Male sterilization (synonyms: vasectomy; vasoresection) is a surgical procedure performed to achieve infertility. The procedure is considered potentially irreversible. Male sterilization is a safe method of protection against unwanted pregnancies (0.15 pregnancies per 1,200 cycles of use or per 100 years of use [adjusted Pearl index: 0.1]).
Indications (areas of application)
- Completed family planning
- Repeated prostatitis – inflammation of the prostate gland.
- Repeated epididymitis – inflammation of the epididymis.
Before surgery
- Preoperatively, the patient must be informed about the definitive nature (finality) of the operation. Furthermore, about:
- Vasectomy failure in about 0-2% of cases.
- Approximately 6% of sterilized men desire refertilization (restoration of fertility) later in life; microsurgical refertilization surgery results in restoration of patency in approximately 85% of cases
- Spermatozoa autoantibodies (antibodies against spermatozoa) occur postoperatively in up to 80% of patients, but this is only relevant if refertilization surgery is planned
- Hair removal – In all surgical procedures in the genital area, it is necessary to perform removal of hair in both the genital and inguinal areas, so as to reduce the risk of infection. However, when removing the hair around the area to be operated on, it is important to make sure that the hair is removed using a method that is not very irritating to the skin. When performing an outpatient surgery, the removal of hair in the surgical area is done by the patient himself or, in the case of an inpatient stay, by the nursing staff.
- Anesthesia – Since this operation is a relatively uncomplicated and short procedure, it is usually not necessary to perform general anesthesia. Therefore, if the surgery is performed on an outpatient basis, it is not necessary for the patient to be fasting. However, if the patient is operated on under general anesthesia, it should be noted that no eating or drinking is allowed for 12 hours preoperatively. If general anesthesia is not performed, the vas deferens are each locally anesthetized by an injection in the groin area. After the application of the local anesthetic, a period of 15 minutes must be waited to ensure adequate anesthesia.
- Cleaning and disinfection – Before surgery, it is necessary that the entire genital area is sufficiently washed. After successful induction of anesthesia is then completed surface disinfection.
The surgical procedure
In men, the following procedure is used to achieve sterility:
- Vasotomy or vasoresection
In this operation, the ductus deferentia (vas deferens) in the area of the scrotum are interrupted, usually a piece is removed and the ends are coagulated, and performing fascial interposition (positioning the ends of the vas deferens in different layers of tissue). Sterility does not occur until about three months after the procedure, so additional contraceptives (contraceptives) must be used until then. To check whether sterility has set in, samples of the ejaculate are examined. If two samples show no sperm within several weeks, the person can assume sterility. With vasectomy, there is no risk of impotence for the man. Male sterilization can be reversed surgically. The chances of success are 80-90%. The operation is not paid by the public health insurance. This operation is usually performed on an outpatient basis by a urologist under local anesthesia (local anesthesia). Male sterilization is a relatively simple and safe method.
After the operation
- One week after the procedure, the stitches can be removed and a check-up can be performed.
- To check infertility, it is necessary to make a first spermiogram (sperm examination) after 6-8 weeks. The second examination should be done after 4 months (due tofrequency peak at 3-4 months for early recanalization). The findings of azoospermia should confirm, according to the WHO standard of 2010, that after centrifugation of the ejaculate (3,000 G/15 min.).no spermatozoa were detected.
Possible complications
- Minor soreness in the first few days after surgery and a hematoma (bruise) in the scrotum (scrotum) and penis (member) area, resulting in discoloration; mild scrotal swelling (swelling of the scrotum)
- Bleeding and rebleeding due to injury to blood vessels (rare); as a result, impaired blood flow to the testicle (very rare), which can lead to testicular atrophy (shrinkage of the testicle) or testicular loss (extremely rare)
- Wound healing disorders in the surgical area due to infection; possibly also orchitis and/or epididymitis (inflammation of the testicle and/or epididymis) due to infection.
- Pain in the groin region or testicular pain, which usually recede on their own.
- Due to the positioning on the operating table, it may come to positioning damage (eg, pressure damage to soft tissues or even nerves, with the consequence of sensory disturbances; in rare cases thereby also to paralysis of the affected limb).
- In case of hypersensitivity or allergies (e.g. anesthetics/anesthetics, drugs, etc.), the following symptoms may temporarily occur: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
- Longer-term possible complications and consequences:
- Vasectomy pain syndrome (post-vasectomy pain syndrome/genital neuralgia; up to 5% of patients).
Other notes
- The Health Professionals Follow-Up Study (HPFS) of 49,405 men from health professions showed that vasectomized men had a 10% increased risk of prostate cancer (prostate cancer risk). There was no statistically significant increase in risk for low-grade carcinomas, but the risk for advanced carcinomas was 20% higher and the risk for carcinomas resulting in death was 19% higher than for non-vasectomized men.
- A meta-analysis found only a weak positive association between vasectomy and prostate cancer (relative risk: 1.08; 95% confidence interval between 0.87 and 1.34), which showed no significant difference (p = 0.48).
- Epidemiologists from Denmark, analyzing registry data from more than two million men, found that men with vasectomy had a 15% increased risk of prostate cancer compared with men without; the higher risk persisted for at least 30 years.
- The Cancer Prevention Study II (CPS-II) analysis conducted by the Cancer Society in Atlanta found no increased risk of prostate cancer for vasectomized men (hazard ratio of 1.01 with a narrow 95% confidence interval of 0.93 to 1.10).
- Data from the EPIC study:Men who had a vasectomy showed no increased risk of overall, high-grade, or advanced stages of prostate cancer or death from prostate cancer.The small increase in intermediate-grade prostate cancer risk among men who had a vasectomy may be due to differences in health–monitoring behaviors (more frequent PSA testing).
- Another meta-analysis showed that as the quality of studies increases, the risk of prostate cancer becomes smaller: relative risk 5%, this means for the individual man: 0.6% absolute lifetime risk of prostate cancer (“Number needed to harm”: 156).
