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The control of fertility gains its importance in modern life after that the understanding to the social and cultural values of ourselves has been advanced to accept that the man can also be sterilized to avoid unexpected pregnancies. The acceptance of our female partners to the value of the procedure and its meaning both for the male and for her has also been changed in the last decade.
In our modern cultures and advanced industrial world one lets sterilization be done because of his protection from having a not planed child, or for having a psychological release during sexual activity that this will not happen. It is also performed after having children in a pair where the male wants to protect his female partner from the side effects of hormonal contraceptives or because the female suffers already under these complications.
The procedure is also resorted to because it is easier to perform in comparison to the sterilization of the woman. This can be done on temporary basis to preserve the possibility of may have children in the future regardless of the time laps after the procedure.
Temporary sterilization is done through the injection of RISUG inside the vas deferens. There is no change in the pressure inside the vas.
Temporary sterilization is a simple procedure but in spite of this fact it harbors some hazards with it. The first important one is infection. This may affect the epidedymis, The prostate, The testicles or the scrotal sac as a whole. The other hazard is that some nearby structures may be injured if involved in the process which is easy to happen in inexperienced hands. This is because the structures in the area are all cord like and similarly feeling. Understanding the anatomy is only a part of the procedure the second part is understanding the function of the organ.
Physiology: The injection of RISUG into the vas is assumed not to produce increase in the pressure inside the first part of the vas emerging from the tail of the epidedymis. This experiences no back pressure on the structures producing the sperms and they are preserved for permanent production of sperms as they usually do. The procedure is easy to reverse through massage on the vas to milk out the injected plump or through the injection of a dissolving substance (DSMO).
On planning to perform Vasal injection, I discuss the above mentioned facts with my patient. I also ask him about his motive to let the operation done. The second very important question is about his future intentions. This is important to advise him for which procedure to go with, if it is permanent or temporary. This is because Temporary sterilisation (vasal injection) is always reversable regardes of the laps of time after the procedure while microsurgical reversal is advisable within the first 3-5 years after permanent sterilization. Vasectomy reduces the chance of re fertilization and the production of healthy sperms considerably after 2 years of being done. This is not the case in non scalpel vasal injection. This is an important fact to be discussed seriously with patient. The female partner must be present and must sign the consent of the operation with him.
The patient should have a spermiogram before the operation done if he has no children to proof that he is fertile otherwise the operation is done for good and could have been avoided. There is no better prove of fertility than having your own children.
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Normal Sperm
Changes in semen after treatment
What is RISUG?
This is an organic pharmaceutical substance (copolymer) which when injected inside the vas, it swells through absorption of water and becomes entangled in between the folds of the mucous membrane of the vas. It is then fixed in place. The minute particles (molecules) inside the copolymer react with fluids inside the vas, in particular water, and change themselves into negative charged particles. These negative charges affect the positive charge on the head of the sperms and let them rupture and become dissolved or completely ineffective.
RISUG
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Who qualifies for the Operation?
Males who wish to be temporarly sterile, males of couples who want to have no children, males who want to protect their wives from the disadvantages of the anti baby pills.
How does the operation work?
Temporary sterilisation is done on an outpatient basis. I sometimes use a simple sedation and infiltrate the area with a local anesthetic as not more than 20 ml of xylocain 1% for both sides.
The patient is lying supine. The vas is felt and rolled between 2 fingers as mentioned above. The structure is held using special shape toothed forceps. A 5 mm incision (or a non scalpel procedure) is done immediately above the structure. Which starts to protrude out of the wound as a white glistening loop. This loop is again hold as above. Bleeding is nearly nil and can be easily controlled by the high frequency current forceps, if any, while the patient is protected by connecting him to the earth electrode.
The structure is examined and the base of a scalpel is inserted under the vas. The lumen of the vas is punctures with a very fine special needle for the injection of the RISUG. Pressure is applied for seconds. The procedure is repeated on the other side. The wound is closed by a single suture and dressing is applied.
The operation time is about 20 minutes. There is also the non scalpel method of vasectomy which I perform also but it does not differ much both technically and functionally from the above mentioned method.
The patient visits me 24 hours after the operation. I check his genital area clinically and examine him with the ultrasonography to exclude any sign of infection or hematoma. The bandage is changed with tegaderm. This has the advantage to let the wound be easily inspected and the patient to wash himself or take a shower without wetting the wound. Visits are repeated every other day for a week. There is no need for antibiotics but it is advisable to give a drug against swelling and some drops against pain for just in case the patient is in need of them particularly at night.
The sexual life is not allowed in particular the patient is not declared sterile before the laboratory evidence of having no sperms in his ejaculate. This is diagnosed though the spermiogram done after 4 days to 1 week of the operation. There may be some sperms which even if not motile are suspicious. The sperms that are observed earlier are those which were stored in the seminal vesicles.
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Incision
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Frequently asked questions (FAQ):
- Is temporary sterilization reversible ?
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Yes, it is at any time.
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- Does temporary sterilization affect my potency ?
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No, it does not at all.
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- What are the hazards of temporary sterilization ?
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These are infection, hematoma, injury to other structures, permanent sterilization, spontaneous reversal.
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- When can I return back to my sexual life safely ?
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After 4 days to 1 week and only after proving that you are azoospermic that is to say there are no sperms in your ejaculate. You can return to a protected sexual life within the first 4 days after the operation while you use a preservative for safe sex or your partner uses a contraceptive.
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- Does the vasal injection affect my ejaculate or its volume ?
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No, it does not. It only devoids you from viable sperms.
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- Is there any deformity left on my scrotum after vasal injection ?
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No, The vasal is done through minute incision of 3-5 mm length which heals smoothly and leave an inconspicuous scar in the behind part of the neck of the scrotum. This fades away after 6 months.
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- How is temporary sterilisation reversible ?
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It is reversible through milking the vas towars the stream of sperms to expel the drug out. This may be done 3-4 times before the spermiogram proves normal sperms.
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- What is the time limit of reversibility of vasal injection ?
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Scientific proves doccument that it could be reversed even after 15 years of application.
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- Are there side effects to any other organ of the body due to the injection of RISUG ?
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No there are. Miticulous chemical and laboratory examinations of the body organs prooved its safety.
RISUG ready for injection
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