July 14, 2022 Author : Vitor Oliveira A vasectomy prevents sperm from being included in the ejaculate and thus makes pregnancy impossible. Sperm are produced in the testes and stored in the epididymis; In addition to the testes, the prostate and seminal vesicles also produce semen components and these represent about 96% of the ejaculate volume; At the time of ejaculation, sperm and other semen components are transported through the vas deferens to the urethra; In a vasectomy the vas deferens are cut and sealed so that only the sperm, which are responsible for conception, are no longer part of the ejaculate. A vasectomy is a safe, permanent, effective male contraceptive method that: Prevents pregnancy with a very high success rate, of around 99% , making it unnecessary to use other contraceptive methods. Does not protect against sexually transmitted infections . For this purpose, barrier methods such as condoms should be used. Although it can be successfully reversed, vasectomy is considered a definitive contraceptive method, which should only be considered when man is sure that he does not want to have biological children . Vasectomy and vasectomy reversal are surgeries performed by urologists . How is a vasectomy performed? Vasectomy is a simple surgery, which i n most cases is performed on an outpatient basis and under local anesthesia. It can be performed by several techniques, the most common has the following main steps: After local anesthesia, a small incision is made in the upper region of the scrotum of one of the testicles; The vas deferens is identified, isolated and exposed (pulled out); It is then sectioned, the two free ends are sealed and put back inside the scrotum; The skin incision is closed with stitches; The same procedure is performed on the opposite side. After surgery it is common to experience some pain or local swelling after surgery. These usually resolve during the rest period of a few days that is advised after having a vasectomy. Other rarer side effects and complications may occur, but vasectomy is a generally well tolerated procedure . Vasectomy results After a vasectomy, the intended sterility effect is not immediate : It takes several months and several ejaculations so that the semen no longer has sperm; In the postoperative medical follow-up, spermograms (semen analysis) are performed to quantify the sperm present and determine the success of the vasectomy. The vasectomy: Does not affect sexual performance , nor induces noticeable changes in the volume of the ejaculate, nor causes damage to the genital organs, nor increases the risk of other diseases; It is a simpler surgery than the equivalent female surgery – tubal ligation – and has also fewer potential complications, a faster recovery and is less expensive. Despite this, tubal ligation is five times more frequent. How is a vasectomy reversed? Despite vasectomy is a definitive method of contraception it is well known that some men (2%-6%) want to reverse it. The most common reason they give is the desire to have children, related to family changes, for example a new partner. More rarely, it may be necessary to reverse a vasectomy to solve any chronic complications related to this previous surgery. The same procedure can still be used when there is an undesired obstruction of the vas deferens by any other cause. Vasectomy reversal is performed by microsurgery (surgery using an optical microscope), on an outpatient basis, under locoregional (spinal anesthesia) or general anesthesia, or in an inpatient setting. Through a small bilateral incision, at the same location as the vasectomy incision, a vasovasostomy is performed. The ends of the previously sectioned vas deferens are recanalized and their permeability restored. The incision is closed with stitches. Vasectomy reversal results Vasectomy reversal is a safe procedure with a success rate concerning recanalization and vas deferens patency of 90%-95% . This rate is lower the longer the time period since the vasectomy was performed and is also related to age and the vasectomy technique used. In a group of 44 Portuguese men, aged around 42 who underwent a vasectomy reversal: The recanalization and permeability rate was almost 100% at six months after the intervention; The spontaneous natural pregnancy rate was 50%. The possibility of reversing a vasectomy and later achieving a natural spontaneous pregnancy eliminates the need to resort to medically assisted reproduction techniques to have biological children. Sources Araújo D, Oliveira V, Amorim, R Satisfação e segurança da reversão microcirúrgica na obstrução do canal deferente. XVI Congresso Nacional da Sociedade Portuguesa de Andrologia, Évora, 2022. Belker AM, Thomas AJ Jr, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the vasovasostomy study group . J Urol 1991;145:505-11. Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. European Association of Urology guidelines on vasectomy . Eur Urol 2012;61:159-63. Oliveira V, Amorim R, Espiridão P, Dias J, Xambre L, Ferraz L. Vasovasostomia microcirúrgica: a nossa experiência. Acta Urológica Portuguesa 2015;43:118-22. Meet the urology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
