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Urology Surgery Procedures

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Urology is the medical and surgical specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Medical professionals specializing in the field of urology are called urologists and are trained to diagnose, treat, and manage patients with urological disorders. The organs covered by urology include the kidneys, adrenal glands, ureters, urinary bladder, urethra, and the male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis). Urology is one of the most competitive specialties to enter for physicians.Problems in these areas are common and new medical technology continues to offer an expanding array of effective treatments. The urinary and reproductive tracts are closely linked, and disorders of one often affect the other, so a major part of the conditions managed in urology fall in the area of genitourinary disorders. Urology combines management of medical (i.e., non-surgical) problems such as urinary tract infections and benign prostatic hyperplasia, as well as surgical problems such as the surgical management of cancers, the correction of congenital abnormalities, and correcting stress incontinence. Urology is closely related to, and in some cases overlaps with, the medical fields of oncology, nephrology, gynecology, andrology, pediatric surgery, gastroenterology, and endocrinology. Urology is the medical specialty that deals in the medical and surgical diseases of the kidneys and urinary tract, which include the ureters, bladder and urethra, and the male reproductive system and genitalia.

Urology is one of the few specialties that also dabble in pediatric and plastic/reconstructive techniques. Urologists are second only to Radiologists and Radiotherapists as being the most "radioactive" doctors since we rely strongly on radiographic and ultrosonographic studies. As a result, Urologists are at least as skilled as Radiologists and Ultrasonologists when performing or reading imaging studies of the genito-urinary tract, and these include CAT Scans and MRI's, as well as Radionucleide scans.

Urinary System Overview.

Bladder.

Bladder control problems are medical conditions that prevent you from being able to control when you urinate. If you live with a bladder control problem you are not alone. Over 30 million Americans, both men and women, suffer from the involuntary loss of urinary control. While there may be many different causes and degrees of severity, one thing is certain: bladder control problems are not normal in adults of any age. Most problems can be treated successfully at any age. More than ten billion dollars are spent each year on this condition and, of this, one billion is spent on adult diapers. Overactive Bladder and Urinary Incontinence can lead to embarrassment, prevent those affected from participating in life's activities as they would like, and leads to social isolation. The information below covers overactive bladder and urinary incontinence. To better understand incontinence it helps to know a bit about the urinary tract (urinary system) particularly the parts that store and release urine.

Three sets of muscles control urine. One set is the bladder muscle itself. The second set is sphincter muscles that open and close the urethra and the third set is the pelvic floor muscles. They support the uterus, rectum and the bladder. The bladder is the muscle that sits just under your pubic bone and is connected to the kidneys. The two tubes (ureters) bring urine made by the kidneys down to the bladder.

Incontinence.

An estimated 51million women (17 million of them in the U.S. alone) cope with urinary incontinence. Some are unable to prevent leaking urine when they cough, sneeze or exercise. Others experience a strong urge to urinate but are unable to make it to the bathroom in time.

Urinary incontinence is the medical term used to describe the condition of not being able to control the flow of urine from your body. Incontinence usually occurs because the urethra cannot close tightly enough to hold urine in the bladder.

Kidneys.

The urinary tract normally consists of two kidneys, each attached to a ureter (urine tube) that connects the kidney to the bladder, and one urethra which empties the urine out of the bladder to the outside world. The kidneys perform many jobs including removing waste from the blood, keeping a stable balance of salts and other substances in the blood, and producing hormones that help build strong bones and form red blood cells. The ureters have only one job, to carry urine from the kidneys to the bladder. The bladder located in the lower abdomen, has two jobs, to store urine and to empty the stored urine out through the urethra.

Our Procedures.

Bladder cancer is any of several types of malignant growths of the urinary bladder. It is a disease in which abnormal cells multiply without control in the bladder.The bladder is a hollow, muscular organ that stores urine; it is located in the pelvis. The most common type of bladder cancer begins in cells lining the inside of the bladder and is called transitional cell carcinoma.

Signs and symptoms:

Bladder cancer characteristically causes blood in the urine; this may be visible to the naked eye (gross hematuria) or detectable only by microscope (microscopic hematuria). Other possible symptoms include pain during urination, frequent urination (polyuria) or feeling the need to urinate without results. These signs and symptoms are not specific to bladder cancer, and are also caused by non-cancerous conditions, including prostate infections and cystitis. Kidney cancer also can cause hematuria.

Causes:

Tobacco smoking is the main known contributor to urinary bladder cancer; in most populations, smoking is associated with over half of bladder cancer cases in men and one-third of cases among women. Thirty percent of bladder tumors probably result from occupational exposure in the workplace to carcinogens such as benzidine. 2-Naphthylamine, which is found in cigarette smoke, has also been shown to increase bladder cancer risk. Occupations at risk are bus drivers, rubber workers, motor mechanics, leather (including shoe) workers, blacksmiths, machine setters and mechanics.

Diagnosis:

The gold standard for diagnosing bladder cancer is biopsy obtained during cystoscopy. Sometimes it is an incidental finding during cystoscopy.Urine cytology can be obtained in voided urine or at the time of the cystoscopy ("bladder washing"). Cytology is very specific (a positive result is highly indicative of bladder cancer) but suffers from low sensitivity (inability of a negative result to reliably exclude bladder cancer).

Staging:

Stage 0: Cancer cells are found only on the inner lining of the bladder (This stage is also often called Stage Ta).

Stage I: Cancer cells have proliferated to the layer beyond the inner lining of the urinary bladder but not to the muscles of the urinary bladder.

Stage II: Cancer cells have proliferated to the muscles in the bladder wall but not to the fatty tissue that surrounds the urinary bladder.

Stage III: Cancer cells have proliferated to the fatty tissue surrounding the urinary bladder and to the prostate gland, vagina, or uterus, but not to the lymph nodes or other organs.

Stage IV: Cancer cells have proliferated to the lymph nodes, pelvic or abdominal wall, and/or other organs.

Recurrent: Cancer has recurred in the urinary bladder or in another nearby organ after having been treated.

Treatment:

The treatment of bladder cancer depends on how deep the tumor invades into the bladder wall. Superficial tumors (those not entering the muscle layer) can be "shaved off" using an electrocautery device attached to a cystoscope. Immunotherapy in the form of BCG instillation is also used to treat and prevent the recurrence of superficial tumors.BCG immunotherapy is effective in up to 2/3 of the cases at this stage. Instillations of chemotherapy, such as valrubicin (Valstar) into the bladder can also be used to treat BCG-refractory CIS disease when cystectomy is not an option.

What does the procedure involve?

This operation involves the telescopic incision of the obstructing, central part of the prostate with heat diathermy and temporary insertion of a catheter for bladder irrigation. The correct terms for this procedure are transurethral incision of the prostate or prostatotomy.

What are the alternatives to this procedure?

Drugs, use of a catheter/stent, observation or open operation, laser enucleation of the prostate (HoLEP).

What should I expect before the procedure?

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits.

You will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse.

You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your Urologist in advance of your surgery if you have any of the following: an artificial heart valve, a coronary artery stent, a heart pacemaker or defibrillator, an artificial joint, an artificial blood vessel graft, a neurosurgical shunt, any other implanted foreign body, a prescription for Warfarin, Aspirin or Clopidogrel (Plavix®), a previous or current MRSA infection, high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human-derived growth hormone).

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you.

You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The prostate and the neck of the bladder are incised using a metal "spike" to relieve the obstruction. A catheter is placed in the bladder to allow irrgation with saline solution which prevents the development of blood clots in the bladder.

The process of the surgery:

In Bladder Neck Incision, first a telescope is passed through the urethra in the bladder. Now the blockage is seen. Then with a knife the blockage is removed carefully. Once the blockage is removed a catheter is inserted in the bladder. This helps the bleeding and wound to heal up fast.

What happens immediately after the procedure?

There is always some bleeding from the prostate area after the operation. The urine is usually clear of blood within 12 hours, although some patients lose blood for longer. It is unusual to require a blood transfusion after bladder neck incision. It is useful to drink as much as possible in the first 12 hours after the operation because this helps the urine clear of blood more quickly. Sometimes, fluid is flushed through the catheter to clear the urine of blood. You will be able to eat and drink on the same day as the operation when you feel able to.

The catheter is generally removed at midnight on the first night after surgery. This allows your bladder time to fill overnight so that, in the morning, the doctors can decide whether you can go home without the catheter At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by tablets or injections and the frequency usually improves within a few weeks. Some of your symptoms, especially frequency, urgency and getting up at night to pass urine, may not improve for several months because these are often due to bladder overactivity (which takes time to resolve after prostate surgery) rather than prostate or bladder neck blockage. It is not unusual for your urine to turn bloody again for the first 24-48 hours after catheter removal. Some blood may be visible in the urine even several weeks after surgery but this is usually not a problem.

Let your nurse know if you are unable to pass urine and feel as if your bladder is full after the catheter is removed. Some patients are unable to pas urine at all after the operation due to temporary internal swelling within the prostate area. If this should happen, we normally pass a catheter again to allow the swelling to resolve and the bladder to regain its function. Usually, patients who require re-catheterisation go home with the catheter in place and return after a week or so for a second catheter removal which, in almost all cases, is successful. The average hospital stay is 2 days.

What should I expect when I get home?

Most patients feel tired and below par for a week or two because this is major surgery. Over this period, any frequency usually settles gradually. When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

What else should I look out for?

If you experience increasing frequency, burning or difficulty on passing urine or worrying bleeding, contact your GP. About 1 man in 5 experiences bleeding some 10-14 days after getting home; this is due to scabs separating from the incision in the bladder neck. Increasing your fluid intake should stop this bleeding quickly but, If it does not, you should contact your GP who will prescribe some antibiotics for you. In the event of severe bleeding, passage of clots or sudden difficulty in passing urine, you should contact your GP immediately since it may be necessary for you to be re-admitted to hospital.

Prostate biopsy is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. It is typically performed when the scores from a PSA blood test rise to a level that is associated with the possible presence of prostate cancer.

The procedure, usually an outpatient procedure, requires a local anesthetic, with fifty-five percent of men reporting discomfort during the biopsy. The most frequent complication of the procedure is bleeding in the urine for several days, some bleeding in the stool for several days, and blood in the ejaculate for several weeks afterwards.

The procedure may be performed transrectally, through the urethra or through the perineum. The most common procedure is transrectal, and may be done with tactile finger guidance, or, more commonly and precisely, with ultrasound guidance. About a dozen samples are taken from the prostate gland through a thin needle - about six from each side. If the procedure is performed transrectally, antibiotics are prescribed to prevent infection. An enema may also be prescribed for the morning of the procedure. In both the transrectal and the transperineal procedure, the doctor inserts an ultrasound probe into the rectum to help guide the biopsy needles. A local anesthetic is then administered into the tissue around the prostate, similar to the local anesthetic administered for a dental procedure. A spring-loaded prostate tissue collection needle is then inserted into the prostate, through the rectum (or more rarely through the perineum), about a dozen times. It makes a clicking sound, and there may be considerable discomfort.

Negative Biopsy:

Biopsies detect prostate cancer in about 25% of men with abnormal screening tests. However a negative biopsy does not ensure the absence of disease. Repeat prostate biopsies are positive in about 25-30% of patients whose initial biopsy was negative. During a biopsy procedure, less than 1 percent of the entire prostate gland is sampled, so men can harbor prostate cancer in spite of having a negative initial biopsy.

Causes, incidence and risk factors:

Prostate cancer is the third most common cause of death from cancer in men of all ages and is the most common cause of death from cancer in men over age 75. Prostate cancer is rarely found in men younger than 40.

People who are at higher risk include:

* African-American men, who are also likely to develop cancer at every age.

* Men who are older than 60.

* Men who have a father or brother with prostate cancer.

Other people at risk include:

* Men exposed to agent orange exposure

* Men who abuse alcohol.

* Farmers.

* Men who eat a diet high in fat, especially animal fat.

* Tire plant workers.

* Painters.

* Men who have been exposed to cadmium.

The lowest number of cases occurs in Japanese men living in Japan (this benefit is lost after one generation of living in the U.S.) and those who do not eat meat (vegetarians). A common problem in almost all men as they grow older is an enlarged prostate (benign prostatic hyperplasia, or BPH). This problem does not raise your risk of prostate cancer.

Symptoms:

The PSA blood test is often done to screen men for prostate cancer. Because of PSA testing, most prostate cancers are now found before they cause any symptoms. The symptoms listed below can occur with prostate cancer (Most of the time these symptoms are caused by other prostate problems that are not cancer):

* Delayed or slowed start of urinary stream.

* Dribbling or leakage of urine, most often after urinating.

* Slow urinary stream.

* Straining when urinating, or not being able to empty out all of the urine.

* Blood in the urine or semen.

* Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread).

Radiation Therapy:

Radiation therapy uses high-powered x-rays or radioactive seeds to kill cancer cells. Radiation therapy works best to treat prostate cancer that has not spread outside of the prostate. It may also be used after surgery, if there is a risk that prostate cancer cells may still be present. Radiation is sometimes used for pain relief when cancer has spread to the bone.

Prostate mapping:

Prostate Mapping is a new biopsy method that uses a combination of multi-sequence MRI scans and template-guided multiple biopsies. It involves taking 30-50 biopsies through the skin that lies in front of the back passage instead of the rectum. The procedure is carried out under general anaesthetic. This method can determine with high accuracy the location and aggressiveness of cancer.

Monitoring:

After treatment for prostate cancer, you will be closely watched to make sure the cancer does not spread. This involves routine doctor check-ups, including serial PSA blood tests (usually every 3 months to 1 year).

adical nephrectomy represents the surgical method of removing the kidney from our body. The kidney is removed together with its collecting system, adrenal gland and ipsilateral lymph nodes. The patients with renal cell carcinoma (stages I, II and III) as well as those suffering from polycystic kidney disease whose kidney is completely destroyed undergo this procedure.

The very procedure requires general anesthesia. Two approaches are used, Abdominal and Laparoscopic approach. Unlike the first one Laparoscopic procedure is less invasive and only 4 small incisions are made. It does not take long to be finished (approximately less that three hours). Radical Nephrectomy is much more complex, lasts longer (up to or even over three hours) and is more invasive. It leads to greater scars.

Before the operation patient must undergo certain examinations. Complete physical examination is required. The following must be done so the surgeon can assure him/herself that patient has no contraindications for the surgery: ECG, chest X-ray, complete blood count, complete kidney profile, pulmonary function tests, blood gas analysis, blood typing together with cross matching in case a blood transfusion is necessary. For better anatomic insight specialized test such as intravenous pyelography, cystoscopy/ uretheroscopy, retrograde pyelography, cystourethography, CT scan, ultrasonography, MRI and renal angiography are conducted. It is essential that the surgeon is informed about all the additional conditions that might affect the recovery or even interfere in the course of the surgery. All medications and remedies that are taken must be reported. It is recommendable for patients not to take aspirin or NSAIDs for at least two weeks prior operation since this can lead to prolonged bleeding.

Recovery within the hospital takes approximately a week. Your heart and lung function are monitored and prolonged hemorrhage can be spotted immediately within few hours after the surgery which you spend in the recovery room. Pain is what bothers patients most so they are given pain killers. Patients are supposed to avoid strenuous physical activities, picking up heavy objects and they can easily come back to their daily routines within 4 to 6 weeks. The renal function will be monitored since the function of the remaining kidney has to compensate for the lost one.

There are certain risks that might develop during or after the surgery. These include injury or perforation of internal organs (bowel, liver, spleen, pancreas or pleura), over bleeding, failure of the contra-lateral kidney, infections. Extreme cases involve heart attack, congestive heart failure, pulmonary embolism, cerebrovascular accidents or thrombophlebitis.

Indications For Surgery:

The indication for radical nephrectomy is a clinically localized solid renal mass in a patient with a normal contralateral kidney. Patients with solitary kidneys, renal insufficiency, and bilateral renal masses should be considered candidates for nephron-sparing surgery. A thorough preoperative history and physical examination should be performed before the procedure. If significant comorbidities are suspected, consultation with the appropriate physician is recommended. The patient should be expected to physically withstand the operation and have a reasonable overall performance status and a 5-year life expectancy.

Complications:

The potential for bleeding during radical nephrectomy necessitates careful patient preparation and preoperative planning to significantly reduce the chances. Any medications that interfere with platelet function or clotting should be discontinued, and patients should be type and cross matched for 2 units of packed red blood cells. The patient should have either two large-bore peripheral intravenous lines or a central venous line to allow for rapid infusion of fluids or blood products.

Radical Nephrectomy benefits:

The benefits of this kidney surgery depend on factors such as the type and stage of cancer and the size of the tumors. In stage I of Renal Cell Carcinoma, the survival rate is around 90 per cent as the tumor is inside the kidney and has not affected other tissues. Post surgery, you can lead a normal life with urine production close to normal. You can opt for Laparaoscopic surgery for faster healing and recovery.

People should not be afraid since living with only one kidney is not a problem in case it functions properly.

A prostatectomy is the surgical removal of all or part of the prostate gland. Abnormalities of the prostate, such as a tumour, or if the gland itself becomes enlarged for any reason, can restrict the normal flow of urine along the urethra.There are four main types of radical prostatectomy surgery. These procedures take about 3 to 4 hours:

* Radical retropubic prostatectomy: Your surgeon will make a cut starting just below your belly button and reaching to your pubic bone. The entire surgery should take 90 minutes to 4 hours.

* Laparoscopic radical prostatectomy: The surgeon makes several small cuts instead of one big cut. Long, thin tools are placed inside the cuts. The surgeon puts a thin tube with a video camera (laparoscope) inside one of the cuts. This helps the surgeon see inside your belly during the procedure.

* Robotic-assisted laparoscopic prostatectomy: Sometimes laparoscopic surgery is done using a robotic system. The surgeon moves the robotic arm while sitting at a computer monitor near the operating table. Not every hospital can do robotic surgery.

* Radical perineal prostatectomy: Your surgeon makes a cut in the skin between your anus and base of the scrotum (the perineum). The cut is smaller than with the retropubic technique. This makes it harder for the surgeon to spare the nerves around the prostate, or to remove nearby lymph nodes. Perineal surgery usually takes less time than the retropubic way. There is also less blood loss.

For these procedures, you will be asleep (under general anesthesia) or receive medicine to numb the lower half of your body (spinal or epidural anesthesia).

* The surgeon removes the prostate gland from the surrounding tissue. The seminal vesicles, two small fluid filled sacs next to your prostate, are sometimes also removed.

* The surgeon tries carefully not to damage nerves and blood vessels.

* The surgeon reattaches the urethra to a part of the bladder called the bladder neck. The urethra is the tube that carries urine from the bladder out through the penis.

* Many surgeons will also remove lymph nodes in the pelvis to check for cancer.

* The surgeon may leave a drain, called a Jackson-Pratt drain, in your belly to drain extra fluids after surgery.

* A tube or urinary catheter is left in your bladder to drain urine.

Why the Procedure is Performed?

Radical prostatectomy is most often done when the cancer has not spread beyond the prostate gland. This is called localized prostate cancer. Other treatment options for prostate cancer are:

External beam radiation therapy, Implant radiation therapy (brachytherapy), Hormone therapy (androgen deprivation therapy), Cryotherapy of the prostate, Visits with your doctor and tests to check for changes in your prostate cancer (called active surveillance)

Sometimes, your doctor may recommend one treatment for you because of what is known about your type of cancer and your risk factors. Other times, your doctor will talk with you about two or more treatments that could be good for your cancer.

Factors you and your doctor must think about include:

* Your age and other medical problems you may have. Healthy men who will probably live 10 or more years often have this procedure.

* Side effects that occur with each type of treatment.

* How much the prostate cancer has spread.

Risks of this procedure are:

* Difficulty controlling urine (urinary incontinence).

* Erection problems (impotence).

* Injury to the rectum.

* Difficulty controlling bowel movements (bowel incontinence).

* Urethral stricture (tightening of the urinary outlet from scar tissue).

Transurethral resection of the prostate (also known as TURP, plural TURPs and as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH). As the name indicates, it is performed by visualising the prostate through the urethra and removing tissue by electrocautery or sharp dissection. This is considered the most effective treatment for BPH. This procedure is done with spinal or general anesthetic. A large triple lumen catheter is inserted through the urethra to irrigate and drain the bladder after the surgical procedure is complete. Outcome is considered excellent for 80-90% of BPH patients.

Indications:

BPH is normally initially treated medically. This is done through alpha antagonists such as flomax or alpha-1A reducatase inhibitors such as proscar and avodart. If medical treatment does not reduce a patient's urinary symptoms, a TURP may be considered- following a careful examination of the prostate/bladder through a cystoscope. As medical management of BPH improves, the numbers of TURPs have been decreasing. If TURP is contraindicated a Urologist may consider: a simple prostatectomy, in and out catheters, or a supra-pubic catheter to help a patient void urine effectively.

The process of TURP:

First an examination of the bladder is done vide cystoscope. The treatment of BHP is done by the process of alpha antagonists. Examples of alpha antagonists are flomax or alpha-1A reducatase inhibitors. Once the initial treatment of urinary problem does not cure the patient, TURP or TUEVP is done. This process is simple as it involves removal of parts of the prostate gland, which obstructs the urethra. The removal of these glands allows urine to flow easily. The operation is done by an urologist. A special tube is passed through the urethra and a hot wire loop is used to remove the overgrown area.

Risks:

Because of bleeding risks associated with the surgery, TURP is not considered safe for many patients with cardiac problems.

* Bleeding (most common).

* Clot retention and clot colic.

* Bladder wall injury such as perforation (rare).

* TURP Syndrome: Hyponatremia and water intoxication (symptoms resembling brain stroke in an elderly presenting patient) caused by an overload of fluid absorption from the open prostatic sinusiods during the procedure. This complication can lead to confusion, changes in mental status, vomiting, nausea, and even coma. To prevent TURP syndrome the length of the procedure is limited to less than one hour in more centers.

* Bladder neck stenosis.

* Urinary incontinence due to injury of external sphincter system which may be prevented by taking the Verumontanum of the prostate as a distal limiting boundary during TURP.

* Retrograde ejaculation due to injury of preprostatic (internal) sphincter system.

TURP/ TUEVP:

Hospitals is one of its kinds and you can undergo treatment of BHP here. Under the Urology Department you will get renowned practitioners. The supervision and the care of the non medical staff are worth a mention. It will take a day’s time in this hospital for this operation.

Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream (ejaculate). Vasectomies are usually performed in a physician's office or medical clinic.

There are several methods by which a surgeon might complete a vasectomy procedure, all of which occlude (seal) at least one side of each vas deferens. To help reduce anxiety and increase patient comfort, men who have an aversion to needles might opt for the "no-needle" application of anesthesia while the "no-scalpel" or "open-ended" techniques help to speed-up recovery times and increase the chance of healthy recovery.

Due to the simplicity of the surgery, a vasectomy usually takes less than 30 minutes to complete. After a short recovery at the doctor's office (usually less than an hour), the patient is sent home to rest. Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical lifestyle routines within a week, and do so with minimal discomfort.

Because the procedure is considered a permanent method of birth control (not easily reversed), men are usually counseled/advised to consider how the long-term outcome of a vasectomy might affect them both emotionally and physically.

Procedure:

The traditional incision approach of vasectomy involves numbing of the scrotum with local anesthetic (although some men's physiology may make access to the vas deferns more difficult in which case general anesthesia is recommended) after which a scalpel is used to make two small incisions on each side of the scrotum at a location that allows the surgeon to bring each vas deferens to the surface for excision. The vasa deferentia are cut (sometimes a piece removed), separated and then at least one side is sealed by ligating (suturing), cauterizing (electrocauterization), or clamping. Currently, there are several variations to this method that improve healing, effectiveness and help mitigate long-term pain such as Post-vasectomy pain syndrome (PVPS).

No-Scalpel vasectomy: Also known as a "key-hole" vasectomy, in which a sharp hemostat (as opposed to a scalpel), is used to puncture the scrotum (scrotal sac). This method has come in to widespread use as the resulting smaller "incision" or puncture wound typically limits bleeding and hematomas. Also the smaller wound has less chance of infection, resulting in faster healing times compared to the larger/longer incisions made with a scalpel. The surgical wound created by the No-Scalpel method usually does not require stitch(es).

Open-Ended vasectomy: The testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This method may avoid testicular pain as a result of increased back-pressure in the epididymis. Studies suggest that this method may reduce long-term complications such as Post-vasectomy pain syndrome.

No-Needle anesthesia: Fear of needles for injection of local anesthesia is well known.

Fascial Interposition: Recanalization of the vas deferens is a known cause of vasectomy failure(s). Fascial Interposition ("FI") helps to prevent this type of failure, increasing the overall success rate of vasectomy.

Vas Irrigation: Injections of sterile water or euflavine (which kills sperm) in to the distal portion of the vas at the time of surgery brings about a near-immediate sterile (azoospermatic) condition. The use of euflavine did however, decrease time (or, number of ejaculations) to azoospermia vs. the water irrigation by itself.

Complications of vasectomy:

Short-term complications include temporary bruising and bleeding, known as hematoma.