OK, so you get an awesome ‘no scalpel vasectomy’ but that just means the doctor is holding the vas deferens in a ring forceps. Do you now ‘occlude’ the upper end, the lower end, or both? This is where things get a little convoluted.
Strangely enough, remove a segment of each vas is not effective because the two ends will simply re-attach. Dr Dick Beatty gets out the whiteboard with two occlusion scenarios:
Both ends are occluded
Closed Vasectomy results from blocking the lower end, potentially causing ‘blue balls’ from an increase in backpressure. You can’t just cauterise one end and leave the other open, or the tubes have a 10% risk of growing back. Closed vasectomy therefore requires both the upper and the lower end to be occluded – typically with electrocautery.
The concern with closed vasectomy is that the sperm have ‘nowhere to go’ and may lead to discomfort caused by congestion.
The lower end is left open
Open Vasectomy describes the scenario where only the upper end is occluded. In other words, The lower end is left alone so that sperm are free to swim upstream from the testicle through the open end.
Open-ended vasectomy is considered to be the gold standard method of occluding the vas deferens.
You may think that open vasectomy is quicker than closed vasectomy. Wrong! You can’t just cauterise the upper end and be done, because there would be a 10% failure rate. What else can you do to the upper end to ensure the vasectomy works? The answer is Fascial Interposition.