Vasectomy

13 years of experience

over 11,000 vasectomy procedures performed personally

---

Good morning,

I have specialised in contraception for 33 years, and for the last 15 years I have been continuously developing my practice in andrology (the science of male fertility and sexuality). Since 2013, a particular focus of my clinical work has been vasectomy procedures, of which I have personally performed over 11,000.

Since 1992 I have had the honour of serving patients in private medical practice. Over more than three decades I have provided over 35,000 paid consultations and procedures, which reflects the trust of
over 26,000 patients who voluntarily chose my care despite the availability of free alternatives.

Wazektomia ZdrOva is a highly specialised andrology and gynaecology practice.
At the ZdrOva practice, Dr Robert Kulik has specialised in performing microsurgical vasectomy procedures since 2013.

Vasectomy is a surgical, reversible method of contraception for men. This minimally invasive, roughly fifteen-minute procedure – no needle, no scalpel, performed through a keyhole in the “Canadian” variant – blocks the vas deferens, the tubes through which sperm normally travel from the testicles, where they are produced, to the penis. The procedure is performed under local anaesthesia using an operating microscope or very powerful surgical loupes.

 

Vasectomy effectiveness

It is one of the most effective methods of contraception. The effectiveness of vasectomy is higher than the average effectiveness of all methods of blocking the fallopian tubes in women. The procedure is performed under needle-free local anaesthesia and usually takes about fifteen minutes. Most everyday activities can be resumed the day after the procedure.

Permanence of vasectomy

Vasectomy is a permanent method of contraception (so-called sterilisation), unless the man who has undergone it makes costly efforts to restore fertility through a vasectomy reversal (an operation to reconnect the vas deferens) or in vitro fertilisation (IVF).

Vasectomy – who is it for?

Vasectomy is most suitable for a man who is certain that he will not want more children. Men considering this method of contraception should bear in mind that a possible operation to restore the patency of the vas deferens (vasectomy reversal, vasovasostomy, vasoepididymostomy) or even in vitro fertilisation (IVF) does not always succeed. Similarly, a woman using a so-called IUD has no guarantee of regaining the ability to become pregnant after its removal from the uterus. That is why both vasectomy and the “coil” are addressed mainly to women and men who already have children. Another group of men, rare in the modern world, for whom vasectomy makes sense are adult men who often have casual, unprotected encounters with previously unknown partners – under the influence of substances that impair judgement. Men who find themselves in such situations should consider taking responsibility for the uncertain fate of an accidentally conceived child, a desperate pregnant woman, often a single mother, and their own life burdened with responsibility until its end.

Vasectomy – who benefits

The man, the woman and their children all benefit. Sex without worry is better. Just as pure honey is better than honey with a drop of tar in it. As research shows, sex after vasectomy improves. One of the advantages of vasectomy is that it is a modern (fairly new in Poland) method of contraception that protects women from the adverse effects of long-term hormonal contraception, which is very often associated with reduced libido, outbursts of anger and depressive moods. Long-term hormone use increases the risk of developing cancer. Vasectomy can free women from the need to use other contraceptive methods, such as the intrauterine device (coil), when these cause various complications. Condoms are also not always well tolerated.

Does the vasectomy method matter?

Occluding the vas deferens is done around the world using various combinations of techniques. One end or both ends are closed by tying with sutures (a fairly unreliable method), clamping with clips (a somewhat better method but also fairly unreliable), excising a fragment of the vas, closing with electrocautery, leaving the ends inside or outside the spermatic cord. Different variants are used by different doctors even in the same city. Older methods are commonly used even in countries where vasectomy is very popular. To be fair, all these methods are very effective as contraception; it is only with the older variants that the procedure more often needs to be redone and various kinds of usually transient discomfort occur more frequently.

Vasectomy – the so-called “Canadian method”

At ZdrOva in Warsaw and Katowice we perform no-scalpel vasectomy in the so-called Canadian variant:

1. no scalpel (a 4-8 mm opening in the skin is made with special dissecting forceps invented by Dr Li Shunqiang)
2. no needle
3. It is a minimally invasive method. Its so-called “Canadian” variant, described by a centre in Quebec, is the one we use. This method has:
   • the lowest complication rate and
   • the highest effectiveness, which is why it has been recommended by the American Urological Association.

This variant consists of:

1. not placing sutures or clips on the vas deferens itself – only cauterising (thermally sealing) the end leading to the penis. This ensures very high effectiveness, measured by the percentage of procedures that need to be repeated due to the presence of sperm, and
2. bringing the testicular end of the vas outside the sheath of the spermatic cord and leaving it open. This ensures that so-called “chronic testicular pain” almost never occurs:
   • because the sperm being produced have an outlet and
   • they escape into an area where no nerves run (many nerve fibres run in the cord alongside the vas deferens and blood vessels). There they are absorbed, just like all dying and unneeded cells in the body.
3. the opening in the sheath of the spermatic cord, which contains the testicle and through which the vas deferens runs, is closed with a special clip or suture.

This variant is listed first among three others in the Guideline Statements, point 7. The full document can be downloaded as a PDF in English.

Which vasectomy method is best?

Vasectomy effectiveness depends on the method used. The American Urological Association analysed all available scientific publications printed between 1949 and 2011. Around 70 scientists reviewed the results of several thousand papers. It turned out that the conflicting reports on the effectiveness and various complications of vasectomy stem mainly from the method used to perform the procedure. The oldest methods, involving cutting and tying both ends of the vas deferens, carry the highest failure rates. In some centres, the need to redo the procedure due to the persistent presence of sperm in the ejaculate reached 13%. Of course, the pregnancy rate with these methods still remains very low. Such centres simply tend to perform a free “touch-up” when the post-operative semen analysis shows the procedure was ineffective. The American Urological Association recommends the open-ended method, with the open testicular end brought outside the sheath of the spermatic cord (FI, fascial interposition) and cauterisation of the segment leading to the penis (thermal cautery).

Needle-free anaesthesia

For anaesthesia during vasectomy in Warsaw (as well as in Katowice), a special device is used that injects the anaesthetic without the need for a needle. That is why vasectomy is a painless procedure. The sensation accompanying the administration of the anaesthetic resembles the “snap of a rubber band”. Unlike anaesthetic given with a regular needle, this anaesthesia works immediately (there is no need to wait for the drug to spread through the surrounding tissue). Many patients describe the discomfort during the procedure as far less unpleasant than a visit to the dentist. Men who are afraid of vasectomy should watch these videos:

Is vasectomy the same as castration?

Of course not! Castration is a procedure involving the removal of the male gonads (testicles). It leads to many serious changes in the person who undergoes it. In the past it was performed on boys who were to guard a harem or sing in the opera. Such practices no longer exist in the modern civilised world. Only in the case of testicular cancer is amputation of a testicle necessary. If one testicle is left in place, the man remains fertile and continues to produce androgens. Only in the case of tumours on both sides is amputation of both testicles necessary, and that could be called castration. In such cases other glands (the adrenal glands) take over the production of male sex hormones.

Incorrect or imprecise names for vasectomy

There are many incorrect and misleading names for the vasectomy procedure.

Our locations

We perform vasectomies in Warsaw and Katowice

Vasectomy in Warsaw

In Warsaw the ZdrOva practice is located at ul. Floriańska 6, unit U-4. Address:  ul. Floriańska 6, lokal U-4, 03-707 Warszawa, phone: +48 607 776 777

HOW TO FIND US

The building at Floriańska 6 is so large that one big wall faces Floriańska Street, from which it takes its postal address. Its other, even bigger wall faces Jagiellońska Street.

Our clinic is on the Jagiellońska Street side.

The entrance is directly from the pavement.

It is best to enter the address 03-707 Warszawa, ul. Jagiellońska 32 into your GPS. That building is directly opposite the entrance to ZdrOva.

Vasectomy in Katowice

In Katowice the ZdrOva practice operates within the NL-Clinic at ul. Obroki 68. Address: ul. Obroki 68, 40-833 Katowice, phone: +48 607 776 777

Directions map:

Book your vasectomy