No scalpel open-ended technique reduces vasectomy side effects

Ben Falkenmire

writer

Ben Falkenmire

Writer

Ben Falkenmire

More men are getting the snip, but misconceptions hang around

Nearly 34,000 vasectomies were performed in Australia in 2021 according to Medicare data, compared to 22,000 in 2011.

Some GPs might not be aware that most vasectomies are now performed using a no scalpel open ended surgery technique that has reduced side effects, says National Director of MSI Australia Dr Justin Low.

There are no official figures on the breakdown of No Scalpel Open Ended vs Traditional technique as the item number is the same, but Dr Low estimates that about three-quarters of procedures are now done using the newer technique.

A 2014 Cochrane Review found the no scalpel technique led to less bleeding, infection and pain during and after the procedure.

With the no scalpel technique, a small puncture in the scrotum is made to access the vas deferens using specially designed forceps, instead of making two incisions.

“When we cut the vas we don’t tie off both ends like they used to. On the prostatic end, we trap the vas within its own fascial tissue and seal it with a permanent suture,” Dr Low says.

“We leave the testicular end of the vas open to allow sperm to escape, so it doesn’t create back pressure on the epididymis. This reduces the chance of post vasectomy pain syndrome, which can be one of the more concerning side effects of the operation.”

“There are variations on how to do it, but the principle is the same: leaving the testicular end open to reduce back pressure,” Dr Low says.

As for the recent rise in vasectomies overall, Dr Low says part of it is due to people playing catch up after covid lockdowns and hospital closures.

“It may be that covid has also solidified men’s and couple’s thoughts on not having any further children or in fact not having children at all, which is reflected in the increased presentation of childless men looking for vasectomy,” he says.

Yet he says misconceptions about vasectomies remain.

Concerns around post-surgery sexual dysfunction still get medical researchers’ attention. In his experience having performing over 8,000 vasectomies, Dr Low says it is extremely rare for patients to experience temporary or long term sexual dysfunction or pain after sex.

“Studies out of Stanford and Frankfurt showed that sexual frequency and sexual enjoyment is actually higher because patients are less anxious,” he says.

Another ‘extremely rare’ consequence of the operation is a person feeling depressed about losing their sense of manhood.

In the unlikely event that does occur, Dr Low says it requires “counselling and support, and a last resort option is a vasectomy reversal.”

Globally, approximately 3-6% of men opt for a reversal. Reversals performed within 3 years of surgery have an 84% success rate. If it’s been more than 15 years, the success rate falls to 44%.

Dr Low says GPs should warn patients that out-of-pocket costs for a vasectomy can vary greatly, from no gap to thousands of dollars, and it’s worthwhile shopping around.

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Ben Falkenmire

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