Editing Vasectomy (section)

==Procedure==

The traditional incision approach of vasectomy involves numbing of the scrotum with local anesthetic (although some people's physiology may make access to the vas deferens more difficult in which case general anesthesia may be recommended) after which a [[scalpel]] is used to make two small incisions, one on each side of the scrotum at a location that allows the surgeon to bring each vas deferens to the surface for excision. The vasa deferentia are cut (sometimes a section may be removed altogether), separated, and then at least one side is sealed by ligating ([[suturing]]), [[cauterizing]]  ([[electrocauterization]]), or clamping.<ref name=Cook2014>{{cite journal|last1=Cook|first1=LA|last2=Pun|first2=A|last3=Gallo|first3=MF|last4=Lopez|first4=LM|last5=Van Vliet|first5=HA|title=Scalpel versus no-scalpel incision for vasectomy.|journal=The Cochrane Database of Systematic Reviews|date=30 March 2014|volume=2014 |issue=3|pages=CD004112|doi=10.1002/14651858.CD004112.pub4|pmid=24683021|pmc=6464377}}</ref> There are several variations to this method that may improve healing, effectiveness, and which help mitigate long-term pain such as post-vasectomy pain syndrome or [[epididymitis]], however the data supporting one over another are limited.<ref name="www2.cochrane.org" />
* '''Fascial interposition:''' Recanalization of the vas deferens is a known cause of vasectomy failure(s).<ref>{{cite web |author=webmaster@vasectomy-information.com |url=http://www.vasectomy-information.com/moreinfo/recanalisation.htm |title=Recanalization of the vas deferens |publisher=Vasectomy-information.com |date=2007-09-14 |access-date=2011-12-28 |archive-url=https://web.archive.org/web/20120104203420/http://www.vasectomy-information.com/moreinfo/recanalisation.htm |archive-date=2012-01-04 |url-status=dead }}</ref>  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.<ref name="pmid=15056388">{{cite journal |doi=10.1186/1741-7015-2-6 |year=2004|display-authors=3 |last1=Sokal |first1=David |last2=Irsula |first2=Belinda |last3=Hays |first3=Melissa |last4=Chen-Mok |first4=Mario |last5=Barone |first5=Mark A |journal=BMC Medicine |volume=2 |page=6 |pmid=15056388 |title=Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial ISRCTN77781689 |pmc=406425 |issue=1 |doi-access=free }}</ref>  The [[fascia]] is a fibrous protective sheath that surrounds the vas deferens as well as all other body muscle tissue. This method, when combined with intraluminal cautery (where one or both sides of the vas deferens are electrically "burned" closed to prevent recanalization), has been shown to increase the success rate of vasectomy procedures.
* '''No-needle''' anesthesia: [[Fear of needles]] for injection of [[local anesthesia]] is well known.<ref name=pmid15821547>{{cite journal |pmid=15821547 |year=2005 |last1=Weiss |first1=RS |last2=Li |first2=PS |s2cid=13097425 |title=No-needle jet anesthetic technique for no-scalpel vasectomy |volume=173 |issue=5 |pages=1677–80 |doi=10.1097/01.ju.0000154698.03817.d4 |journal=The Journal of Urology}}</ref> In 2005, 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.  Lidocaine applied in this manner typically achieves anesthesia within 10 to 20 seconds.<ref>{{Cite journal |last1=Weiss |first1=Ronald S. |last2=Li |first2=Philip S. |date=May 2005 |title=No-needle jet anesthetic technique for no-scalpel vasectomy |url=https://pubmed.ncbi.nlm.nih.gov/15821547/ |journal=The Journal of Urology |volume=173 |issue=5 |pages=1677–1680 |doi=10.1097/01.ju.0000154698.03817.d4 |issn=0022-5347 |pmid=15821547}}</ref> Initial surveys show a very high satisfaction rate amongst vasectomy patients.<ref name=pmid15821547/> Once the effects of no-needle anesthesia set in, the vasectomy procedure is performed in the routine manner. However, unlike in conventional local anesthesia where needles and syringes are used on one patient only, the applicator is not single use and can only be properly disinfected by [[Autoclave | autoclaving]].<ref>{{Cite journal |last1=Barolet |first1=Daniel |last2=Benohanian |first2=Antranik |date=2018-05-01 |title=Current trends in needle-free jet injection: an update |journal=Clinical, Cosmetic and Investigational Dermatology |language=English |volume=11 |pages=231–238 |doi=10.2147/CCID.S162724 |pmc=5936486 |pmid=29750049 |doi-access=free }}</ref>
* '''No-scalpel''' vasectomy (NSV): Also known as a "key-hole" vasectomy,<ref name=Cook2014/> is a vasectomy in which a sharp [[hemostat]] (as opposed to a scalpel) 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. NSV is the most commonly performed type of minimally invasive vasectomy, and both describe the method of vasectomy that leads to access of the vas deferens.<ref name="pmid23098786">{{cite journal | vauthors = Sharlip ID, Belker AM, Honig S, Labrecque M, Marmar JL, Ross LS, Sandlow JI, Sokal DC | title = Vasectomy: AUA guideline | journal = The Journal of Urology | volume = 188 | issue = 6 Suppl | pages = 2482–91 | date = December 2012 | pmid = 23098786 | doi = 10.1016/j.juro.2012.09.080 }}</ref>
[[File:Open Vasectomy .jpeg|thumb|Open-ended vasectomy]]
* '''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]].<ref name=christiansen/> Studies suggest that this method may reduce long-term complications such as [[post-vasectomy pain syndrome]].<ref>{{cite journal|last=Moss|first=WM|title=A comparison of open-end versus closed-end vasectomies: a report on 6220 cases|journal=Contraception|date=December 1992|volume=46|issue=6|pages=521–5|pmid=1493712|doi=10.1016/0010-7824(92)90116-B}}</ref><ref>{{cite journal|last=Shapiro|first=EI|author2=Silber, SJ |title=Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia|journal=Fertility and Sterility|date=November 1979|volume=32|issue=5|pages=546–50|pmid=499585|doi=10.1016/S0015-0282(16)44357-8|doi-access=free}}</ref>
* '''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 which then brings about a near-immediate sterile ("azoospermatic") condition.  The use of euflavine does however, tend to decrease time (or, number of ejaculations) to azoospermia vs. the water irrigation by itself. This additional step in the vasectomy procedure, (and similarly, fascial interposition), has shown positive results but is not as prominently in use, and few surgeons offer it as part of their vasectomy procedure.<ref name="www2.cochrane.org">{{cite journal|last1=Cook|first1=Lynley A.|last2=Van Vliet|first2=Huib AAM|last3=Lopez|first3=Laureen M|last4=Pun|first4=Asha|last5=Gallo|first5=Maria F|year=2014|editor1-last=Cook|editor1-first=Lynley A.|title=Vasectomy occlusion techniques for male sterilization|journal=Cochrane Database of Systematic Reviews|volume=2014 |issue=2|pages=CD003991|doi=10.1002/14651858.CD003991.pub4|pmid=24683020|pmc=7173716}}</ref>

===Other techniques===
The following vasectomy methods have purportedly had a better chance of later reversal but have seen less use by virtue of known higher failure rates (i.e., recanalization). An earlier clip device, the VasClip, is no longer on the market, due to unacceptably high failure rates.<ref>{{cite journal |pmid=17070280 |year=2006 |last1=Levine |first1=LA |last2=Abern |first2=MR |last3=Lux |first3=MM |title=Persistent motile sperm after ligation band vasectomy |volume=176 |issue=5 |pages=2146–8 |doi=10.1016/j.juro.2006.07.028 |journal=The Journal of Urology}}</ref><ref>{{cite web |url=http://www.imccoalition.org/newsletter/2008_August_public.htm |title=Male Contraception Update for the public - August 2008, 3(8) |publisher=Imccoalition.org |access-date=2011-12-28 |url-status=dead |archive-url=https://web.archive.org/web/20120327213833/http://www.imccoalition.org/newsletter/2008_August_public.htm |archive-date=2012-03-27 }}</ref><ref name="vasweb">{{cite web |url=http://www.vasweb.com/vasclip.htm |title= VasClip|website=www.vasweb.com |archive-url=https://web.archive.org/web/20111019201121/http://www.vasweb.com/vasclip.htm |archive-date=2011-10-19}}</ref>{{Unreliable medical source|date=July 2011}}

The VasClip method, though considered reversible, has had a higher cost and resulted in lower success rates. Also, because the vasa deferentia are not cut or tied with this method, it could technically be classified as other than a vasectomy. Vasectomy reversal (and the success thereof) was conjectured to be higher as it only required removing the Vas-Clip device. This method achieved limited use, and scant reversal data are available.<ref name="vasweb" />

====Vas occlusion techniques====
{{main|Vas-occlusive contraception}}
* '''Injected plugs:''' There are two types of injected plugs which can be used to block the vasa deferentia. [[Medical-grade]] polyurethane (MPU) or medical-grade silicone rubber (MSR) starts as a liquid polymer that is injected into the vas deferens after which the liquid is clamped in place until is solidifies (usually in a few minutes).<ref>{{cite web|url=http://malecontraceptives.org/methods/mpu.php |title=Injected plugs |publisher=MaleContraceptives.org |date=2011-07-27 |access-date=2011-12-28}}</ref>
* '''Intra-vas device:'''  The vasa deferentia can also be occluded by an intra-vas device (IVD). A small cut is made in the lower abdomen after which a soft silicone or urethane plug is inserted into each vas tube thereby blocking (occluding) sperm.  This method allows for the vas to remain intact. IVD technique is done in an out-patient setting with local anesthetic, similar to a traditional vasectomy. IVD reversal can be performed under the same conditions making it much less costly than [[vasovasostomy]] which can require general anesthesia and longer surgery time.<ref>{{cite web|url=http://www.malecontraceptives.org/methods/shug.php#refs |title=Intra Vas Device (IVD) |publisher=MaleContraceptives.org |access-date=2011-12-28}}</ref>

Both vas occlusion techniques require the same basic patient setup: local anesthesia, puncturing of the scrotal sac for access of the vas, and then plug or injected plug occlusion. The success of the aforementioned vas occlusion techniques is not clear and data are still{{when?|date=May 2025}} limited.  Studies have shown, however, that the time to achieve sterility is longer than the more prominent techniques mentioned in the beginning of this article. The satisfaction rate of patients undergoing IVD techniques has a high rate of satisfaction with regard to the surgery experience itself.<ref>{{cite journal |last1=Cook |first1=LA |last2=Van Vliet |first2=HA |last3=Lopez |first3=LM |last4=Pun |first4=A |last5=Gallo |first5=MF |title=Vasectomy occlusion techniques for male sterilization. |journal=The Cochrane Database of Systematic Reviews |date=30 March 2014 |volume=2014 |issue=3 |pages=CD003991 |doi=10.1002/14651858.CD003991.pub4 |pmid=24683020|pmc=7173716 }}</ref>

===Recovery===
{{multiple images|perrow =1
| image1 = Vasectomy day 1.jpg
| caption1 = Incision [[surgical suture|stitches]] and a [[shaved]] scrotum
| image2 = Vesectomy after 14 days.jpg|14 days after vasectomy surgery
| caption2 = 14 days after vasectomy surgery
}}
Sexual intercourse can usually be resumed in about a week (depending on recovery); however, pregnancy is still possible as long as the [[sperm count]] is above zero. Another method of contraception must be relied upon until a sperm count is performed either two months after the vasectomy or after 10–20 ejaculations have occurred.<ref>{{cite web |url= http://www.webmd.com/sex/birth-control/vasectomy-14387 |title=Vasectomy Procedure, Effects, Risks, Effectiveness, and More |author=Healthwise Staff  |work=webmd.com |date=May 13, 2010 |access-date=March 29, 2012}}</ref>

After a vasectomy, contraceptive precautions must be continued until [[azoospermia]] is confirmed. Usually two semen analyses at three and four months are necessary to confirm azoospermia. The British Andrological Society has recommended that a single semen analysis confirming azoospermia after sixteen weeks is sufficient.<ref>{{cite web|title=Post Vasectomy Semen Analysis|url=http://www.cambridge-ivf.org.uk/patients/andrology-services/post-vasectomy-semen-analysis-pvsa|website=Cambridge IVF|access-date=23 October 2015|ref=CambridgeIVF|archive-date=26 February 2021|archive-url=https://web.archive.org/web/20210226162148/https://www.cambridge-ivf.org.uk/patients/andrology-services/post-vasectomy-semen-analysis-pvsa|url-status=dead}}</ref>

Post-vasectomy, testicles will continue to produce sperm cells. As before vasectomy, unused sperm are reabsorbed by the body.<ref>{{cite web |url= http://urology.med.miami.edu/specialties/male-urologic-health/vasectomy |title= Vasectomy |author=<!--Not stated--> |website=University of Miami Health System, Miller School of Medicine |access-date=28 December 2019}}</ref>