FAQ – Clinical | No-Scalpel Vasectomy

Image of Dr M Kittel, No-scalpel vasectomy surgeon

Dr Kittel, Lead Surgeon

Why do I want a No-scalpel Vasectomy rather than a conventional one?

  • Less discomfort
  • No stitches
  • Faster procedure
  • Faster recovery
  • Only one small opening of the skin (keyhole procedure)
  • Less chance of bleeding and other complications
  • Just as effective

What is Different about a No-Scalpel Vasectomy?

No-Scalpel Vasectomy is different from a conventional vasectomy because of the way the doctor gets to the tubes and interrupts them. In a conventional vasectomy the doctor makes one or two small cuts in the skin and lifts out each tube in turn, cutting them and tying a stich around each end of each tube so the sperm cannot reach the semen. Then the doctor stitches the cuts closed.

In a No-Scalpel Vasectomy the doctor feels for the tubes under the skin and holds them in place with a small clamp. Instead of making two incisions, the doctor creates one tiny opening with a special instrument. The surgeon then cauterises and interrupts the vas using new and advanced techniques through hyfrecator equipment.

The procedure is “open ended” resulting in significantly reduced discomfort following the procedure. Patients tend to bleed very little with the No-Scalpel technique. To close the tiny opening we do not use stitches because it heals quickly, with no scar. A Chinese surgeon called Li invented No-Scalpel Vasectomy in the 70ies. It came to the US in the 90ies. Since then it is continuing to spread all over the world.

For details about Dr Kittels vasectomy method (a vasectomy datasheet) and reasons why he uses his specific method click here

Is No-Scalpel Vasectomy Safe?

No Scalpel Vasectomy in general is safe and simple. No Scalpel Vasectomy is an operation, and all surgery has some risks, such as bleeding, bruising, and infection. But serious problems usually do not happen and are much reduced with this method.

Does No-Scalpel Vasectomy Work?

No-scalpel vasectomy works very well. Because of its safety profile failure rates are the lower than with some other methods. There is a less than 1% chance of failure. And remember, even a failure can be sorted out.

 

What is a vasectomy failure?

Failure means, that following a procedure and a sufficient time gap allowing for all sperm to die you still have life sperm in your semen. The chances are usually around 1:200, but my own figures are better than this, more like 1:500. Once you have been cleared the chance of a failure afterwards however is remote. This rare occurrence is fittingly called “late failure” and textbooks estimate it as 1:2000. I am not aware of any in all the years I have been practicing (and I tell every patient to contact me).

Failure can happen due to different reasons. Provided the surgeon is experienced it is usually due to so called “spontaneous re-canalisation” of the vas. This means the “tubes” grow together again following a procedure. If a failure happens your semen sample will not be negative, but contain life sperm. A repeat procedure would be required. Occassionally chance of failure can be higher due to previous surgery or injuries and the resulting scarring in a patients scrotum.

Do I need my GP to refer me?

No. Just call us and make an appointment (unless you qualify for NHS treatment in which case you have to ask your GP to refer you)

How long will the No-scalpel Vasectomy Procedure take?

Not long. The consultation in our service is now done in form of a webinar, a new change since COVID that has been very much welcomed by patients, so you only have to attend once. The procedure takes anywhere betweem 5 and 30 minutes depending on surgeon and difficulty (the very large majority of vasectomies are very straightforward). However, including the setting up and the aftercare instruction as well as recovery you should probably calculate 1 hour at the clinic. You should bring somebody with you to drive you home.

Will it hurt?

You may be nervous before the vasectomy. Some patients request a pre-medication you can take an hour before the procedure to relax you, but in latter years I have shied away more and more of pre-medication. Why 1) it frequently doesn’t work when a patient is very nervous 2) I am myself confident in managing anxious patients and 3) there is often a considerable “hangover” from tranquilizers.

Most patients decide they do not need a sedation because once they have met me at the webinar they feel more confident and comfortable. You will feel some minor discomfort when we inject the local anaesthetic into the skin with a very small Botox type needle. Beware of so called “no-needle anaesthesia”, because it often does NOT work properly and while it avoids the needle there are a lot of disadvantages to it. For example It is very loud, like an explosion of air on the skin. It only penetrates into the skin by micrometres and therefore does not anaestetise the vas (tube we need to work on). It is also very unhygienic because the same instrument (not the same needle) is used on every patient.

You should not feel any discomfort after anaesthetic has taken effect. Occasionally a patient may require additional local anaesthetic during the operation. Afterwards you may experience some discomfort, but normal “over the counter” painkillers are usually all it needs to alleviate any possible discomfort and an ice bag is indispensable!

After-effects are usually much less with the no-scalpel technique, because there are fewer injuries to the tissues and many patients do have virtually no discomfort at all. There are also no stitches to be removed after the procedure (as the small single incision does not need suturing). You will be supplied with a complete set of instructions about what to do after surgery.

Can I drive home after No-Scalpel Vasectomy?

We prefer you to be driven by somebody. If you have to drive home, let us know. We can use a short acting local anaesthetic, which only does not let you drive for 2 hrs, but you have to warn us before the procedure and your pain levels once it wears off may be increased. There are 2 reasons why you may wish not to drive. 1) The constant use of clutch, break and gas may increase the chance of bleeding and in some cases 2) in case of a car accident the insurance could be invalidated if you let them know you had a vasectomy with local anaesthetic.

As you should rest, initially, we would hope you can keep your car journey as short as possible. We definitely recommend an ice-bag in the car for journeys longer than 20-30 minutes. The initial period after surgery is crucial for a recovery with little or no side effects. If you have to drive yourself ensure you are driving an automatic car because you don’t have to do so much gear shifting. Also, as said before, ideally drive no more than a short distance because this will reduce vibration and rubbing of your scrotum right after surgery.

Can I fly home after surgery?

While flying itself is not a problem, airports are usually stressful. We therefore, and for other reasons, advise to book the flight back no earlier than 2 working days after your vasectomy. For example if you have a vasectomy on Wednesday, its a Friday and if its on a Friday it would be a Tuesday (so I could theoretically review you on Monday in case of a problem). After vasectomy, you should preferrably lie down, be reclined or at least rest sitting after surgery for 6 hours to minimise circulation and the possibility of side effects. For 48 hours you should do pretty little. You should not stand in an airport for hours or handle heavy luggage. Please refer also to the section designed for international customers.

How soon can I get back to work?

We advise to relax for 48 hours following your vasectomy and not to do any heavy physical labour for about a week. Otherwise you are free to return when you wish to.

Will vasectomy change me sexually?

The only thing that will change is that you will not be able to make your partner pregnant. Your body will continue to produce the hormones that make you a man. You will have the same amount of semen. Vasectomy won’t change your beard, your muscles, your sex drive, your erections, or your climaxes. Some men say that without the worry of accidental pregnancy and the bother of other birth control methods, sex is more relaxed and enjoyable than before.

Will I Be Sterile Right Away?

No. After a vasectomy, there are always some active sperm left in your system. It takes at least 30 ejaculations to clear them. New guidance also tells us, that the vas deferens can re-canalise for at least 20 weeks. You and your partner should use some other form of birth control until your semen has been tested and we write to you it is free of sperm.

When Can I Start Having Sex Again?

As soon as you are comfortable, a week is probably a good guidance, but remember to use some other kind of contraception until we let you know you are sterile.

Does No-Scalpel Vasectomy Cause Any Medical Problems?

Most medical experts, including special panels convened by the National Institutes of Health and by the World Health Organization, have concluded that vasectomy is a safe procedure. A number of studies have examined the health effects of vasectomy. The body of research evidence continues to be reassuring and suggests that vasectomised men are no more likely than other men to develop heart disease, cancer (except prostate cancer), or other illnesses.

However a study released by the Journal of Clinical Oncology on 7-July-2014 has linked vasectomy to prostate cancer. While the study did not show that vasectomy caused prostate cancer it showed that the group of men they studied had a increased risk of aggressive prostate cancer from 16 in 1000 to 19 in 1000. This could be caused by a large number of different factors, for more information, click here. Most expert organisations dismissed this study. However, I want to inform patients, so you can make your own decision.

How about post vasectomy pain?

There is research evidence, that an estimated 1:400 men (source ASPC) can get post vasectomy pain, which means they suffer pain, which can start some months after vasectomies. I counsel each and every patient I see about this issue and about the need to see me should they suffer, even if it occurred months or years afterwards. However, despite of this counselling verbally AND in writing, I very rarely see somebody with pains several months or longer after their vasectomy. Furthermore, the 6-10 patients I have seen over the last 12 years, appeared to improve over time with treatment.

In terms of PVP and comparisons with other surgical procedures my view is the following: The risk of PVP is no different than the possibility of suffering permanent pain after a hernia OP (5%), the permanent sensitivity of a tooth after filling (5-10%) or even the fact a whiplash could persists more than the usual 2 weeks after a road traffic accident, in some cases for years or life (5%). Would this stop you driving?

On the internet some people claim “up to 43% of patients” suffer PVP. Sometimes they advocate a ban of vasectomy. Furthermore there are claims that vasectomy could leave you with severe Erectile Dysfunction etc. We assure you this is not evidence based. While vasectomy will not cure a pre-existing ED problem, it won’t cause it neither.

Once a patient from the US contacted me very unhappy I was carrying out vasectomies. He had suffered PVP and I responded: Click here for some further information / my own thoughts.

Will Vasectomy Protect Me from Getting or Passing on STIs or AIDS?

No. It will only prevent you from making your partner pregnant. If you or your partner have a sexual infection, or have more than one sexual partner, the best way to protect yourself and your partner is to use a latex condom.

 

Are there any patients you who definitely need a prior bespoke assessment?

Some vasectomies are more difficult than others and I would definitely like a chat with you prior to your operation if you fit in any of the following categories of patients:

  • Diabetes that you do not control well
  • Taking Corticosteroids (=Cortisone =Prednisolone and similar)
  • Any blood thinners (Aspirin, Warfarin, Dabigartan, Rivaroxaban, Apixaban, Clopidogrel etc). Read more here for patients on Aspirin
  • Immunosupression (weakened immune system) through any of the following possibilities:
    • Conditions HIV etc
    • Diabetes unless you control it well. Note, an HbA1c over 69 is a contraindication.
    • Treatments like Chemotherapy, Methotrexate, etc.
    • Operations like organ transplant or splenectomy
  • Hernias into the scrotum
  • You are less then 30 years old with no children or
  • You are less than 25 years old and have children
  • Your BMI is above 35 (i.e. you are obese, this can make vasectomy more difficult and infection more likely)
  • You had an orchidopexy (surgery to lower your testicles as a baby)
  • A previous vasectomy reversal or any other surgery.
  • You noticed a lump in your scrotum. A health professional should assess this for its innocence prior to vasectomy (I had to send back a patient with a hernia, who came from Scotland).

Please be aware, vasectomies in patients with prior surgery can sometimes be difficult to perform and have a higher risk of failure:

Can I still ejaculate after No-Scalpel Vasectomy?

This is a common question in my clinic. Yes you can, because most of your sperm is your semen. The prostate makes semen  (this is one of the main reasons you have a prostate). Once clear you will have empty ejaculations. Even the volume does not reduce by much, because of this, usually no more than 3-7%.

Where does the sperm go?

We do not know about this in terms of scientific papers, It is therefore one of the common questions patients ask me. My own theory according to medical school knowledge is, the body “digests” sperm through helper cells, called macrophages. Larger amounts of sperm form little sperm granulomas, which are usually a good sign as they indicate…

  1. That vasectomy is likely to have worked
  2. That you are a fertile man and vasectomy was a necessary operation and
  3. Reversal would also be much more likely to be successful.

Once you have supplied a semen sample you need to wait for written confirmation.

Can I reverse my No-Scalpel Vasectomy?

No more or less  than any other vasectomy procedure. Although No-scalpel-vasectomy is quick, easy, and convenient and causes very little discomfort you should consider it permanent. Reversal operations are expensive and not always successful. As all surgery they depend on operator experience. Reversals are also more unsuccessful if carried out a long time after your vasectomy. But this may also be due to increasing age. If you are thinking about reversal, perhaps vasectomy is not right for you…

© Dr Martin Kittel, MRCGP, DRCOG, DFFP

 

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