So the tube has been divided, leaving an upper end and a lower end. Do you now block the upper end, the lower end, or both? This is where things get a little convoluted. Dr Dick Beatty gets out the whiteboard with three scenarios:
You block the lower end, leaving the upper end open
The lower end is blocked, the sperm have ‘nowhere to go’, so this is called a closed vasectomy. ‘Closed Vasectomy’ means that the lower end is blocked.
You can’t cauterise just one end and leave the other open, or the tubes have a 10% risk of growing back. When heat is used on its own, you therefore ‘have to’ seal both ends …
You block both ends
Closed Vasectomy also results from blocking both the upper end and the lower ends and is the most common form of closed vasectomy. Heat in the form of electrocautery may be used on its own to seal tube (this is done before the tube is divided).
The concern with closed vasectomy is that the sperm have ‘nowhere to go’ and may lead to discomfort caused by congestion.
In the UK, you get a closed vasectomy and this is how Dr Beatty started doing vasectomies.
You block the upper end, leaving the lower end open
Open Vasectomy describes the scenario where the lower end is left untouched so that sperm are free to swim upstream from the testicle through the open end.
Open-ended vasectomy is considered by many Vasectomists to be the gold standard method of performing No Scalpel Vasectomy.
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.