Blog o wazektomii

An answer to a patient’s question from the ABC-zdrowie portal:

It has been 2 years since my vasectomy – is there still a risk of recanalisation?
MALE, 49, ZAMOŚĆ

FULL ANSWER

Yes. But fortunately a very small one.

Depending on the method used, recurrences happen more or less often. 

So-called “recanalisation” does not mean that the two cut and somehow “blocked” ends of the “tubes” – through which sperm normally travel from the “factory” to the “warehouse” – meet again and grow back together. 

The phenomenon is dynamic in nature. 

A man after a vasectomy (usually, though not always) still produces healthy, functional sperm. 

Highly motile and in huge numbers – hundreds of millions. Every normal sperm cell carries so-called acrosomal enzymes (proteolytic = dissolving protein structures) at the “tip” of its head. 

What are these enzymes? What is their role? 

These enzymes can dissolve tissue, so that the sperm can “drill/burn” a hole in the “shell” of the egg cell, the so-called zona pellucida. Once released, these enzymes can also dissolve other tissue structures. That is the first point. 

Secondly, with such an enormous number of sperm, moving freely in every direction and highly motile – if somewhere in some labyrinth there is even the smallest “passage”, some will find the right way through.  

Fortunately, these “destructive” actions of the sperm are met by a counter-response from the body, which “sends in” the “bricklayers” who “patch the holes” and “devour the intruders”. These are immune response processes as well as repair processes. Usually the repair forces prevail over the sperm invasion. However, in men with particularly strong semen, motile sperm may periodically appear in the ejaculate. 

Depending on the method used, recurrences happen more or less often. 

Among the least effective, with a sperm-return rate of up to 13%, are the old methods involving cutting the vas, tying both resulting ends with thread and leaving them in the same space. 

Here it is worth explaining why. 

The vas deferens is a very thick-walled “pipe” with a diameter of 2-4 mm. The lumen of this “pipe” is about 0.3-0.5 mm across. The wall of this “tube” is built of living muscle cells. These cells need a blood supply delivering oxygen and nutrients to survive. If the vas is squeezed tightly with a ligature – to block the passage of sperm through the lumen – the very fine blood vessels supplying the muscle cells of the wall are also clamped. The undernourished cells consequently atrophy. The walls of the tied ends of the vas become thinner, and the once-tied, rigid thread no longer compresses them. The lumen opens up. And if both ends of the cut vas are in the same space – it’s an easy road to the penis and the ejaculate.

Fortunately, these methods are being used less and less. 

According to the American Urological Association’s report, the most effective method is the one with an open testicular end brought outside the sheath, and thermal coagulation of the prostatic segment of the vas.

 

Why titanium clips?

What advantage do titanium clips have over sutures?

First and foremost, they are easier to apply and thus shorten the procedure time.

Titanium clips are widely used in microsurgery and vascular surgery. They have proven their effectiveness and cause no complications. Even several dozen clips can be used in a single surgical procedure without any side effects.

Of course, in our practice nowhere near that many clips are needed to perform an effective vasectomy 🙂

The clips have stood the test of time in vasectomy procedures. Titanium, from which they are made, is a material used for years in dentistry, in general surgery, even in artificial prostheses and artificial heart valves.

Titanium is not a ferromagnetic metal, so it does not “beep” at airport security gates. Nor does it interfere with CT or MRI scans.

A wound with a titanium insert heals more easily than one sutured with thread, and less often becomes inflamed. Using sutures also lengthens the patient’s time on the operating table, which may not be very comfortable for patients with sensitive nerves.

 

If you’re asking yourself whether a vasectomy hurts, I encourage you to read the text below.

“Doctor, does a vasectomy hurt?” is one of the questions patients ask most often. A vasectomy is a microsurgical procedure performed under local anaesthesia – which means it DOES NOT HURT. For anaesthesia we use a device that injects the anaesthetic under pressure – during the anaesthesia itself you already stop responding to stimuli in the intimate area. We do not use a needle, and the anaesthesia itself is a painless process.

During the procedure you may feel the doctor’s touch and manipulations, but you will not feel pain. Many patients feel nothing at all and are surprised when it is all over. If your nerves allow, you can glance at the operated area and watch the procedure’s progress as it happens.

After the procedure, the anaesthetic wears off fairly quickly and your normal sensations return. You may then have a feeling of pressure or pulling in the lower abdomen, but most patients have no negative sensations at all. If you feel uncomfortable and need time to recover, you can sit in an armchair and calmly come round.

If you intend to drive yourself, it is worth having a coffee, and ideally a meal, before the journey. Fortunately there are several nice restaurants near our practice 🙂

For a few days after the vasectomy we recommend taking it easy – no extreme sports, no excessive physical exertion, no lifting heavy objects. Your recovery will then go more smoothly.

And what if I feel pain after the procedure? Don’t worry – you will receive a set of instructions from us explaining what to do in case of pain. Remember, you can always call us with a question or a problem.

Semen cryopreservation – should I freeze my sperm just in case?

Semen cryopreservation is a topic that comes up from time to time among vasectomy patients. Before deciding on the procedure, some patients surely wonder:

What if I change my mind in the future and one day want children after all?

What if my partner, who doesn’t want children now, feels the need for offspring in the future?

The decision to freeze semen plays an important role in the decision-making process about the procedure itself. If you are wondering about this yourself, read these few facts:

Fact no. 1: Cryopreservation provides semen with about 50% less value compared to fresh semen. This is because, to make the sperm suitable for freezing, they must first be chemically “dried”, which kills some of them. The freezing itself also reduces their viability.

Fact no. 2: A vasectomy does not make you sterile – only infertile. The difference is that you still produce fully viable sperm capable of fertilisation. In the future, if you decide to have children, you will be able to have fresh sperm retrieved directly from the epididymis. They can be used in assisted reproduction. And you will still have your vasectomy.

Fact no. 3: If you and your partner do want to conceive a child naturally, it is possible to undergo a reversal operation and restore the patency of your vas deferens. However, firstly, the effectiveness of a reversal depends on many factors. One of them is the time elapsed since the procedure. Secondly, after a successful reversal and conceiving a child, you will have to return to the old methods of contraception.

If you have no children at all, consider whether you should freeze your semen in case you change your mind in the future. If you are unsure whether you might still want children, also consider banking your semen.

Discuss the matter with your family. Don’t be afraid to talk about it with your father, even if you are a mature man yourself. And don’t fear criticism – the people you choose to talk to certainly have your best interests at heart, and their opinions are worth hearing.

Vasectomy does not increase the risk of prostate cancer

Does vasectomy really not increase the risk of prostate cancer? Despite numerous studies, no link has been documented so far between vasectomy and an increased risk of prostate cancer. Vasectomy also does not increase the risk of heart disease or immune system disorders in men.

What it certainly does increase is a man’s attentiveness to his own health. As a result, in situations that look suspicious, he ends up in front of a doctor sooner. Because men after a vasectomy take better care of their health, they have preventive check-ups more often.

Consequently, more diseases are detected in them. Often at an earlier stage than in patients who do not like visiting doctors. More of their diseases are also treated successfully, because the sooner a disease is diagnosed and the sooner treatment begins, the lower the toll on the patient’s body and the easier the recovery.

Prostate cancer is, alongside lung cancer, the most frequently detected cancer in men, accounting for around 13% of all male cancer cases. That does not, however, make it the biggest killer – it is much easier to die with prostate cancer than of prostate cancer, because by its nature it is not a particularly aggressive cancer: only 16% of men with prostate cancer die because of it, and cure statistics improve for patients every year thanks to the introduction of new, more effective treatments. Of course, once detected, the cancer must be monitored continuously, not left to itself.

So what is all the fuss about? Over a decade ago, results of studies were published in the United Kingdom on the level of T* (an androgen, the male sex hormone) in men after vasectomy, which suggested that in some men the level of this hormone rises slightly after a vasectomy.

At the time, a higher T level  was cited as one of the risk factors for developing prostate cancer. However, none of the subsequent studies confirmed this hypothesis.

* The initial of the name of the well-known androgenic hormone, produced in every healthy human – including women – is used here rather than the full name,  because Google’s robots, and the Polish employees of that company, seem to think this text encourages the purchase of a drug by that name.