Vasectomy

Open Ended Vasectomy: The Metrocentre Way

Our open-ended vasectomy offers:

• reduced incidence of post vasectomy pain (related to congestion) syndrome
• better success rates when it comes to a reversal if required in the future

29,000 Australian men undertake a vasectomy procedure every year, and at Metrocentre our highly experienced team can provide an advanced and highly successful open-ended vasectomy technique.

How does it work?

A vasectomy procedure involves cutting the vas deferens to prevent sperm from entering the ejaculate.

The vas deferens are the two tubes that carry sperm from the testicle to the glands at the base of the bladder called the seminal vesicles and the prostate gland. It is at this point that the sperm mixes with the seminal fluid to form fertile ejaculate. A vasectomy is typically performed via small incisions in the front of the scrotum.

It is important to note that the production of the male hormone testosterone or a man’s ability to perform sexually is not affected by this procedure.

There are 3 main techniques used for vasectomy procedures

At Metrocentre we owe our ability to perform the Open-Ended Vasectomy to the pioneering work of our mentors Prof Owen Bruce Errey and Dr Walters.

1. Open-Ended Vasectomy

A true open ended vasectomy should take at least 25 minutes to perform.

This procedure involves two tiny incisions to access the vas tubes. The tubes are then cut and the testicular end is left opened and unsealed, with both ends of the tubes separated by layers of tissue within the scrotal sac by fine suturing. Sperm continues to be produced after the vasectomy so this fluid travels from the testicle up the vas where it then flows out of the vas and into the tissues. The body reabsorbs this naturally. The testicular vas deferens and the vas deferens that leads to the prostate reconstructed in separate compartment to minimise the risk of failure.

As a result of this technique:

• Sperm do not suddenly build up in the testicle, so the development of an inflammatory cascade, blow out and scarring of the fine epididymal tubules is avoided.
• Sperm flow is directed and absorbed under the skin rather than left to clog up the tubules.
• An open ended vasectomised patient is unlikely to be aware that they have had a vasectomy unlike the closed ended vasectomy patients that often experience some form of aching and tenderness.
• The nature of this technique prevents the build-up of sperm and the associated congestion (post vasectomy pain syndrome), a lower rate of postoperative pain, and a better potential for vasectomy reversal in the future.

It is highly important to use contraception for the first few months after surgery. This is done to allow the remaining sperm to be flushed out beyond the scrotal ties. It is important to note that sperm will continue to be produced in the testicles after surgery.

2. No Scalpel Vasectomy (NSV)

A “no scalpel” technique merely describes how the vas tubes are accessed. Once the skin is opened, a traditional technique is generally used to perform the vasectomy.

A “no scalpel” technique involves tearing the skin with sharp pointed forceps to access the vas tubes.  Both ends of the tubes are then cut, tied or cauterised to prevent the movement of sperm. Sperm production continues once the vas deferens sealed, and the sperm build up in these tubes can clog the system over a period of time.

3. Traditional Vasectomy

A traditional vasectomy takes around 10 minutes to perform.

This technique uses either a scalpel or sharp forceps (see No Scalpel Vasectomy below) to access the vas tubes.  It is usual to have either  one central or two large incisions, the vas tube is cut and sealed (either  burnt, tied or stapled) and sections of the vas deferens may be removed.

If large sections are removed and sutures or staples damage the blood supply in the scrotum, then a vasectomy reversal may be more difficult after this technique is used. By tying the ends attached to the testicles, blow outs and scarring of the fine storage tubules called the epididymis is more likely to cause chronic scrotal pain of varying severity (post vasectomy pain syndrome) and a more complex vasectomy reversal.

In one case we repaired, 10 metal staples (counted on ultrasound) were used in the vasectomy. This can cause significant collateral damage to important blood vessels, nerves and lymphatics that can increase the long term risk of complications and lessen the chance of successful vasectomy reversal if there was a change of circumstance.

What are the benefits?

The Open-ended Vasectomy we offer at Metrocentre offers a range of benefits over traditional procedures

Dr Lekich has trained extensively under Dr Bruce Errey, who has pioneered and performed over 30,000 open-ended vasectomies. As men continue to produce more than 20 million sperm per day after a vasectomy, the open-ended technique is engineered to reduce the inflammatory pain associated with the blockage of the testicular vas deferens that occurs during traditional vasectomy procedures.

During this procedure the testicular end of the vas deferens is left open to allow sperm to continue to move through the surrounding tissues, which means that the clogging and inflammation associated with the sealing of the vas tubes is avoided.

The benefits of an open-ended Vasectomy:

• A carefully considered reconstructive procedure, inspired by microsurgical vasectomy reversals, to maximise success of sterility
• Reduction in Post Vasectomy Pain (Congestion) Syndrome as a post-operative complication
• Retain normal function of the male reproductive organs
• Maximise the potential of a successful future reversal
• Preserving  lymphatics, nerves, veins and arteries

Contrary to popular belief, open ended vasectomies do not have a higher failure rate, as the two ends are separated and placed in different scrotal positions to prevent the two ends joining together once more.

Dr Lekich sees many vasectomised men utilising the ultrasound for vasectomy reversal assessment and is amazed that even at 30 years after an Open-Ended Vasectomy the testicular structures look much less inflamed and scarred than those of a Traditional vasectomy performed six months earlier.

What can we offer?

• Same day consultation and procedure: This is offered in all of our clinics, with the total appointment taking approximately one and a half hours. We perform this as an outpatient procedure, and there is no requirement for overnight hospitalisation.
• Additional anesthesia: We offer an additional inhalant medication that is quite relaxing for nervous and anxious patients. All of our patients receive a local anesthetic and are able to drive home afterwards. An additional inhaled relaxant is also available for patients to use, although they cannot drive for the remainder of the day if this is used.
• Highest resolution ultrasound scan: this detailed information allows us to prepare a tailored surgical approach for each of our individual patients.
• Operating microscope: this effectively assists our team to locate the tiny (0.2mm in diameter) vas deferens and identify the three distinct layers within the vas deferens (which are not easily discernible to the naked eye).
• Dedicated theatre: Our specialised theatre is dedicated to both open-ended vasectomy and microsurgical vasectomy reversal procedures.

At Metrocentre we strive to educate our patients about the various treatment options available, allowing them to make an educated decision on the treatment path they would like to pursue.

Explore the following to discover more about the Open Ended Vasectomy procedure and patient care we offer at Metrocentre