Vasorezection and vasectomy in men: what's the difference?

Surgical intervention on the organs of the reproductive system of men, in particular, on the vas deferens - vasorectomy - is considered a method of permanent male contraception by sterilization (that is, the absence of sperm in seminal fluid).

The essence of this procedure is the excision of a part of the vas deferens, making the output of spermatozoa into the ejaculate impossible, which is the condition of the programmed excretory azoospermia, and as a result, men lose fertility-the ability to fertilize. After vaso-cutting, the testicles still produce sperm, but their movement is blocked. But thus all sexual functions, first of all, erectile, are saved.

This operation has one more name, more common among doctors is a vasectomy. Vasorezection and vasectomy, what's the difference between them? These terms are synonyms. Vasorezection: from vas (lat - vessel) and resectio (lat - cutoff), and vasectomy - from vas (lat. - vessel) and ektome (Greek - excision, removal).

Indications for the procedure

Among the indications for this operation, first of all, they note the decision of the man not to have any offspring at all, or if there are enough children in his family and unwillingness to increase it. Perhaps as a result of a genetic consultation, the presence of chromosomal mutations in a man was revealed, or in the genus he has Y-associated severe congenital pathologies, and there is a fear of their transmission through the male line.

In addition, the decision to conduct a vasectomy may be due to the fact that due to the state of health of the wife, pregnancy is fraught with a threat to her life and therefore extremely undesirable.

Medical indications for vasoectomy: tuberculosis lesion of the vas deferens or its abscessing inflammation (deferentitis), as well as recurrent inflammation of the epididymis  epididymitis, which develops in case of chronic inflammation of the seminal vesicle (spermatocystitis).

Abroad, vasectomy (vasectomy) in men in the past 40 years has become a fairly common method of preventing unwanted pregnancies in women (according to WHO, approximately 40-60 million men worldwide have undergone this procedure).

In the United States - according to official information - husbands made vaso-cutting in almost 10% of married couples with children. Approximately the same indicators in Canada, Great Britain, the Netherlands. And in the first place for vasoectomy - New Zealand, where 25% of all married men so warn the birth of children in their families.

It should be borne in mind that the vasectomy is likely to be irreversible, so potential patients should be warned about this. Although the functions of the vas deferens can be restored in an operative way, reverse vasoectomy (reversing the vasectomy) is done. However - despite all the achievements of microsurgery - such an operation is still technically very complicated and only in 40-45% of cases leads to the desired result. In this case, according to surgeons, an attempt to reverse vasectomy is more likely to succeed, if it is carried out no later than five years after sterilization.

Preparation

Preparation for vasorectomy includes the delivery of blood tests (general, for STDs, HIV, hepatitis viruses and coagulability - coagulogram) and urine (general), as well as ultrasound of the urogenital area and ECG.

Approximately two weeks before the procedure, taking acetylsalicylic acid (Aspirin) and other drugs that dilute the blood (Warfarin, any NSAIDs) is discontinued.

Within three days before the operation, it is recommended to wash the scrotum and adjacent areas with antibacterial soap, you need to shave off your hair in the genital area. In the morning on the day of the operation, a shower is taken, with you you need to take clean fitting clothes (to support the scrotum and minimize the postoperative swelling).

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Technique of the vasorelations

Vasorezection is performed with local anesthesia - injection of a local anesthetic (for some patients sedation is additionally applied); the duration of the operation is up to 30 minutes.

The urologic surgeon - through a small incision in the lateral inguinal cavity - conducts a longitudinal cleavage of the muscle that lifts the egg and exposes the spermatic cord, separating the vas deferens and the vessels (together with the perivasal tissues they are held by the clamp).

Further, the vasoligator of the vas deferens is carried out: in two places (at a distance of up to two cm), it is bandaged (that is, ligatures are superimposed). After that, the duct is cut in the middle of this gap, and the ends are either buried in nearby tissues with fixation by their absorbable suture (this is called fascial interposition), or cauterized by electrocoagulation. Open technique of vasoligators can be used when only part of the duct leading to the penis is blocked (bandaged).

Closure of the wound is carried out by layer-by-layer suturing, the nodal seams, which tighten the edges of the incision, are superimposed on the skin.

Similar manipulations are carried out on the second channel (from the opposite side).

There is a technique for performing vasorectomy through a single incision, as well as minimally invasive vasectomy - without a scalpel, through one small puncture of the scrotum skin (using a special instrument).

Contraindications to the procedure

Vasorezection is contraindicated to carry out with hemophilia and poor coagulation of blood, caused by thrombocytopenia or diabetes. Also, contraindications relate to cases:

• presence of venereal diseases and other urogenital infections that are transmitted during sexual intercourse;
• diseases of testicles  (orchitis, epididymitis, orchoephedmititis, etc.);
• fungal and bacterial urethritis;
• chronic cystitis;
• tumor formations in the pelvic region.

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Consequences after the procedure

Studying the complaints and reviews of patients after vasoectomy, the specialists compiled a list of short-term (rather quickly passing) consequences of this procedure and complications that arise later.

Most often the consequences after the procedure are manifested in the form of pain in the scrotum (normally within a few days) and local hematomas and swelling of the tissues in the genital area (up to two weeks).

Also after vasorectomy, there may be minor bleeding (as indicated by the presence of bloody discharge from the penis or blood in the ejaculate). It is not excluded the development of a secondary bacterial infection (with a rise in body temperature to + 38 ° C).

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Complications after the procedure

Delayed complications after the procedure may include chronic orchialgia (pain in the testicles), to which 1-3% of patients complain.

When blocking the vas deferens due to increased pressure in the appendages of the testicles, varicocele may develop  , accompanied by a feeling of pressure in the testicles and pain of the pulling character. There is also a formation of a hydrocele around the testicle, which causes swelling in the scrotum and blunt pains that increase with ejaculation. For the same reason, the duct in the epididymis stretches and breaks (usually asymptomatic).

Because of the weakening of the ligature, the spermatozoa along the cut through the vas deferens continue to pour into the scrotum, and in two or three weeks spermatogenic (spermatozoa) granulomas can form. Most often they are not felt by patients and eventually resolve, but with large granulomas (less than 1% of cases), treatment (steroid injections) or surgical removal is necessary.

 Stagnant epididymitis is possible  (in 2.8-5.6% of cases) and abnormal cysts (spermatoceles), which are formed on the epididymis.

Approximately 50-80% of men (according to the European Association of Urology, in 52-68%) after vasoectomy develop an immune response against their own spermatozoa, that is, antisperm antibodies in the blood are detected  . This can provoke an inflammatory process, since the body's own antibodies form circulating immune complexes that cause the same reaction as when there is an infection. It is for this reason, as foreign studies have shown, that vasectomy in the first years after surgery raises the risk of developing genitourinary system diseases.

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Care after the procedure

What is the withdrawal after the procedure of vasorectomy?

It is necessary: compliance with bed rest for at least two days; application of cold on the scrotal area (from bruising and swelling) - especially in the first 24 hours; maintaining the purity of the genital area, performing hygiene procedures; Wearing tight-fitting underwear or a supporting bandage.

At least two weeks exclude alcohol, for a month and a half - any physical activity. Sexual life can be resumed a couple of weeks after the operation, but the male or his partner should use other methods of contraception until the success of the vasorectomy is confirmed by the result of a sperm analysis after a vasectomy (PVSA).

According to the experts of the American Urological Association, patients can stop using other methods of contraception, when PVSA will show azoospermia or the presence of only single immobile spermatozoa (RNMS or ≤ 100000 / ml).

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Changes in the human body after vasoretection

After vasorectomy in the body, men continue to develop both testosterone and pituitary gonadotropins. The physiology of the reproductive system does not change, that is, there are no sexual problems (in the form of impotence), since the nerves involved in erection and ejaculation are not affected.

Even the production of semen and spermatogenesis continues, but the man will not notice the decrease in the volume of sperm, since spermatozoa that do not find "output" are utilized by macrophages in the lumen of the epididymal tubules.

True, there may be an increase in the thickness of the walls of the vas deferens due to interstitial fibrosis, and in 35% of patients a scar tissue forms at the site of their excision.

Vasorezection as a method of male contraception does not guarantee 100% effectiveness. For example, according to British doctors, a partner's pregnancy occurs in one of two thousand patients who decided on this operation.

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