The traditional incision approach of<unk>  involves numbing of the scrotum with local anesthetic (although some men's physiology may make access to the vas deferens more difficult in which case general anesthesia may be recommended) after which a scalpel is used to make two small incisions, one on each side of the scrotum at a location that allows the surgeon to bring each vas deferens to the surface for excision. The vasa deferentia are cut (sometimes a section may be removed altogether), separated, and then at least one side is sealed by ligating (suturing), cauterizing (electrocauterization), or clamping. There are several variations to this method that may improve healing, effectiveness, and which help mitigate long-term pain such as post-vasectomy pain syndrome (PVPS) or epididymitis, however the data supporting one over another are limited. * Fascial interposition: Recanalization of the vas deferens is a known cause of<unk>  failure(s). Fascial interposition ("FI"), in which a tissue barrier is placed between the cut ends of the vas by suturing, may help to prevent this type of failure, increasing the overall success rate of<unk>  while leaving the testicular end within the confines of the fascia. The fascia is a fibrous protective sheath that surrounds the vas deferens as well as all other body muscle tissue. This method, when combined with intraluminal cautery (where one or both sides of the vas deferens are electrically "burned" closed to prevent recanalization), has been shown to increase the success rate of<unk>  procedures. * No-needle anesthesia: Fear of needles for injection of local anesthesia is well known. In 2005, a method of local anesthesia was introduced for<unk>  which allows the surgeon to apply it painlessly with a special jet-injection tool, as opposed to traditional needle application. The numbing agent is forced/pushed onto and deep enough into the scrotal tissue to allow for a virtually pain-free surgery. Lidocaine applied in this manner achieves anesthesia in less than one minute. Initial surveys show a very high satisfaction rate amongst<unk>  patients. Once the effects of no-needle anesthesia set in, the<unk>  procedure is performed in the routine manner. However, unlike in conventional local anesthesia where needles and syringes are used on one patient only, the applicator is not single use and cannot be properly cleaned leading to concerns regarding infection control. * No-scalpel<unk>  (NSV): Also known as a "key-hole"<unk> , is a<unk>  in which a sharp hemostat (as opposed to a scalpel) is used to puncture the scrotum. This method has come into widespread use as the resulting smaller "incision" or puncture wound typically limits bleeding and hematomas. Also the smaller wound has less chance of infection, resulting in faster healing times compared to the larger/longer incisions made with a scalpel. The surgical wound created by the no-scalpel method usually does not require stitches. NSV is the most commonly performed type of minimally invasive<unk> , and both describe the method of<unk>  that leads to access of the vas deferens. Open-ended<unk>  * Open-ended<unk> : In this procedure the testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This method may avoid testicular pain resulting from increased back-pressure in the epididymis. Studies suggest that this method may reduce long-term complications such as post-vasectomy pain syndrome. * Vas irrigation: Injections of sterile water or euflavine (which kills sperm) are put into the distal portion of the vas at the time of surgery which then brings about a near-immediate sterile ("azoospermatic") condition. The use of euflavine does however, tend to decrease time (or, number of ejaculations) to azoospermia vs. the water irrigation by itself. This additional step in the<unk>  procedure, (and similarly, fascial interposition), has shown positive results but is not as prominently in use, and few surgeons offer it as part of their<unk>  procedure. Other techniques The following<unk>  methods have purportedly had a better chance of later reversal but have seen less use by virtue of known higher failure rates (i.e., recanalization). An earlier clip device, the VasClip, is no longer on the market, due to unacceptably high failure rates. The VasClip method, though considered reversible, has had a higher cost and resulted in lower success rates. Also, because the vasa deferentia are not cut or tied with this method, it could technically be classified as other than a<unk> .<unk>  reversal (and the success thereof) was conjectured to be higher as it only required removing the Vas-Clip device. This method achieved limited use, and scant reversal data are available. Vas occlusion techniques * Injected plugs: There are two types of injected plugs which can be used to block the vasa deferentia. Medical-grade polyurethane (MPU) or medical-grade silicone rubber (MSR) starts as a liquid polymer that is injected into the vas deferens after which the liquid is clamped in place until is solidifies (usually in a few minutes). * Intra-vas device: The vasa deferentia can also be occluded by an intra-vas device (IVD). A small cut is made in the lower abdomen after which a soft silicone or urethane plug is inserted into each vas tube thereby blocking (occluding) sperm. This method allows for the vas to remain intact. IVD technique is done in an out-patient setting with local anesthetic, similar to a traditional<unk> . IVD reversal can be performed under the same conditions making it much less costly than vasovasostomy which can require general anesthesia and longer surgery time. Both vas occlusion techniques require the same basic patient setup: local anesthesia, puncturing of the scrotal sac for access of the vas, and then plug or injected plug occlusion. The success of the aforementioned vas occlusion techniques is not clear and data are still limited. Studies have shown, however, that the time to achieve sterility is longer than the more prominent techniques mentioned in the beginning of this article. The satisfaction rate of patients undergoing IVD techniques has a high rate of satisfaction with regard to the surgery experience itself. Recovery Sexual intercourse can usually be resumed in about a week (depending on recovery); however, pregnancy is still possible as long as the sperm count is above zero. Another method of contraception must be relied upon until a sperm count is performed either two months after the<unk>  or after ten to twenty ejaculations have occurred. After a<unk> , contraceptive precautions must be continued until azoospermia is confirmed. Usually two semen analyses at three and four months are necessary to confirm azoospermia. The British Andrological Society has recommended that a single semen analysis confirming azoospermia after sixteen weeks is sufficient. Post-vasectomy, testicles will continue to produce sperm cells. As before<unk> , unused sperm are reabsorbed by the body.
Vasectomy
Hymenotomy
Chemical castration
Vaginectomy
Sacrohysteropexy
Menstrual extraction
Prolotherapy
Vasoepididymostomy