Male Sterilization-Vasectomy

• Vasectomy is a surgical procedure for male sterilization and a method of permanent birth control.
• During the procedure, the vasa deferentia or ductus deferens  of a man are tied and separated to prevent sperms from entering into the seminal stream.

PROCEDURE:

• No–scalpel vasectomy (also called keyhole vasectomy) is a vasectomy procedure in which a sharp hemostat is used to puncture the scrotum.
• Done through a small incision in the scrotum, under local anaesthesia
• One single incision is made with a special forceps and skin stitch is not required.
• Clips and plugs can be applied over the vas instead of cutting.
• The sterility is not immediate.
• The sperms are stored in reproductive tract for up to 3 months.
• Reversal is most successful within 10 years of initial surgery
• The couple must therefore abstain from intercourse during this period or use other methods of contraception.
• Approximately,20 ejaculates or  10 to 12 weeks clear the semen of all sperms.
• Two semen analysis reports must confirm the absence of sperms before the man can be declared sterile.
• 1 in 2000 men can become fertile again
• Vasectomy is cheaper than tubectomy
• Reversible inhibition of sperm under guidance(RISUG):
• Polymer gel is injected into the vas. 
• Reversibility is possible by flushing the vas with sodium bicarbonate

Newer Techniques:

Chemical sclerosing agents:

• Such as 90% ethanol, 3.6% formaldehyde, silver nitrate, hydrogen peroxide, acetic acid
• Eiminate the need of surgery, are effective and easily administered

Occlusive plugs and intravasal devices:

• A device called ‘SHUG’ consists of two flexible silicon plugs connected by a nylon thread which lies outside the vas
• This thread prevents migration of plugs and allows easy removal through a small incision

COMPLICATIONS:

• Local pain, skin discolouration, bleeding, haematoma formation (1–2%).
• Infection (1%), trauma to the testicular artery causing gangrene, rare.
• Antibody formation and autoimmune disease (40%).
• Failure rate of 0.15/100 woman years at the end of 1 year.
• Granuloma formation in 0.1–3% cases.
• Spontaneous recanalization.
• Formation of spermatocele.
• Decreased libido or impotency are mainly psychological in origin and occur in men who were not properly motivated.
• Does not prevent HIV, STD.

ADVANTAGES:

• It is an outpatient procedure.
• Local anaesthesia is adequate.
• It is a minor surgical procedure and the man can resume duty after rest of 1 or 2 days.
• Libido not affected.
• No evidence of prostate cancer.

CONTRAINDICATIONS:

• Local skin infection
• Varicocele, hernia
• Undescended testis