One of the biggest questions on a man’s mind when contemplating a vasectomy is – ‘will it affect my ...
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
At Metrocentre we have the ability to offer same day vasectomy consultations and procedures.
Our consultations take around 40 minutes and partners are more than welcome to attend also. The open-ended vasectomy procedure takes approximately 25 minutes with a short stay in recovery required afterwards.
At Metrocentre we use local anaesthic to avoid the side effects associated with general anaesthic.
This means that most men can drive to and from the procedure. Many of our patients report that they experience little to no discomfort during and after the procedure.
In conjunction with local anaesthic we can additionally offer inhaled relaxant medication for men who are nervous about the procedure or more sensitive to pain.
This can help you relax and feel more comfortable during the procedure. It is important to note that recovery time takes a little longer if this medication is used and you will not be able to drive for the rest of the day.
The effects of the local anaesthic should wear off after about 2 – 3hours and after this time, most men report that they experience minimal discomfort.
We will send you home after the procedure with an ice pack on the area – the more ice you can keep on for the rest of the day after the procedure, the better you will feel the day after the procedure.
As many of our patients experience minimal discomfort after the procedure, we suggest that taking at least one dose of paracetamol before bed is beneficial. Don’t be brave – if you have any unrelieved pain – no matter how little, use paracetamol.
Some men return to work the day after their procedure (particularly if they have an office occupation).
For men who do highly physical work involving heavy lifting, we recommend that they take at least seven days off from these activities. If you have taken inhaled medication you will need at least 12 hours off work to recover.
For most males it takes around three months for the sperm to be cleared from the tubes.
On the day of your procedure, we will give you everything required for your three month sperm test. This test can be performed by your local pathology lab and they will send the results through to us. We will then notify you of these results.
During the procedure some of the sperm will be flushed out ‘downstream’. After the procedure when you feel comfortable and up until you perform your three month sperm count, it is recommended that you have at least 30 ejaculations (sex with your partner will result in the most forceful muscular contractions at orgasm). This will completely flush out residual sperm and usually achieves a nil result on your sperm test.
Use contraception up until you have received your post vasectomy sperm count results.
Sometimes, we find that if you have not had enough sex, you may have a test result that indicates dead sperm present rather than no sperm present. If this is the case, the sperm are dead so you will not be able to get your partner pregnant, however you should still use contraception and have another test done in a month’s time to ensure a nil sperm count.
In short, have lots of sex post operatively to avoid the hassle of repeat testing.
Published results of vasectomy failure are 1 in 500 or 1 in 1000 depending on the study referred to.
80% of failures will be detected at the three month testing.
20% of the remaining 1 in 500 or 1 in 1000 (i.e. .04 % to 0.02 %) have a chance of failure after three months due to the ends joining back together.
At Metrocentre, the chance of failure of vasectomy would be rather surprising, as our Open-Ended reconstructive technique minimises scarring. Excessive scarring causes contraction of tissues at the procedure site and is usually the cause of the vas ends re-joining.
Dr Lekich has noted with his ultrasound assessment of 3000 sides of men consulting him for vasectomy reversal that extensive scarring due to an aggressive vasectomy technique brought the two ends of the vas extremely close together.
A reconnection was confirmed on ultrasound for the many failed vasectomies performed elsewhere that he has assessed and since redone successfully.
As with all scrotal surgery, there are published risks and complications and these include:
- Bleeding
- Minor cases of skin irritation from the antiseptic or dressings
- Mild to severe pain early or long term
- Post vasectomy chronic congestion pain due to the traditional vasectomy technique resulting in the blocking of the testicular vas. This pain can be mild to severe where in rare cases, patients can be suicidal.
- Nerve related pain following vasectomy. This pain can be mild to severe where in rare cases, patients can be suicidal.
- Congestion pain combined with nerve related pain. This pain can be mild to severe where in rare cases, patients can be suicidal.
- Scrotal haemorrhage (that is unfortunately far too commonly reported from the patients that we see for reversals who have had their vasectomy performed elsewhere) that could require more surgery and compromise testicle/s blood supply and loss of testicle/s requiring lifelong testosterone
- Scrotal infection that could require more surgery and compromise testicle/s blood supply and loss of testicle/s requiring lifelong testosterone
- Rare cases of psychological disturbance feeling less than a man
- Rare cases feeling there is less “cum” and that it does not taste the same OR shoot as far
- Rare cases that climax is not as strong and sex less enjoyable
Complications of vasectomy are not a feature in our high volume open – ended vasectomy and micro-surgical vasectomy reversal practice. There has never been a scrotal haemorrhage and an almost zero infection rate. The reasons are:
- Experience
- Teaching and mentoring by the most significant micro surgeon in Australia – Professor Earl Owen (Sydney Australia)
- Training with Dr Sherman Silber (USA), Dr Bruce Errey (Brisbane Australia) and Dr Barry Walters (Melbourne Australia)
- The open ended technique is not a quick snip
- More time is required than a standard vasectomy
- The position of our open -ended vasectomy is very important, allowing us to avoid damage to delicate structures and to maximise reversal potential
- Two very small incisions (rather than one central incision) are required to maximise perfect placement and exposure as there are two testicles that sit in different positions with their respective vas deferens
- There is a reconstruction to avoid destruction
- Inspired by microsurgical vasectomy reversal
For most patients sex is even more pleasurable after surgery…
As the fear of accidental pregnancy is removed, many couples find that a vasectomy actually adds to their sexual pleasure. After surgery the sensations of sex will remain unchanged, although the volume of ejaculate will decrease only slightly (approx. 0.2ml – usually not detected by the naked eye) as the fluid contribution from the prostate and seminal vesicles is unchanged.
This surgery will not affect your sexual ability, although sex should be avoided for the first 3-5 days after surgery. After this time we recommend that you have as much protected sex as possible- this enables faster clearance of the remaining sperm from the vas above the vasectomy site.
Any man single or married, with or without children may consider undergoing a vasectomy.
Although at Metrocentre open-ended vasectomies can be reversed in many cases, this is still considered a permanent procedure.
During your initial consultation, all aspects of the procedure will be discussed to ensure that you are an appropriate candidate. As for every patient, counselling is important.
For men that have not fathered children, it is advised that you have your consultation on a separate day to your procedure. This will allow you to discuss all issues in detail and have time to think about how you feel once you have spoken to the doctor. Dr Lekich has reversed vasectomies on many males that have never fathered children.
Men whose partners are pregnant should consider waiting until the baby is born in the event that the pregnancy or birth becomes complicated.
A vasectomy is partly covered by Medicare.
Metrocentre is not a budget cut price vasectomy service and we do not offer a ‘quick snip’ like many clinics that do exist.
We have a dedicated theatre in which our open ended vasectomies are performed. We do not perform our procedures in doctors’ rooms. No additional inpatient fees are charged.
If you are considering storing sperm for the future before undergoing a vasectomy, we are more than happy to discuss this with you.
Further Reading About Open-ended Vasectomy
Our highly experienced and caring staff are more than happy to answer any of your queries and concerns in regards to the open-ended vasectomy procedures we offer at Metrocentre located in Brisbane, Sydney, Melbourne and on the Gold Coast.
Suite 14, Level 1, PA Central Building
250 Ipswich Road
Buranda QLD 4102
Level 7, 44 Miller St
North Sydney NSW 2060
Vasectomies - 62 Wellington Parade
East Melbourne VIC 3002
Reversal Consults - Level 2,Suite 105, 1 Princess Street
Kew VIC 3101