Blogfinger

Georgia on Route 95 heading south, stopping for gas and looking around. It seems we reached a crossroads.   PG photo.  Left click for full view.

By Paul Goldfinger, MD, FACC.  2013 on Rt. 95  Re-post 2020.

Sometimes in life you reach a crossroads, and in this case you can choose between a drink or a no-needle, no-scalpel vasectomy.  If you are in the market for a permanent pregnancy preventer, then maybe you would consider doing both.

When I saw that billboard, however, my interest as a physician was raised significantly  (perhaps “raised” is not the ideal verb) because I couldn’t figure out how that promise could be kept.

For those of you unfamiliar with this procedure, the vasectomy is a surgical intervention performed on the male to prevent any of his sperm from ever reaching the promised land.  It is the most commonly performed urological procedure.  About 500,000 are done each year in this country.    The operation is minor and safe in the hands of an experienced surgeon. It rarely fails to work, and it frees up the female from using contraceptives or having surgery herself.

So, when I got to a Wi-Fi zone, I had a Starbucks and checked out the new method.  In the traditional form of the technique, a local anesthetic is administered by a thin 1 1/2 inch needle which is gently used to numb the scrotum skin and then penetrates further to reach the vas deferens (ie the spermatic cord) a long tube whose job is to transmit sperm from the testicles to the penis.  An incision is then made, and the vas deferens is cut and tied off. There are two vas deferenses, so usually two incisions are used. 

The new technique was developed in China where a lot of men are fearful of the needle/scalpel method.   The numbing is accomplished using a high pressure spray device  (“a jet injector” made in New Jersey) which numbs the skin and the deeper tissues—thus, no needle.   Then, the scalpel incision is avoided by creating a self sealing puncture hole which allows the surgeon to do the job.  As you might imagine, this procedure requires a lot of experience, but it attracts many men who fear the needle and the scalpel more than their wives.  Side effects including bleeding and infection are less with this new method. It also feels like you are dragging your scrotum around for two weeks.

The bottom line is that the surgeon still has to anesthetize the area and he still has to cut the vas deferens. But this new technique gets the job done with less discomfort, less psychologic distress, and reduced risk of side effects. If you consider this procedure, make sure that the surgeon has had a lot of experience. If you are a married woman  who has had all the children she wants, you might suggest this to your spouse, and then go with him to the doctor and don’t let go of his hand.

Note that they do it at NYPresbyterian Hospital. It is an outpatient procedure  and it takes about 30 minutes or less. Dr. Stein  (the urologist on the billboard) charges $490.00, but, if you want it reversed, the charge is $4,900.00.  However, reversal surgery doesn’t always work.

BRUCE SPRINGSTEEN with DARLENE LOVE:   “A Fine Fine Boy”