Unexpected swelling after a vasectomy? What is a scrotal hematoma?

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If you look closely you’ll see small blood vessels along the side of the severed vas deferens. Above the the suture (the vas deferens and the suture have been enlarged about ten times) you’ll note that the blood vessels have been blanched by having been fulgurated. Below the suture (looks like a small brown rope) the blood vessels are red. These blood vessels are tiny and sometimes not seen by the urologist and then after the vas deferens retract back into the scrotum-they ooze. Like a small oil leak, the blood continues to leak and accumulate until the surrounding tissues stop it. The result is a hematoma. Hematomas can vary in size depending on the size of the vessels and the amount of blood that leaks before the tamponade (pressue that stops bleeding)  of the surrounding tissues stop it.

Hematomas are not an infection and are not dangerous but both the patient and the urologist wish that it doesn’t happen after a vasectomy. The problem is that they stay around for weeks because it takes time for the body to absorb it. For the most part it is preventable if the urologist is careful to completely occlude these vessels around the vas deferens.

When I do a vasectomy I remove a section and then fulgurate both sides of the vas deferens. This in the majority of cases will handle the small vessels along side the tubes but it doesn’t always. In addition to the above, I place a suture at the very base of of the vas deferens that is beyond where the vas has been dissected thus preventing inadvertent bleeding beyond where the vas has been fulgurated. (These are the red vessels you see near the clamps. The suture is placed and tied just beyond the clamp.)

So…when you talk to people about your upcoming vasectomy and they tell you that they had a lot of swelling of the scrotum that was black and blue…they had a hematoma and in most cases it could have been prevented. Some how attention to these pesky little vessels that travel along side the vas and cause hematomas…were not appropriately given the respect they deserve.

Did you know that if a surgeon needed to or inadvertently cut the testicular artery, that the vasal artery is sufficient enough to keep the testicles alive and viable?

This is why hematomas can be substantial and cause a significant post vasectomy issue.

“Respect thy vessels that accompany the vas deferens!”

 

 

Vasectomy vs. tubal ligation-Which is more common?

Northeast Georgia Urological Associates

The prevalence of vasectomy was 6.6% (compared with a tubal ligation prevalence of 16.35%).

Many factors, including social, medical, and unknown reasons, contribute to the decision of a couple to proceed with one form or another of surgical sterilization.

Objective: To describe the demographics and family planning attitudes of vasectomized men.

Design: Retrospective cohort analysis of National Survey for Family Growth data collected through the National Center for Health Statistics between June 2006 and June 2010.

Methods: The survey sampled 10,403 men from various urban and rural communities, aged 15 to 45 years, regarding family planning attitudes. These sampled statistics could be extrapolated to provide a reasonably accurate national survey portrait.

Results: The prevalence of vasectomy was 6.6% (compared with a tubal ligation prevalence of 16.35%). The odds ratios (OR) for having a vasectomy in this sample were: currently married 7.8; previously married 5.8; and increased age 1.1. The odds…

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Common question-Does having a vasectomy affect frequency of sexual activity?

Vasectomy is not associated with decreased frequency of sexual intercourse.

Background: Men often report the concern that having a vasectomy will impair their future sexual function.

Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.

Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.

Methods: Data were extracted from 2 cycles of the NSFG (2002 and 2006-2008) and analyzed. Men were included if they were previously sexually active and were aged >25 years. Female partners were also surveyed in the NSFG and were included if they were between 25 and 45 years of age. Sexual frequency was compared between men (or male partners of female respondents) who had a vasectomy and those who did not. The database captured sexual intercourse frequency over the preceding 4 weeks.

Results: A total of 5838 men met inclusion criteria, with 353 of these having a previous vasectomy. Men who had a vasectomy engaged in intercourse at a mean rate of 5.9 times per month compared to 4.9 times in men who had not had a vasectomy (P =0.0004). Additionally, men who had a vasectomy were less likely to have not engaged in any sexual intercourse in the preceding month. In the survey of female partners, 5211 women responded regarding their male partners, and 670 partners had a previous vasectomy. Again, men with a previous vasectomy had a higher frequency of sexual intercourse during the previous month (6.3 vs 6.0), although this difference was not statistically different (P =0.1341).

Conclusions: Vasectomy does not appear to negatively influence sexual frequency.

Reviewer’s Comments: The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy. Previous reports have investigated if vasectomy has any effect on sexual function and satisfaction, with most finding minimal to no effect on sexual function. In fact, some reports have demonstrated improved sexual function with improved sexual satisfaction, likely due to the loss of anxiety about unwanted pregnancy. The authors of this article demonstrate through objective survey results that sexual frequency does not decrease and may increase with vasectomy. While no explanation can be extracted from these data, the results are encouraging and can certainly be mentioned while counseling men before vasectomy.(Reviewer–Charles Welliver, MD).

Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.

Is the fluid quality noted at the time of a vasectomy reversal important?

reversal with vasal fluid

When someone has a vasectomy reversal the vas deferens is transected above and below the previous vasectomy site. The portion of the vas deferens coming from the testicle most commonly has fluid that will be released when when it is cut. This fluid becomes more particulate the longer it has been since the vasectomy. So the sooner a person has vasectomy reversal after a vasectomy, the better the quality of the fluid and the less negative effect on the testicle in returning to producing good sperm.  Clear fluid with whole sperm is good, milky fluid with some whole sperm and sperm parts (head and tails) is better, and creamy fluid with fully decomposed sperm without identifiable sperm or parts is even less desirable. This is why the further out a couple is from a vasectomy, the lower the success rates with achieving the number and quality of sperm to eventuate in pregnancy.

In the picture above, the patient is in the 1-3 year range post-vasectomy and the fluid is clearish/milky and the microscopic evaluation revealed whole sperm and sperm parts. The success rate is then that which is expected from a patient in this situation i.e. patentcy 90% and pregnancy 75%.

Most all of this can be predicted at the time of a vasectomy reversal consult to honestly give the reversal couple a pretty good picture of their chances in success, but more importantly the likelihood that despite the time, money and inconvenience experienced by the male, that the procedure may not result in pregnancy.

So the fluid quality tells you a lot, is very important and is often times associated based on the number of years since the vasectomy and the success rate of the vasectomy reversal.

We do vasectomy reversals on a regular basis, offer a convenient package deal pricing, free pre-reversal consultation, and complimentary overnight stay in Gainesville if necessary.  Contact us by email for either the free consultation in the office or a phone consultation with Dr. McHugh.

Does female age make a difference in the success of a vasectomy reversal?

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Yes! Read on.

Effect of female partner age on pregnancy rates after vasectomy reversal.

OBJECTIVE:

To determine the effect of female partner age on pregnancy rates after vasectomy reversal.

DESIGN:

Retrospective review.

SETTING:

Two academic infertility practices.

PATIENT(S):

Men undergoing vasectomy reversal and their partners.

INTERVENTION(S):

Microsurgical vasectomy reversal.

MAIN OUTCOME MEASURE(S):

Patency and pregnancy rates.

RESULT(S):

Two hundred ninety-four patients met the inclusion criteria. Groups were similar with regard to types of procedure performed (vasovasostomy or vasoepididymostomy), obstructive interval, female factors, number of repeat procedures, and quality of vasal fluid. Patency rates were 90%, 89%, 90%, 86%, and 83% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. Pregnancy rates were 67%, 52%, 57%, 54%, and 14% for patients with female partners aged 20-24, 25-29, 30-34, 35-39, and 40+ years, respectively. The pregnancy rate for couples with female partner aged 40 or older was lower than for those with the female partner aged 39 or younger (14% vs. 56%).

CONCLUSION(S):

Pregnancy rates for vasectomy reversal were good regardless of female age as long as the partner was 39 years old or younger. Pregnancy rates were lower if the female partner was 40 or more years old.