Most casual observers will think of the North Star as the brightest star, in fact it is Sirius. (The North Star is known for its dependable location in the sky, not its brightness.)
According to Greek mythology, Sirius was the dog of the hunter Orion, and the ancient Romans placed the star in the constellation Canis Major (Latin for “Greater Dog”). The Romans thus referred to the sweltering period when the rising of the sun and Sirius converged as the “dies caniculares” or “days of the dog star.”
By the 1500s, the English world began to call the same summertime point on the astronomical calendar as the “dog days.”
You have had your vasectomy…here are some “after the procedure” instructions and a heads up on potential issues that are peculiar to having a vasectomy.
The small opening at the midline of the upper strotum does not have a suture and will close on its own. A thin film of Neosporin ointment daily is recommended.
You can shower the day after the procedure, but don’t let water hit the procedure site directly.
Ice to the scrotum after the procedure helps with swelling and with discomfort. (Lidocaine is used at the opening and along the course of the vas tubes so there is anesthesia for an hour or so after the procedure.)
You’ll be given something for pain, this is to be used in an “as needed fashion.” If you don’t have pain, don’t take it or use Advil or Aleve. Taking a half a pill is acceptable.
Try to be off your feet with the scrotum elevated strictly for the first 24 hours and then as much as possible for the next two days. Most patient who have the procedure on a Thursday or Friday take it easy over the weekend and return to work on Monday. If you have a strenuous job, you may want to gradually get back into your routine.
For the first week after the vasectomy, compression underwear to stabilize the scrotum and elevation of the scrotum with a rolled sheet when sitting can reduce any swelling.
No sexual activity for one week.
No unprotected sexual activity until we have evaluated two negative specimens. It takes approximately 25 ejaculations to clear the tube beyond the vasectomy site. (A couple can achieve pregnancy if there is unprotected sexual activity before the sperm has completely cleared.) We recommend evaluation of specimens as a rule at 6-8 weeks. It is not about the time since the vasectomy, it is about the number of ejaculations.
Even though the opening is in the middle of the upper scrotum, the vasectomy sites are on the left and right underneath the skin. Discomfort, bruising or asymmetrical swelling is not uncommon, but should slowly improve over several days.
Each patient is given two specimen containers after the procedure and there are several options regarding checking the post-vasectomy specimen. Dr. McHugh examines semen specimens with a microscope at no expense. (The best days for dropping off the specimen is Monday, Wednesday and Friday-but it best to call to be sure he is available to examine.) For out of town patients, specimens can be taken to a local hospital for a “post vasectomy” semen analysis (we can fax an order) or use online test kits such as spermcheck.com.
It is not unusual, maybe 5-10% of specimens, will have a rare sperm. This just means that more time/ejaculations are necessary to completely clear all of the sperm. We will require two consecutive completely negative evaluations.
There are no special instructions about the specimen. If you obtain the specimen in the morning and drop off later in the day, this is not a problem. We are not doing a formal count, only the presence of absence of sperm. We will call you back with the results that day.
If any issues arise that you have questions about, feel free to contact us. We will be happy to speak to you or if you feel necessary examine you in the office at no expense to you.
Thank you for allowing us to participate in your care.
A common question asked is whether the reversal will be harder if clips were used or if the patient was told by the urologist “I took out a section and burned it.”
In the vast majority of cases this has no influence on the microscopic vasectomy procedure.
The procedure is harder if both sides of the vasectomy were done in the vas deferens closest to the testicle-the convoluted vas. This area is smaller in diameter and not straight (convoluted) and this makes the repair a little harder.
Whether clips or burned, there is not difference in how difficult the reversal will be. Having had clips makes the area of the vasectomy easier to locate.
The amount of vas tube removed is usually not an issue unless there is a very large segment removed and this is customarily not done.
Of note, if you have had two vasectomies done, this could be an issue. If you had a complication after the vasectomy, say a large hematoma or infection that had to resolve or be operated on, these may affect the repair. On all unusual issues, be sure to make the reversal doctor aware.
Bullet points/instructions for the post vasectomy reversal operative period:
You can shower but for the first two to three days, don’t let water hit the operative site directly.
A thin layer of Neosporin over the suture sites daily is recommended.
A formal dressing is not required but one 4×4 gauze between underwear and the sutures may be more comfortable.
The sutures dissolve-but not all at the same time. Some separation of the skin in areas is not uncommon and resolves.
The feeling of a “lump” under the skin above either testicle is not uncommon, this is where the body is reacting to the surgical procedure. (It is not uncommon to have this on one side but not the other.)
Compression underwear for three weeks. (This is preferred to the traditional “jock strap.”
No sexual activity for three weeks. Slowly returning to your normal exercise at that time can resume as well.
The more you can be off your feet the first week following the procedure the less swelling you will have. Some bruising of the skin around the suture sites is common.
Patients can walk and even drive if necessary after 5 days if wearing compression underwear and being careful. Again, the more you are off your feet the better.
The testicles begin producing normal sperm again in 4-6 months, depending on the length of time from the vasectomy. (The longer the interval from the vasectomy, the slower return to sperm production.)
If you desire to have an evaluation of a semen specimen to check for the presence of sperm, one would wait until the 4-6 month period after the reversal. The presence of sperm is a very good sign, however it is not unusual for a longer interval is required for the return of sperm. A specimen can be given to our office and can be quickly evaluated for the presence of sperm. If a formal semen analysis is desired which provides an actual count of sperm, an order can be placed to your local hospital negating having to travel to Gainesville.
If pregnancy occurs, it is usually in the 6-18 month time frame.
If pregnancy occurs…we’d appreciate a picture.
Finally…we appreciate the opportunity to participate in your care.
Georgia’s most experienced No Scalpel Vasectomy and Microscopic Vasectomy Reversal urologist.
The question was- “What are the options for the no scalpel vasectomy?”
In terms of anesthesia (Absolutely no discomfort): we offer conscious sedation by a board certified anesthesiologist on Thursday. In this scenario, you’ll have an I.V., monitored and will sleep through the procedure safely with absolutely no discomfort. The medicine used by the anesthesiologist goes to work quickly and goes away out of your system quickly, so it is ideally suited for this type of procedure.
Local anesthesia with a pre-med (Usually Ativan/Norco by mouth, or a I.V. injection of similar medications) before the procedure and then local anesthesia with Lidocaine. This method is suited for the patient that has no fear of needles, no anxiety with medical procedures or passes out easily. This is a more streamlined method and is commonly done on Friday.
In terms of payment options: Our office accepts most all insurances and we have relationships with them. This means that we accept what they allow. You may have a deductible and other particular specifics of your plan, but that is what we go by.
If you are self pay: Our fee is $950.00 and this is all inclusive and can be done on a Thursday or a Friday.
The Consultation: This can be with an in office visit which has the advantage of being able to perform an exam, or with a Telehealth visit. One only has to call the office to arrange.
The procedure itself: All no scalpel vasectomies across America use a small hemostat to spread the skin (i.e. no scalpel), however whether after dividing the vas deferens tube the urologist uses cautery, clips or suture the success rate of 1/2000 is about the same. It becomes about the preference of the urologist. Dr. McHugh uses electrocautery (fulgurate or heat). We have learned over the years that many patients prefer not having the foreign body of the clip left in the scrotum.
So the answer to the question is that there are several combinations of how the procedure is billed and options re: how it is performed. We do them all. We have done thousands of vasectomies over the years and perform hundreds a year.
“We know a thing or two about doing vasectomies, because we’ve done a vasectomy or two.”
Dr. McHugh is Georgia’s most experienced no scalpel vasectomy and microscopic vasectomy reversal urologist.
“The office staff was very nice and very informative to me and my wife. The doctor was very personable and made you feel comfortable. He explained everything he was doing and explained it before he did it. I would recommend him to anyone and you don’t find that in many doctors these days.” Z.S.