Dr. Silverstein spends extra time mobilizing and then dividing the vas high up in the scrotum, as far away from the epididymis as anatomically possible.
- Testicular atrophy -This is an extremely rare complication since the testis have an elaborate blood supply network. Patients at increased risk include patients with preoperative compromised testicular blood flow (e.g. recent varicocelectomy or hernia surgery where testicular artery is not preserved)
What should I do before the procedure?
- Avoid taking Aspirin, baby aspirin, or anti-inflammatories for a week before your vasectomy.
- Do not consume alcohol on the day of the procedure.
- Shave the underside of the penis and the front wall of the scrotum the day before the procedure.
- On the day of the procedure, clean the genital area thoroughly.
- Do not use powder on the scrotum.
- Wear jockey type underwear, not boxers. Scrotal support or Jock strap is not needed.
- Valium not needed, but if you want it we can prescribe one dose. If you do opt to take Valium, someone must drive you to and from your appointment.
- Remember to print and fill out the downloadable new patient form and the consent form. Bring these to the office the day of your visit.
What should I do after the procedure and when should I get post Vas semen check ?
- You will be able to drive yourself home after the procedure.
- You should limit your activity for 24 hours after the procedure. An ice pack, though optional, can be applied to the scrotum (over the underwear) on and off for a few hours after the procedure to ease any swelling or discomfort.
- You may shower the evening after the procedure.
- Tylenol or an NSAID (like Advil, or Motrin) is usually all that is required for post procedure discomfort.
- An antibiotic is rarely prescribed. If given an Rx for antibiotic please fill and take this medication as directed.
- You may resume light work the day following the procedure. Resume sports or heavy work in 4-5 days.
- Avoid sexual relations and/or an ejaculation for 7 days.
- Vasectomy does not produce immediate sterility. Thus, when you do resume sexual relations, some form of temporary birth control (IE. Condoms, pill), must be used. The alternative form of birth control must be used until the absence of sperm is confirmed by semen analysis 10 weeks post vasectomy.
You should submit a semen specimen for analysis approximately 10 weeks post vasectomy. The evaluation can be done one of several ways:
- Patients can bring their post procedure semen specimen to a lab in their area (Quest, Lab Corp etc.). A prescription for the test can be provided by us or by your regular physician. The Rx for the test should be for "Post vasectomy semen analysis on un-centrifuged specimen and test for the presence or absence of sperm, ICD 10 code Z30.2"
- You should obtain the specimen at home, keep it at room temperature, and you or your designee should bring the Rx for the test, and the specimen, to the lab. We will call you once we get result. If you are called and told there are a few sperm in your specimen it does not mean that the vasectomy has failed. However, additional specimens will be requested and you will be asked to continue alternative birth control until clearance of sperm is assured.
- Other options for testing have recently become available:
- Useful option for post vasectomy semen testing is the use of the Mail-In Kit. This mailer test can be arranged and paid for on-line by visiting www.sementesting.org. Test is completed at home and mailer is then dropped in any US mail box.
- Sperm Check Vasectomy: SpermCheck® VASECTOMY Home Test Kit. New test and more data is needed to be sure it is as good as other options above.
Is a No-Scalpel Vasectomy reversible?
There are microsurgical procedures to reverse a vasectomy and reconnect the cut ends of the vas deferens. However, this technique, called vasovasostomy, is expensive ($5,000-$10,000), usually not covered by insurance, and is not always successful in restoring sperm in the ejaculate or in guaranteeing a return of fertility. Thus, vasectomy, and, NSV, should be considered irreversible. Before you choose to have a vasectomy, make sure that you and your partner do not want any more children.
What about pre vasectomy sperm banking?
Prior to vasectomy, sperm can be frozen and stored at a sperm bank. In case of unforeseen situations such as the death of a spouse or child, separation, divorce or any other situation when you might desire to father a child, these sperm can be used for assisted reproduction. However, sperm storage is an expensive option.
What are other alternative forms of birth control?
Temporary methods of birth control include condoms, diaphragms, spermicidals, IUDs, hormonal implants, and the female birth control "pill." Birth control pills are a popular form of birth control, however, not a good long-term method, as they are associated with cardiovascular complications, and there hormonal influences may increase the risk of some cancers. Tubal ligation is a permanent form of birth control for the woman. The fallopian tubes are blocked to prevent the eggs from traveling to the uterus from the ovaries. A No-Scalpel Vasectomy is a simpler procedure, requires a shorter recovery period and also costs less than a tubal ligation. Additionally vasectomy can be done in the office whereas tubal ligation requires general anesthesia in the hospital. The failure rate of tubal ligation is slightly higher than that of a vasectomy.
Why do I need a consult before the procedure?
The consultation consists of an opportunity to meet Dr. Silverstein. The vasectomy procedure is explained, and benefits, alternatives, complications, risks and failure rates are discussed. The doctor will answer all questions, and then will perform a history and detailed physical exam. At the conclusion of the consultation you will be provided with written pre/postoperative instructions and a consent form. The consent form is to be read and then signed by the patient. The procedure can be scheduled at a convenient time for the patient.
Consultations and the vasectomy procedure are done at our Freehold office. We have 25 time slots available for vasectomy each week. As we block out this time, patients can usually reserve a vasectomy slot within one week of a request.
Patients who are using an "out of network" insurance or not going through insurance can schedule an "All-in-one procedure" with us which allows for a cost effective consult and vasectomy on same day. In particular, out of town patients find this option very convenient. If you are a patient from New York State you should know that laws in New York require a mandatory 30 day waiting period between the consultation/consent signing and the actual vasectomy procedure. New Jersey has no such requirement. This is one of the many reasons patients come from New York to our center in New Jersey...and take advantage of our "All-in-One" consult and vasectomy on same day!
As in-network insurance plans already provide for discounted care, and these plans do not reimburse us for our consult/medical history screen by phone/email prior to the All-in-One appointment nor the extended time required for the "all in one " appointment, we are unable to provide this all-in-one service to our BC/BS, Horizon, Empire and Aetna patients.
Again, what are the advantages of vasectomy care at the Center for No-Scalpel VasectomyTM?
- Knowledge, skill and experience.
- Since 1997, vasectomy has been a major focus of our practice.
- Special expertise that benefits our patients.
- Refined and optimal technique.
- Achieves unmatched outcomes and patient satisfaction.