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I’m 44 years old. Long story short, I’ve seen numerous doctors over the years but just recently got serious about getting a vasectomy. After seeing a doctor who specializes in NSV open-ended (which is what my research said to me I should get), he immediately declined because of my “abnormal” genitalia and referred me to a female urologist who specializes in “complicated” surgeries.I saw her Feb. 8, and her take on my “situation” was that, although my genitalia is otherwise “normal”, my scrotum does hang unusually close to my body, and she would prefer to knock me out and have me totally relaxed so she can do a NSV close-ended with minimal damage, bruising, etc. She works under a magnifying glass to avoid cutting any extraneous nerves and blood vessels to ensure as little blood loss as possible and a more comfortable experience.
My GP and a urologist he referred me to would do a conventional two-incision closed-ended vasectomy, which is why, I’m assuming, neither ever commented on my “abnormal” genitalia–they wouldn’t have any difficulty finding the vas, like they would if they did NSV. Reasonable?
While I do prefer the thought of a NSV versus a conventional–no incisions, per se, and minimally invasive, I don’t really like the idea of a general anesthetic. Am I more at risk for post-vasectomy pain with one procedure over the other? Am I high risk anyhow, regardless of procedure?
Am in Canada, living under the evil of socialized medicine, so am sure that money is not an issue for the doctors involved. A dissenting opinion to tip the scales in one direction or the other is greatly appreciated. Thank you!Dr. Edward Karpman
Some men do have a hypolpastic scrotum which is less pendulous and supports the testes very close to the body. This type of scrotum usually has a thick wall making it even more difficult to feel the intra-scrotal contents. A very small percentage of men have this condition making vasectomy more difficult. More commonly, men will have situational scrotal tightness or contraction secondary to a cold room or fright from an impending scrotal examination. The latter situation might explain why one urologist felt he could perform the vasectomy in the clinic whereas the other felt you might require a general anesthetic. The scrotum will always relax when under general anesthesia making the vasectomy VERY easy to perform. If you do get a general anesthetic then it really does not make a difference as to which type of vasectomy they perform (Scalpel or NSV) since you won’t feel anything.
Regarding post-vasectomy pain: Post vasectomy pain is not related to the type of incision your surgeon uses for the vasectomy. It is believed to be due to back pressure on the epididymis after the vasectomy. Leaving the testicular end of the vas deferens open ended MIGHT help decrease post vasectomy pain, but not a guarantee. This is a very infrequent occurrence after a vasectomy, regardless of the approach.
Regarding being a high risk for a vasectomy: In my opinion, there really is no such thing as a high risk vasectomy since it is a very simple procedure performed on a routine basis in doctor’s offices all around the world. In the US alone over 500,000 vasectomies are performed annually. Complications from this procedure are very small regardless of the type of scrotum you have.
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