Open End Vasectomy
What is His Choice Vasectomy open ended vasectomy technique?
An open ended vasectomy technique allows the lower end of the divided vas deferens to remain open immediately after the vasectomy procedure. The end of the divided lower vas deferens will gradually heal closed.
The key word is ‘gradually’ and this is one reason recovery is quicker after a His Choice Vasectomy.
His Choice Vasectomy is not a closed end vasectomy technique.
A closed end vasectomy occurs when the lower end of the divided vas deferens is intentionally closed during the vasectomy using either a titanium clip or a suture.
Since sperm are continually made after a vasectomy, a closed end vasectomy can result in a quicker build up of pressure in the lower vas deferens.
Some who have a closed end vasectomy will experience more pain and discomfort after vasectomy. This can be due to increased pressure in the epididymis as sperm back up in the lower vas deferens and cause distention of the epididymis. In some patients this can cause temporary inflammatory epididymitis. This is temporary, does not require antibiotics but is easily treated with over-the-counter anti-inflammatory medication.
As pressure in the lower end equalizes within several weeks to months after the vasectomy procedure, the discomfort will gradually resolve.
Conventional vasectomy: An older technique
During older conventional vasectomy procedures, the lower ends of the vas deferens are always closed with either sutures or clips. The lower ends are closed because physicians worry leaving the lower end open will result in more vasectomy complications. They are mostly concerned about increasing the risk of vasectomy failure.
Instead, the opposite seems to be true: patients who have open end vasectomy are not at risk of more complications. Patients report less pain and quicker recovery after their vasectomy procedures. Vasectomy failure rates are not increased when the lower ends are allowed to remain open.
During conventional vasectomy, the physician will seal the ends of the divided vas deferens immediately. With an open ended vasectomy, the divided lower end will be left open and will gradually heal closed. The key word is ‘gradually’.
Patients who have an open ended vasectomy procedure may be more likely to have a successful vasectomy reversal. Why?
There are two theories as to why an open ended vasectomy may result in a more successful vasectomy reversal.
- There may be less epididymal disruption because the lower ends are allowed to gradually heal closed. The epididymis has more time to adapt to changes after vasectomy. The epididymis may have less distention and less disruption of sperm production.
- Open ended vasectomy may be more likely to result in formation of a small nodule at the open end as the leaked sperm are contained and absorbed. This nodule provides more room and a better place for sperm recycling and reabsorption. Sperm recycling occurs in the nodule and not in the epididymis. This allows for less pressure in the lower end, more continuous sperm production, and less damage to the epididymis after vasectomy.
Does open ended vasectomy cause more complications?
Is leaving the lower end open a good idea?
If you have an open end vasectomy, you can be assured your scrotum will not fill up with sperm! Regardless of the vasectomy technique used the lower ends will always heal closed.
All vasectomy procedures involve dividing each vas deferens and this results in permanent blockage of sperm transportation. Even after vasectomy sperm continue to be produced in the epididymis but these sperm are unable to travel to their intended internal storage areas.
The key to understanding what “open ended” means is understanding what is done with the lower half of the divided vas deferens during the vasectomy procedure.
If the lower end of the divided vas deferens is closed with anything (suture or a titanium clips) then this is considered a closed ended vasectomy.
If the lower end of the divided vas deferens is left open after the division then this is considered an open ended vasectomy.
Even with an open ended vasectomy technique the lower end will heal closed eventually but this closure will happen gradually.
Open ended vasectomy does not guarantee pain free recovery
This gradual closure of an open ended vasectomy may translate into an easier and quicker vasectomy recovery for many patients, but many is not all.
It is also equally possible, when the lower end eventually heals closed, some patients can have epididymal engorgement and pain later in their recovery phase. An open ended vasectomy does not guarantee you will not have some temporary pain as you recover from vasectomy.
Even with an open ended vasectomy procedure, the lower end will eventually heal closed and it is possible to have delayed symptoms of epididymal disruption. Each patient is different, each patient produces sperm of varying amounts, and every patient’s healing and response will be unique.
Benefits of open ended vasectomy?
Although it may not seem like a good idea to leave the lower end open and allow sperm to ‘leak’ out, an open ended vasectomy may have two important benefits over closed end vasectomy:
- Less post vasectomy pain during recovery
- Higher chance of vasectomy reversal success
Open ended vasectomy is associated with less swelling and inflammation. Healing is gradual and recovery is smoother. The lower end will heal closed and vasectomy failure rates are not increased.
Open ended vasectomy: Less pain
Less pain seems like a good idea after vasectomy… right?
When the lower end is closed off during a vasectomy, some patients will experience a sudden build up of pressure in the lower end within days of their procedure. This pressure can cause swelling and inflammation in the epididymis. This causes disruption of the tubules in the epididymis and sperm can leak out of small fissure in the epididymis. The body’s immune system will produce an inflammatory response and this is technically an inflammatory epididymitis.
This can occur anytime after the vasectomy but is mostly noticed within the first three (3) weeks.
This pain can easily be treated with over the counter anti-inflammatory medication (ie ibuprofen) and should gradually improve but why go through unnecessary pain or discomfort if there is a chance you don’t have to?
With open ended vasectomy the lower ends heal closed gradually. Eventually the ends will close.
Some patients may have temporary, delayed discomfort when the lower ends heal closed, but overall this seems to happen less when compared to patients who have closed end vasectomy.
Open ended vasectomy: More reversible
Sperm are produced in the epididymis. This sperm passively travel (meaning they don’t necessarily get there by swimming) up the tube and are stored behind the prostate.
If you have a closed end vasectomy and sudden pressure buildup in the lower end of the divided vas deferens after your vasectomy then the buildup of pressure will be transmitted directly to the epididymis. The increased pressure can cause disruption of the epididymis. This disruptions results in inflammation, which is your body’s immune response responding to a perceived insult.
Epididymal disruption is like over stuffing a plastic grocery bag. The bag could split open and the contents become exposed. When this happens in the epididymis sperm sperm can leak out of the epididymis and the body creates an inflammatory response to the exposed sperm.
In the short term, this inflammatory response can contribute to more pain and tenderness after vasectomy. In the long run, inflammation in the epididymis can cause epididymal scarring, epididymal disruption, decreased sperm formation, and may cause vasectomy reversal (should you ever need one) to be less successful.
What type of vasectomy procedure do we offer?
We perform an open ended vasectomy procedure with cautery and fascial interposition. This vasectomy has one of the lowest failure rates.
The key components of our vasectomy procedure are the following:
- No needle anesthesia technique
- No scalpel opening
- Minimally invasive vasectomy (one opening and nothing removed)
- Thermal coagulation to the inside of the upper end of the divided vas deferens
- Leaving the lower end of the divided vas deferens open to maintain decompression of the epididymis
- Fascial interposition between the divided ends
- No sutures required to close the skin opening
The end result is usually a smoother vasectomy recovery with an extremely low risk of vasectomy failure. Ice and frozen peas are not required!