VASECTOMY, AS A MODERN METHOD OF CONTRACEPTION - A REVIEW OF THE LITERATURE

Abstract

A vasectomy is a procedure that involves the severing of the sperm ducts on both sides, thus stopping sperm from moving from the testicles through the ducts to the ejaculatory ducts. The procedure of vasectomy is relatively simple. It is also associated with few complications. The good news is that it can be performed in an outpatient setting, meaning that the patient doesn't need to stay in hospital. The convalescence period following the procedure is approximately several days. Currently, the most widely used technique is minimally invasive non-scalpel vasectomy (NSV). This technique uses specialised tools: ring forceps to grasp the vas deferens percutaneously and a chisel. Before the procedure begins, the doctor applies a local anaesthetic by injecting it into the scrotal skin or using a pneumatic injector for a needle-free anaesthetic. Using the three-finger technique, the surgeon locates and grasps the vas deferens percutaneously with forceps. The next step is to separate the skin over the vas deferens without cutting it, creating a wound smaller than 10 mm in diameter. Once revealed, the vas deferens is cut. This is achieved either by excising a short segment (approximately 3 cm) of the vas deferens, or without this step. There are a number of ways to close the ends of the cut vas deferens, and the most suitable one is selected based on the particular circumstances. One option is to sew the two ends together. Use surgical thread. Alternatively, they can be closed with surgical clips. Another option is to seal them using electrocautery or wrap and stitch them up. This reduces the risk of the vas deferens opening again, which is a key consideration in this field. A further possibility is to tie off one end of the vas deferens, leaving the other end open on the side of the testicle. This is intended to reduce the risk of post-operative testicular pain. Surgeons perform this procedure on both sides of the scrotum. The wounds are not sutured, leaving only small scars following the healing process.

It is estimated that the effectiveness of vasectomy as a contraceptive method is 99.9%, with the risk of pregnancy being 1 in 2,000. This is due to the possibility of spontaneous recanalization of the cut vas deferens, which can result in the formation of new channels within the tissue. Following a vasectomy, it is possible to restore the continuity of the vas deferens. The effectiveness of these procedures in specialised clinics is 80%, but they are associated with high costs and are much more technically challenging than vasectomy. Another option is to collect sperm directly from the testes. Then the sperm can be used for in vitro fertilisation (IVF). It is also worth considering the option of cryopreservation (freezing) of sperm obtained before vasectomy, which can be used for fertilisation in the future. Undergoing a vasectomy is a decision that should be made with full awareness of the fact that the procedure is intended to make the man completely infertile.