Vasectomy

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Postoperative Care

Rest and limited mobility are required for 1 to 3 days following the vasectomy procedure to reduce swelling and to allow the vas deferens to heal. Most men lie on their back with their feet elevated. Although it is not necessary to remain immobile, excessive motion, lifting, and excessive walking increases the chance for inflammation and bleeding in the scrotum. Moderate discomfort is normal for a week or more.

Anti-inflammatory drugs and prescription painkillers may be used. Ice packs applied 15 minutes on and 15 minutes off can minimize swelling. Strenuous exercise and lifting should be avoided for a few days or longer if it causes pain or discomfort. The degree of discomfort should dictate activity, as overexertion can postpone healing and a return to normal routine. It may take a week before erection and ejaculation is comfortable.

It may be necessary to keep the incisions dressed for a few days to control bleeding from the healing incisions. Showering is usually allowed, but soaking and swimming should be avoided until the sutures have dissolved.

Sterility
Vasectomy does not result in immediate sterilization. Sperm may live for more than a week in the vas deferens, between the sutured ends and the ejaculatory ducts that lead to the penis. For most men, it takes 10 to 14 ejaculations and 1 to 2 weeks before the ducts are free of sperm. Usually, at least two semen samples are produced and collected for analysis 1 to 3 months after the procedure. When sperm count is zero, the man is sterile. Men who undergo any sterilization procedure (e.g., vasectomy, no-scalpel vasectomy) should use another form of birth control until semen analysis confirms sterility.

After sterility, semen is still ejaculated, but it lacks sperm. The testes continue to produce sperm, but sperm are prevented from reaching the prostate because they are blocked in the tied-off vas deferens, where they die and are absorbed into the body. Because semen is about 5% sperm, there is no discernible difference in the amount of semen ejaculated after vasectomy. The procedure does not affect testosterone production or libido.

Complications
Serious complications with vasectomy are rare. Up to 10% of men experience more pain, bleeding, or inflammation than others, and discomfort may persist longer than expected. This may be caused by a temporary buildup of pressure within the vas deferens. In rare cases, sperm is present in the semen for up to a year after surgery. This may be the result of poor sperm migration out of the vas deferens after surgery, or it may indicate that the severed ends of the vas deferens have reattached, a condition called recanalization. The solution to this problem is repeat vasectomy. Occasionally, a condition called sperm granuloma develops, in which residual sperm make their way out of the tied ends of the vas deferens, producing irritation and a small nodule. These usually heal in time, although surgical removal is occasionally required.

There is no evidence that vasectomy increases a man's chance for prostate cancer. Nevertheless, as a precaution, the American Urological Association (AUA) recommends that men over 40 who had a vasectomy more than 20 years previously should have an annual test for prostate cancer. Annual exams are recommended for all men age 50 to 70.

Vasectomy Reversal

In most cases, it is possible to reverse the vasectomy and restore the flow of sperm to the vas deferens. Vasovasostomy is a microsurgical procedure that involves the use of a tiny camera and ultrafine sutures to reattach the inside and outside of the vas deferens. Vasoepididymostomy is performed when inflammation or scarring from the original vasectomy blocks the epididymis and prevents a successful vasovasostomy. The blockage is bypassed by connecting the vas deferens directly to the epididymis in a new location. Most vasectomy reversals are done on an outpatient basis. For additional information, go to vasectomy reversal.

Needle aspiration is an alternative method to obtain sperm after vasectomy. A special surgical needle is inserted directly into the testes and sperm is collected in the syringe. Sperm can then be used with a variety of alternative insemination techniques (e.g., IVF).

Vasectomy, Sterility, Postoperative Care, Complications, Reversal reprinted with permission from urologychannel.com
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