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After a vasectomy 12 years ago, is recanalization possible? #1140/9

I had a vasectomy 12 years ago.  The method used was snip and stitching of vas tubes.  After all of these years of no concerns and worry free sex, my girlfriend is late.  Is recanalization possible after over a decade?



After all those years, recanalization following vasectomy is very, very unlikely.  It can happen but may well not be the cause of your girlfriend’s late period.  I would suggest that you have your girlfriend do a sensitive urine pregnancy test.

 

For peace of mind, I would suggest that you could go ahead and get a semen analysis to reassure yourself that recanalization has not occurred.

 















Below is what happens: (taken from Contraceptive Technology 19th edition):

For conventional vasectomy, the skin and muscle overlying the vas are incised with a scalpel. Generally only the area around the skin entry site is anesthetized. Some surgeons use a single midline incision, and others make two lateral incisions in the scrotal skin, one overlying each vas deferens.( Figure 17-6) The incision(s) are typically closed with absorbable suture after the vasectomy is completed.

An alternative approach, no-scalpel vasectomy, is currently being used in many programs around the world, including some in the United States. No-scalpel vasectomy (also known as NSV) was developed in 1974 in China. The anesthetic technique used with NSV includes a deep injection of anesthesia alongside each vas to create a perivasal block, as well as anesthetizing the skin. In addition, two specialized instruments, a ringed clamp and a dissecting forceps, are used in the NSV procedure. Both vasa are reached through the same small midline puncture in the scrotum rather than through a scalpel incision, and sutures are not needed (Figure 17-7). A detailed description can be found in No-Scalpel Vasectomy:

The NSV approach has a number of advantages over the conventional scalpel method: fewer complications, including infection and hematoma, less pain during the procedure and early follow-up period, and earlier resumption of sexual activity after surgery. Several modifications to the NSV approach , successful in the investigator’s hands, have been reported in the literature recently.

 EngenderHealth. No-scalpel vasectomy: an illustrated guide for surgeons. Third edition.  New York NY: EngenderHealth. 2003. Available at: http://www.engenderhealth.org/res/offc/steril/nsv/index.html

Black T, Francome C. Comparison of Marie Stopes scalpel and electrocautery no-scalpel vasectomy techniques. J Fam Plann Reprod Health Care 2003;29:32-34.

Chen KC. A novel instrument-independent no-scalpel vasectomy - a comparative study against the standard instrument-dependent no-scalpel vasectomy. Int J Androl 2004;27:222-227.

Jones JS. Percutaneous vasectomy: a simple modification eliminates the steep learning curve of no-scalpel vasectomy. J Urol 2003;169:1434-1436.


Here is how Professor John Guillebaud answered:

What is the risk of late failure?  Can total reassurance be given after say 1-2 years?

 

Unfortunately no.  Such late failures do occur, even after vasectomy with two subsequent negative sperm counts.  Our estimate from the Elliot-Smith clinic in Oxford (at which I have operated since 1970) was around 1:2000.  This still makes vasectomy much more effective than female sterilization: the American CREST study (in which over 10,000 women were followed-up for up to 10 years) showed a surprisingly high overall failure rate of 1.8% (American Journal of Obstetrics and Gynecology 1996 174:1161-1170). For every sterilization method assessed, at least 50% more failures were ascertained after 10 years as had been identified by the end of the first year.

 
Good luck!

 

Key Words:  vasectomy, snip, stitching, worry-free sex, period, recanalization, failure, unlikely, sensitive urine pregnancy test


              

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2010-01-14

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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