vasectomy

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Position of the spermatic duct

Vasectomy , in professional circles also Vasoresektion called hereafter meaning the removal of vessels or vessel parts from the body. Mostly, however, it is a surgical procedure to sterilize the man. The operation is used for contraception . Here, the in be spermatic cord located vas deferens ( vas deferens ) in the region of the scrotum above the epididymis cut through the man.

frequency

In Germany, 3% of all 20 to 44 year old men who are capable of giving consent have been vasectomized. Worldwide it is less than 3% of men. The front runners are Canada with 22%, Great Britain with 19%, Korea with 17%, Australia and New Zealand with 15% and the USA with just under 10%.

Implementation and consequences

Cut wound on the scrotum after a vasectomy

The operation is usually performed on an outpatient basis under local anesthesia . The doctor exposes the vas deferens with a central incision or with a total of two small incisions on the scrotum and removes a 1 to 3 cm long piece of the vas deferens . These are then in the field of interfaces obliterated or folded and a non-resorbable thread ligated (Ligaturtechnik) or a titanium clamp disconnected.

In the USA, vasectomy after condoms , oral contraceptives (“ birth control pills ”) and tube sterilization is the fourth most common method of contraception in women. Compared to tube sterilization for women, which is another widely used method of permanent contraception, vasectomy is just as safe, has significantly fewer complications and is significantly cheaper. The American Urological Association therefore recommends in its current guidelines that vasectomy should be used much more frequently for permanent birth control. In addition, the use of the so-called no-scalpel vasectomy is recommended. In the no-scalpel vasectomy, only a small skin opening (<10 mm) is made, the exposure of the vas deferens is then carried out minimally invasively with special instruments (special ring clamp and special sharpened dissection clamp). No-scalpel vasectomy significantly reduces the risk of pain during and after the operation, as well as the risk of bleeding or infection.

The hormone production in the testicles is maintained and the erectile function of the penis is not affected. Since the sperm that are still produced in the testes can no longer be removed after the vas deferens have been cut, they are reabsorbed by the body . The ejaculate of a sterilized man no longer contains any sperm, otherwise it is largely unchanged in terms of volume, appearance, smell and taste. Only the consistency of the ejaculate is a little more watery and less jelly-like after a vasectomy.

safety

The Pearl Index for a vasectomy is 0.1. This means that over the course of a year, 1 in 1,000 couples having sexual intercourse will develop an unwanted pregnancy. In comparison, the condom has a Pearl index between 2 and 15. The vasectomy is therefore statistically considered to be one of the safest and most permanent contraceptive methods of all. Since sperm can remain in the seminal fluid for up to twelve weeks after the vasectomy, it is common to examine the ejaculate for seminal filaments after four, eight and twelve weeks, for example .

In rare cases (<0.1%), spontaneous recanalization can lead to unwanted renewed patency of the vas deferens, even if the operation is carried out properly. In order to rule out such recanalization, the ejaculate is examined again after one year. The probability of this is given as 1: 2000.

Sexuality after the procedure

Most couples describe sexuality as better and more intense after a vasectomy. Disturbing thoughts of fear of an unwanted pregnancy are no longer given. The man's potency and his sensation of pleasure do not change because the testes continue to produce male hormones in the same amount. The feeling during ejaculation changes only slightly, as most of the fluid for the ejaculate is formed in the prostate and in the vesicle gland, these glands are well above the transection site and continue to perform their function. According to a study by the Vasectomy Center Frankfurt (Urogate), vasectomized men in relationships with female partners ( heterosexuality ) were more satisfied with their sex life and experienced orgasms more often than the men in the control group. No difference in sexual satisfaction could be found for the affected partners.

Complications

Surgical scar and bruise after vasovasostomy

The information on the frequency of complications varies in the specialist literature and depends on the surgical technique used, any previous illnesses or previous surgical interventions (e.g. orchidopexy ) and probably also on the experience and frequency of operations of the performing doctor. Overall, complications are rarely described. The most common occurrences are bruises (0.9%) and infections (up to 1.5%). A review article covering the period from 1964 to 1998 shows a rate of early complications such as hematoma, infection, sperm granuloma , epididymitis and post-vasectomy syndrome in 1 to 6% of cases.

Pain is recorded in the examination by David Sokal. Almost 5% of the men reported moderate to severe pain during the procedure, slight pain was described in up to 35% and is observed somewhat less often with the non-scalpel method, which has been known for several years. Depending on the method, 60–67% of men report no pain. Post-vasectomy pain syndrome is the term used to describe permanent pain in the epididymis that can occur after the vasectomy. Exactly how often such complaints occur is very controversial. In the European specialist literature, in the information of large international family planning organizations and also by the German Society for Urology, this complication is only mentioned very rarely or not at all, although the Federal Center for Health Education mentions an occurrence of 1–14%. In the Anglo-American literature, the pain syndrome is described in 2 to 8% of cases. The cause of this pain is unclear. Increased pressure in the epididymis or nerve irritation are discussed.

The failure rate of the vasectomy is given as 0 to 2%. Most studies found a failure rate of less than 1%. Very rarely, after months or years, the vas deferens can open with subsequent pregnancy, the frequency is given as 1 in 2,000.

Refertilization surgery after vasectomy

Reverse surgery ( re-fertility surgery , also known as a vasovasostomy) , which 5 to 7% of patients strive for, has very high success rates if the operation is performed by an experienced microsurgeon. There are many reasons for a vasovasostomy , but the most common reason is a new partnership. Patency rates are over 95% if the vasectomy was less than five years ago. The pregnancy rate is then over 65%. An important factor influencing the pregnancy rate is the fertility of the partner, here age plays the most important role. If the vasectomy was performed a long time ago, the chances of success of the refertilization surgery decrease slightly. But even after more than 15 years there are still patency rates of more than 80% and pregnancy rates of approx. 50%.

Alternatively, there is the option of assisted fertilization ("artificial insemination") using ICSI (= Intracytoplasmic Sperm Injection ) after the surgical extraction of sperm, e.g. B. by testicular sperm extraction (TESE) or by percutaneous epididymis sperm aspiration (PESA). However, the cumulative pregnancy rates after re-fertilization surgery are on average higher than with artificial insemination. Refertilization is cheaper and more physiological because it restores the man's natural fertility. The stress on the partner associated with artificial insemination is eliminated. Vasovasostomy (microsurgical readaptation of the severed spermatic duct) or, if necessary, tubulovasostomy (microsurgical suturing of the spermatic duct to the epididymal canal) are used for refertilization. The surgeon decides intraoperatively which surgical technique is necessary. If no sperm emerge from the seminal duct near the testicle after exposure, a vasovasostomy does not make sense. The place in the epididymal canal where sperm is present is sought. Then the connection of the epididymal canal and the prostate-side vas deferens takes place ("tubulovasostomy"). A vasovasostomy is a microsurgical procedure that requires a high degree of precision and an absolute rest position of the patient. Therefore, the procedure is performed under general anesthesia.

costs

This article or paragraph presents the situation in Germany . Help us to describe the situation in other countries.

The statutory health insurances in Germany regard a vasectomy as "part of personal life planning" and since January 1, 2004 have generally no longer covered the costs. They only provide for exceptions in medically justified cases. The private costs to be borne amount to approx. 400–500 euros including two spermiograms and a pathological spermatic duct examination. The costs of a vasovasostomy , i.e. the restoration of fertility, are also to be borne privately and are around 3,000 euros. Due to the surgeon's specialization, the necessary general anesthesia and the complicated surgical technique, the costs for a restoration are significantly higher.

Demarcation

The vasectomy must be strictly separated from the castration .

See also

Wiktionary: vasectomy  - explanations of meanings, word origins, synonyms, translations

Web links

Individual evidence

  1. ↑ Federal Center for Health Education: Contraceptive behavior of adults: Results of the representative survey of 20 to 44 year olds 2007. sexualaufklaerung.de .
  2. ^ A b World contraceptive use 2011. UN Department of Economic and Social Affairs.
  3. ↑ ID Sharlip, AM Belker, p honey include: Vasectomy: AUA guideline. In: The Journal of Urology . December 2012, Volume 188, Supplement 6, pp. 2482-2491, doi: 10.1016 / j.juro.2012.09.080 .
  4. ↑ Willard Cates, Elizabeth Raymond: Vaginal Barriers and Spermicides . In: Robert A. Hatcher et al. (Ed.): Contraceptive Technology . 19th edition. Ardent Media, New York 2008, ISBN 978-1-59708-001-9 .
  5. ↑ Patient Brochure Vasectomy Professional Association of German Urologists V.
  6. ↑ a b vasectomy / sterilization men - spermiogram and follow-up care - vasektomie.de. In: www.vasektomie.de. Retrieved October 21, 2016 .
  7. ↑ International Planned Parenthood Federation (IPPF): International Medical Advisory Panel (IMAP) Statement on voluntary surgical sterilization. In: IPPF Medical Bulletin. 2009, Volume 43, No. 4, pp. 1-3.
  8. ↑ Focus health: vasectomy
  9. ↑ Tobias Engl, Sarah Hallmen, Wolf-D. Beecken et al .: Impact of vasectomy on the sexual satisfaction of couples: experience from a specialized clinic. In: Central European Journal of Urology. (Cent European J Urol.) June 2017, Volume 70, No. 3, pp. 275-279, doi: 10.5173 / ceju.2017.1294 .
  10. ↑ a b W.-H. Weiske: Vasectomy, current status. In: Journal of Reproductive Medicine and Endocrinology. 2004, Volume 1, No. 3, pp. 222–227 ( full text as PDF file ).
  11. ^ T. Philp, J. Guillebaud, D. Budd: Complications of vasectomy review of 16,000 patients. In: British Journal of Urology . December 1984, Vol. 56, No. 6, pp. 745-748. PMID 6534499 .
  12. ^ PJ Schwingl, HA Guess: Safety and effektiveness of vasectomy. In: Fertility and sterility . May 2000, Vol. 73, No. 5, pp. 923-936. PMID 10785217 .
  13. ↑ D. Sokal, S. McMullen et al .: A comparative study of the no scalpel and standard incision approaches to vasectomy in 5 countries. The Male Sterilization Investigator Team. In: Journal of Urology. November 1999, Vol. 162, No. 5, pp. 1621-1625. PMID 10524882 .
  14. ^ Pro familia: Family planning circular. August 2011, No. 2, pp. 6-7 ( PDF file ).
  15. ↑ Federal Center for Health Education: Vasectomy: The sterilization of the man. Retrieved February 13, 2018 .
  16. ↑ International Planned Parenthood Federation (IPPF): IMAP Statement on voluntary surgical sterilization. In: IPPF Medical Bulletin. 2009, Volume 43, No. 4, pp. 1-3.
  17. ↑ JU Schwarzer: Vasectomy reversal using a microsurgical three-layer technique: one surgeon's experience over 18 years with 1300 patients. In: International journal of andrology. (Int J Androl) October 2012, Volume 35, No. 5, pp. 706-13, doi: 10.1111 / j.1365-2605.2012.01270.x .
  18. ^ Fertility treatment after sterilization of the man | Nordfertility Clinic. In: www.nordfertility.com. Retrieved December 9, 2016 .
  19. ^ JU Schwarzer, H. Steinfatt: Current status of vasectomy reversal. In: Nature reviews. Urology . (Nat Rev Urol) April 2013, Volume 10, No. 4, pp. 195-205, doi: 10.1038 / nrurol.2013.14 .
  20. ↑ Interview on vasovasostomy (refertilization or refertilization). Interview with Stephan Neubauer at: urologie.klinik-am-ring.de ; Retrieved May 26, 2014.