|
|
Last Updated:
Jan 3rd, 2010 - 00:09:53
|
Question
My husband had a vasectomy a month ago. We immediately had regrets and are considering a reversal-if we ever get enough money. The doctor didn't give him any information about which type of procedure he was using (open vs. closed)(clips vs. cautery)(removal of a piece or not). My husband experienced a much more and a much longer bout of pain than was described to him and still has a very swollen tube on the right side of the penile end and also testicle on that side doesn't seem to be oriented the same way it was before the procedure. We called to ask what procedure was used. It turns out that he used the closed ended technique with hemoclips with one puncture on the left. My husband told me right away that there seemed to be a lot more cutting noise than was described to him also. I understand that the closed ended technique can cause pain and "blowouts" that make the reversal more difficult due to the area that they have to attach instead of vas to vas. But I've also read that sperm antibodies can be worse (if a blowout doesn't occur) with the open ended technique.
My question is--if we are seriously considering the reversal, should my husband have the clips removed immediately to avoid the blowouts or are the antibodies and granulomas more of an immediate problem? If we have the reversal done it will be within 2 years.
The other question that just came up recently is one of testosterone and other hormones. If the body stops producing sperm due to the pressure build up, are other hormones affected as well? The doctor that did the procedure of course said no and all the pro vasectomy sites say no, but I have found other statements, including one on this site, saying that it can be affected but usually undetectably so. My husband is having problems with erections (just the past few days, not originally) and it seems as though his testicles are smaller. Should he have anything checked with his hormones? He had a hernia on the right side repaired also.
Michelle
Answer
A vasectomy can create inflammation in the area of surgery that persists for awhile and manifests itself as tenderness. Occlusion of the vas always causes a gradual increase in pressure in the vas and epididymis and may result in tenderness of the epididymis. Rupture of the delicate tubular system of the epididymis may occur over time (a “blow-out”), but I would think it unlikely to happen within the first few years. That being said, it is technique-related, and the lower down the vasectomy is done (the closer to the epididymis it is) the more quickly the pressure is going to build in the epididymis.
I do not know of any urologists in my area using an “open technique” vasectomy wherein the testis side is left open to spill sperm into the spermatic cord. The body will not put up with this for very long as sperm are extremely immunogenic and induce quite an inflammatory reaction. Ergo, the body will occlude the vas with inflammatory tissue even though the surgeon did not. Interestingly I reviewed the The Journal of Urology (official publication of the American Urologic Association) and there is no mention of this technique.
Anti-sperm antibodies occur in about 85% of men who have had a vasectomy, and they appear within six months of the procedure. Interestingly their presence does not seem to adversely affect the outcome of vasovasostomy (vasectomy reversal) in most men.
Vaectomy does not affect production of male hormone (testosterone) but may have psychological consequences that impair his ability to have marital intercourse.
Gregory Polito, MD
Gregory Polito, MD, KM, is President of the California Association of Natural Family Planning.
Dr. Polito is a urologist in private practice with vasovasostomy (vasectomy reversal) as a subspecialty.
He is a Member of the American Society of Reproductive Medicine, and Chair of Board Quality Committee at Presbyterian Intercommunity Hospital in Whittier, CA.
Click Here
to visit Dr. Polito's web site.
© Copyright 2005 by CANFP
The information on this page and web site is for informational purposes only,
and is not a substitute for medical diagnosis and treatment by a physician.
Top of Page
