No-scalpel vasectomy and vasectomy reversal
Vasectomy is the surgical technique used for male contraception. It consists of securing the deferent ducts to prevent the spermatozoa produced in the testicle from being expelled with ejaculation. To increase the rate of success several maneuvers are used, apart from the section itself, such as the internal electrocoagulation of the ends of the ducts and the use of fascial interposition.
Conventionally, for performing a vasectomy, two incisions with a scalpel were made, one in each duct. Currently, the vast majority of urologists and andrologist use a single incision to locate and sever the two ducts.
No-scalpel Vasectomy was developed in 1974 by Dr. Li Shuinquiang and later introduced in Western medicine by Marc Goldstein in 1985. It is a safe, efficient, much faster (50%) and minimally invasive technique, because it does not need a scalpel or stitches and significantly reduces complications when compared to conventional vasectomy (from 3,1% to 0.4%). A no-scalpel vasectomy wound heals spontaneously within 72 hours after surgery.
Vasovasostomy is the surgical technique used to undo a vasectomy. That is, the two ends of the deferent ducts severed during the vasectomy are connected again.
It is a technically complex intervention that requires an expert andrologist in microsurgery to optimize the results of repermeabilization. A surgical microscope and specific microsurgery material are required. It can be performed by local or epidural anesthesia; the patient can go home on the same day after the surgery is performed.
The success of the surgery depends on several factors:
- Time that has elapsed from vasectomy: The success rate is inversely proportional to the time that has elapsed since the vasectomy. Thus, in those patients that underwent on a vasectomy under a 5-year interval the repermeabilization rate has reached 98%, falling to 35% in those who were operated beyond a 15-year interval ends.
- Granuloma: The presence of granuloma in at least one of the two extremes of the ducts is a factor of good prognosis for the recovery of fertility. The presence or absence of this granuloma can be detected through examination during the consultation.
- Surgical technique and surgeon’s experience: Vasovasostomy is recognized as one of the technically most complex and challenging uro-andrological surgeries due to the mastery it requires in specific domain such as surgical and reconstructive surgery. So, it requires a surgeon with skill, ability, patience and long experience in vasovasostomy to optimize the desired result: the recovery of fertility.