Is Excision And Ligation An Adequate Vasectomy Occlusion Method?


Oct 26, 2015

I am considering a vasectomy, and according to the medical literature (see links to citations below), the recommended methods for vas occlusion are cautery and/or fascial interposition (preferably both methods).

However, I have consulted with two local urologists, and neither of them use either of these techniques. Instead, both simply do an excision and ligation, and one of them takes an additional step of folding back and suturing the ends of the vas deferens. Both physicians have very good credentials and are highly experienced.

Is it unusual for urologists (in the U.S.) to perform only excision and ligation without any cautery or fascial interposition, or is excision and ligation still commonplace and considered good practice? Is it important to perform cautery and/or fascial interposition, and should I therefore continue to look for a urologist who performs one or both of those techniques?

Note, I am particularly concerned about long-term recanalization (i.e., a year or more after the procedure). I know the rates of late recanalization are generally assumed to be low, but as I understand it, the true rate is difficult to ascertain due to a lack of systematic long-term follow-up.

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I've attached 2 images of how it looks from the side and also front-on (which shows how it caves in now). I know it's not a huge thing and is purely cosmetic.

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Their recommendation is no lifting for 2-3 weeks. No bike riding for the same time. To take their over-the-counter prescription of stool softeners for 15 days. DO NOT bear down. Eat a high fiber diet. Otherwise get back to life. And today is day 2 - went shopping, walking and feel totally great. Again, the only sensation is a little tiny bit of fullness, which is normal considering the hemorrhoid has been bandied which makes it swell, until it falls off.
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Hemorrhoids :: Wet Tissue Method To Push Them Inside

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This is how I would advise...

Right after your bowel business, take 3 wet wipes (pref the flushable type - otherwise do not throw into toilet bowl).

I use the first for cleaning. I would wipe twice with it (mine is 19x20 cm)

Then I would fold the second into half, wipe once, then fold again.

Position 2 fingers onto the center of the wet wipe (now quarter-sized) and push gently into anus.

First push at the center of piles (I have 2 big and 1 small, the smaller one most painful).

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Repeat one or twice more, then begin targeting the piles, pushing them in.

Total of 6-8 times shd do the trick.

Third wet wipe? Just a spare. I usually used it to confirm that it is clean.

But why wet tissues? Because they provide enough traction to draw the piles in, but wet enough to make it painless, and tough enough not to break.

Tips:

1. Experiment with different hands when pushing. I used to do it with the hand I normally wipe with, but my first finger started to ache after 3 months. Then I tried the other hand, and behold, angle is such that it is much easier to push in. And because it takes less effort, my finger of that hand has not ache even now.

2. Squeeze your anal muscles gently after the piles have been push in. If you feel a slight sensation of piles being drawn in fully, then you'll know it is done. Even if not, as long as your piles is no longer painful nor interfere your life, it shd be considered ok.

The whole thing only takes one more min in the toilet. And by using flushable wet tissues, it is so convenient, you can just throw into the toilet bowl, at home or outside.

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That is, in the first 6 weeks...

Walking with aids only

No physio

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I take 1 blood thinning tablet for 35 days

No stockings

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The first two weeks were tough but I had had no strains or injuries. my first hip is very strong and doing an admirable job of holding up the new lefty.

After my 7 week check with the first I was advised to slowly build up strength (I drove to the appointment) but was also given some lifetime restrictions of no impact sports, twisting or pivoting to preserve the hip for as long as possible. (My surgeon said I can do the splits, run marathons and take up rugby if I wanted to but he would see me back in his office in 5 years for a revision!!!). Because I was waiting for the second hip to be done my exercise was restricted by pain so I kept fit by swimming.

I know there is no right or wrong and every method depends on the consultant but I have been surprised at the number of stresses and strains that some people have suffered after being made to do exercises by PT's.

I have read about torn tendons, inflamed muscles, swollen knees and ankles and wonder if there is any correlation to the amount of exercise we are given.

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2 questions:

Does anyone have experience they can share of the pros and cons of this newish method of operating  ?

Are there centres in Somerset / South West who offer this treatment?

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Vasectomy :: Too Risky

After being all set and really enthusiastic to go get myself a vasectomy and finally get to enjoy no more worries or needing any more birth control, I did a lot of research online and on men's health and forum posts.

The unknown and unpredictable risks of being one of that certain small percentage of all men that will have problems directly from a vasectomy seems too great for the benefits.

A certain percent of all men will get complications and have problems after a vasectomy. As many as 15 percent or more of all vasectomy men can have complications, that's nearly one of every six men with vasectomies !!! The percentage is still being debated but it seems to go higher each year and higher with each new study done. Most seem to be fairly mild problems with fast cures and quick results. But a very small number or smaller percentage have major and long lasting problems. Maybe beginning so many years later that many men will see no connection between later problems in life and his vasectomy done many years or decades earlier.

The cure rate for fixing chronic pain and immune system troubles seems to be very low. Dr.s don't seem able to get any cures to work for the very few men most badly affected by vasectomy complications.

Most men have no big problems at all or just little long term annoyances like slight pain or decreased ejaculation force or intensity that they feel are well worth the birth control results they wanted from a vasectomy. Some have trouble and get cured. The two biggest long term problems with fewer cures are chronic long term pain afterward and immune system problems in men reacting to their own sperm cells.

No one seems to know ahead of time which men will do fine and which men will have big problems from a vasectomy.

Some men have troubles right away and some don't have any troubles until years or even decades later. Some men do great and never have any problems at all.

One big problem a very few men have is from their own sperm trapped and leaking into other unnatural parts of their bodies (body parts not intended to store sperm) every day with no outlet. Then their own immune systems are stuck needing to dissolve and break down hundreds of millions of new sperm produced by a man's testicles every day of his entire life. New daily sperm that all vasectomies totally block from leaving his body at all. His body is forced to break down all that daily production of sperm cells and rid his body of that pent up sperm being manufactured inside his testicles daily.

All sperm have only one half of each man's own genetic materials, the female's egg provides her half of the total chromosomes needed to make a new and unique baby.

All of the cells in a man's body have his full set of chromosomes inside every cell, except his sperms which only have half of his chromosomes. Men's normal body cells are recognized by his own immune system as being his own cells. Sperm have only half of his chromosomes and sperm seem to be seen as invading stranger's cells once they leak into other parts of a man's body after a vasectomy closes the only escape path for all his sperm to leave his body. The pent up sperm leak into the scrotum and get outside of the normally enclosed testicle and vas deferens system that exits his body before a vasectomy. This leaked out and pent up sperm then need to be digested in the scrotum by a man's own immune system to be destroyed and gotten rid of.

It seems for a very few men that the same digestive cells that dispose of pent up sperm inside the scrotum can travel up into and deep inside the two testicles by traveling the same exact exit leaks that the daily production of sperm use to exit out of the testicles. Even vasectomies that completely seal the testicle end of the vas usually form some leaks to relieve the pent up pressure inside the testicle from the never ending production of more sperm daily inside the testicle.

Some men seem to end up being slowly or more quickly castrated as these same immune system digestive cells enter into the deep interior of their two testicles and begin digesting the insides of both testicles and all of the delicate sperm making factories and tissues inside the testicles. Their own immune system digests the inside of their testicles just as it would digest all of the pent up sperms that cannot exit his body after the sperm finish forming and leaving his testicles into the rest of his body.

Long term chronic pain in the testicles after a vasectomy can be a huge problem for some men too. Some have it soon after and some have it years later. No one seems to know why or how to provide a cure for many of these men. It could be obvious pain from having pressure build up from sperm trapped inside the testicles. Or pain from the insides of the testicles and epididymis slowly being destroyed and dissolved by the man's own immune system. Or pain from nerve or tissue damage that occurred during the vasectomy cutting and when closing the ends of the vas.

No one can predict which men will have troubles before they occur.

I'm still holding out for new and better methods of male birth control for myself. Some new ones are in development that sound much better to me.

Just look it up yourselves on line before you take the jump to get your vasectomy. And read men's vasectomy problems on here first and make up your own mind. It sounds like few Dr.s want to tell every patient in detail about these big problems because of the small number of men who will have the biggest long term problems afterward.

But for those unlucky men with major problems there are few cures to get relief or repaired.

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