My husband had a vasectomy 8 months ago he has had more then 40 ejaculation since his surgery, or maybe even more. The semen analysis came back with more then 20 hpf. Motile and non motile sperm were seen. Could his vasectomy have failed, or can it take a long time to become sterile? Thank you.
Dr. McHugh’s answer:
There two scenarios here. It is possible that the vasectomy has successfully divided the vas and that the sperm are, for whatever reason, slow to completely clear. If this is the thinking you would re check after another twenty or so ejaculations. On the other hand this may represent a recanalization of the vas tubes, a small channel, that has reconnected the vas tubes. In this case another vasectomy would be performed. A couple of things: You could have a formal semen analysis performed to actually get a count, it is possible that 20 per highpower field correlates with a very low total count. Some feel that after a vasectomy less than 100,000 on a semen analysis is acceptable. I have experienced your particular situation about five times in my career and I have repeated the vasectomy. Interestingly each time it corrected the small numbers of sperm that persistently showed up on microscopic exam.
I have been using the Madajet Injector for many years. It works better on thin scrotal skin than that with prominent rugae. For the anxious male, of whom there are many, the urologist stating “I am not using a needle” and the patient not seeing a needle is a beneficial aspect of this device.
No-Needle Anesthesia Reduces Pain Before No-Scalpel Vasectomy
Urology – March 15, 2008 – Vol. 24 – No. 01
No-needle jet anesthesia results in reduced pain only at initiation of vasectomy compared with traditional needle administered anesthesia.
Article Reviewed: Comparative Analysis of Effectiveness of Two Local Anesthetic Techniques in Men Undergoing No-Scalpel Vasectomy. White MA, Maatman TJ: Urology; 2007; 70 (December): 1187-1189.
Comparative Analysis of Effectiveness of Two Local Anesthetic Techniques in Men Undergoing No-Scalpel Vasectomy.
White MA, Maatman TJ:
Urology; 2007; 70 (December): 1187-1189
Background: Improvement in vasectomy technique occurred with the introduction of the no-scalpel vasectomy. This still requires anesthesia of the skin, which traditionally requires use of local anesthesia via a hypodermic needle and associated pain. Introduction of the no-needle jet injection of aerosolized local anesthesia has claimed to reduce pain from vasectomy further. Objective: To compare the visual analogue pain scores after using no-needle jet anesthesia versus needle delivery anesthesia at the time of no-scalpel vasectomy. Design: Prospective, single blinded, nonrandomized study. Participants: 50 men (age range, 26 to 45 years) undergoing no-scalpel vasectomy. Methods: With each patient, 1 vas deferens was anesthetized with the MadaJet XL no-needle jet injector utilizing 0.3 mL of 2% lidocaine with epinephrine and the other side was anesthetized with mepivacaine through a 27-gauge needle. The patient was blinded to which method was used on each side. Visual analogue score questionnaires were given to each patient to assess pain at time of anesthesia and for the procedure to follow.
Results: The average visual pain score for the jet injection side was 1.56 of 10 and the needle injection side was 2.12 of 10 (P <0.029). There was no significant difference in the visual pain score for the vasectomy procedure itself after the 2 anesthetic methods.
Conclusions: No-needle jet infiltration of local anesthesia results in less pain at the time of the injection, but does not change the pain score for the vasectomy itself.
Reviewer’s Comments: This is the first study to compare a different anesthetic delivery system, the jet infiltration, versus traditional injection therapy. The study was powered appropriately to ensure a potential difference could be seen although only 50 patients were included in the study. The study was unique because both techniques were performed in each patient, and therefore eliminating any immediate differences between patient populations. It was also a single surgeon experience. As new technology develops to make vasectomy as “pain free” as possible and thereby more acceptable to men, more attempts at evidence-based practices like this should be performed. (Reviewer–Ajay K. Nangia, MBBS).