Cannot find a doctor willing to do an open ended vasectomy
oldsport
research I decided I wanted an open-ended vasectomy vs a closed end
one. A no scalpel vasectomy might be preferable but this is not as
important to me as the open ended procedure, where the testicular ends
of the vas deferens are left open and the other end is sealed.
Unfortunately I am in an HMO system and did not get the chance to meet
my doctor until today, just before my procedure. I brought in
supporting documentation of the benefits of an open-ended vasectomy but
he said he will not do this type of vasectomy based on the risk of
recanalization (That I might become fertile again). He acknowledged
open ended is superior for protecting against congestion and other Post
vasectomy problems, but simply refused to do this type of procedure
feeling this benefit did not outweight the detriment. I was surprised
as he is a younger doctor who is willing to do the vasclip procedure,
which I'm not interested in. I thought he would do the procedure upon
request but unfortunately I was wrong. Thus with the rest of the day
free I began calling just about every doctor in the bay area of
California and without fail, every doctor refused to do this type of
technique, or so their secretaries informed me. I can't believe I can't
find a single doctor to this procedure but that is the case. If needed
I am willing to travel anywhere in California but obviously the closer
the better. Can anyone point me in the direction of a doctor willing to
do the open-ended vasectomy? And since I probably will have to travel
if they do NSV as well that is a plus, but not a must. I've already
been through all the consultations and understand everything fine, I
just need to get it done.
Thanks
David
There are a couple of people on this board that have had an open ended
procedure. Hopefully they will post (or email) details of who performed it.
As you are prepared to travel, I guess location is not important.
The one thing I would say is that the skill of the surgeon has the biggest
impact on your chances of getting a long term problem - not the procedure
type. Clinical studies show that short term problems such as infection and
hematoma are statistically less when it's performed by surgeons who have
been performing the procedure for some time, and do them regularly. Also,
one of the few doctors treating post vasectomy problems (Pollock in Canada)
says on his page about the causes of PVP that "Rough" surgery is a major
cause. I think you need to take this into consideration when choosing the
surgeon and procedure type.
I'd agree that the evidence for open ended being statistically less likely
to cause long term problems is good, but there is a significant increase in
granuloma incidence. The reliablility, especially when combined with fascial
interposition is as reliable as the standard technique. However, this relies
on all things being equal - especially the skill of the surgeon.
So, as a scenario it may be that somebody is less likely to have a problem
with a conventional vasectomy done by an experiences surgeon, as opposed to
an open ended version performed by someone that only does them occasionally.
I'm not tyring to put you off here, as I'm an advocate of open ended. I'm
just saying that you need to find an experienced practitioner. I'm sorry I
don't have any names to recommend!
It's interesting that he's prepared to offer Vasclip, but not open ended.
That's surprising, as according to the original Vasclip data, the device had
a failure rate of 2.5% as compared to standard techniques which have a
failure rate of 0.05% (according to the UK sterilisation guidelines). I
can't think why this should be. Open ended is no less reliable than standard
vasectomy.
David
www.vasectomy-information.com
oldsport
this site.
www.vasectomy-information.com/pages/oevas.htm
And am going to fly to one of their offices. I agree with you skill is
equally important as the technique that is used. That is why I was
willing to be flexible on NSV or not, as I want the doc to do what
he/she feels comfortable doing. But I am not flexible on the method,
open ended. I realize the risk of congestion is very low, but tell that
to those suffering from it, I'm sure they don't find the low risk
statistics comforting. open-ended makes a lot more sense to me
personally and if the other end of the vas are properly sealed I see
the risk of recanalization as negligable. I will be going to one of the
docs on the list most likely. I'm still interested in hearing referals
to doctors for people who've had open ended though.
David
David
www.vasectomy-information.com
mark
over this. It's not that big a deal, so long as you have an experienced
urologist performing the vasectomy.
"oldsport" <stock...@yahoo.com> wrote in message
news:1104456160.4...@c13g2000cwb.googlegroups.com...
Bruce L.
news:1104456160.4...@c13g2000cwb.googlegroups.com...
open-ended vasectomy but
> he said he will not do this type of vasectomy based on the risk of
against congestion and other Post
"Congestion" is a word I have not heard regarding vasectomy. Does it refer
to the sperm that are "trapped" in the testicles after the vas is tied,
causing possible blowouts? (like I had.)
oldsport
out" some men even require epididectomies. It will always be debatable
what percentage of men suffer from Post Vasectomy pain vs some other
ailment causing pain and or congestion. I'm not going to take chances
with nuts. I'll go with the less problematic open-ended even if to most
it is statistically negligible. I'm not trying to promote hysteria, as
the vast majority of men are fine with closed-ended vasectomies, but it
definitely is not 100%. The doctor who refused to do the open-ended
acknowledged some men do suffer from congestion, his answer was we
don't know why. It's funny I had to find out about this on my own. My
theory is some men have the right enyzmes and proteins to absorb the
sperm trapped in the vas, other men don't and there's only one way to
find out but by then it's too late.
David
> to the sperm that are "trapped" in the testicles after the vas is tied,
> causing possible blowouts? (like I had.)
I don't know if congestion is the right word, but I know what you are
getting at. The congestion doesn't happen in the testicles though, but in
the epididymus. The testicles produce sperm and pump them out regardless of
if there is a blockage down the line anywhere or not. The epididymus is
where sperm are stored and matured. Some 50% of what is produced in
non-vasectomised men never leave it. They are broken down and absorbed
through the membranes of the epididymus wall.
The epididymus is a bit balloon like in that it has some expansion capacity.
When it reaches full expansion then blowouts happen at weak points in the
walls of the epidermis. It's actually the body's first line of defence to
protect the testicle. Blockages occur for all sorts of reasons. Sporting
injuries, std's urinary tract infections, bacterial infections, and a whole
list of other conditions. The blowout (granuloma) is the body's short term
protection method. That's in the case of non-vasectomised men.
Obviously all the above happen in vasectomised men too, but with
vasectomised men the blockage is obviously permanent. Once the body realises
the blockage is permanent, other mechanisms kick in. Hence granuloma's
mostly occur within the first few months.
With the open ended procedure, the testicle end is left open and the
prostatic end is sealed. If fascial interposition (folding some of the
tissue back over the end) is used, then open ended is as reliable as
conventional vasectomy where all ends are sealed. The "Gold standard" for
reliability btw, is where a portion of the vas deferens is removed, and
fascial interposition used - as opposed to techniques and devices where no
vas deferens is removed. However, the end doesn't remain open for long -
scar tissue forms and any granuloma forms by the scar tissue as opposed to
weak parts of the epidermis wall. About 60% of men get sperm granuloma's
after vasectomy - mostly asymptomatic ( you don't know they are there). With
the open ended procedure some 90%+ get sperm granuloma's but they appear to
be less troublesome.
Take a look at the picture at
http://www.vasectomy-information.com/pictures/diags/orig/sfactor.jpg for a
good cross sectional diagram of what we are talking about.
David
www.vasectomy-information.com
oldsport
I agree with your early post about the doctor's skill being of primary
importance. I think there can be problems with either type, open or
closed ended. Both have pros and cons which the individual must weigh.
I have weighed both and have decided I'd prefer the risks of open ended
vs closed ended.
David
> I agree with your early post about the doctor's skill being of primary
> importance. I think there can be problems with either type, open or
> closed ended. Both have pros and cons which the individual must weigh.
> I have weighed both and have decided I'd prefer the risks of open ended
> vs closed ended.
Absolutely. I'm just surprised that there aren't more practitioners offering
the open ended version bearing in mind that the evidence for it is a) long
term, and b) robust.
David
www.vasectomy-information.com
Bruce L.
My V-doctor, who has done 38,000 Vs (he looks to be in his early 70s) told
me he used to do open ended but no longer does. At the time, I only had a
vague idea of what he was talking about, and I did not press him for
reasons. I will be going back for an exam in a few weeks and I will ask.
"David" <david...@tesco.net> wrote in message
news:U5%Bd.503$va3...@newsfe3-win.ntli.net...
trif...@netscape.net
competence, the open ended procedure is superior (and reliable,
assuming interposition of the prostatic ends of the vas tubes). That
said, I wanted to point out that the risks of conventional vasectomy
aren't as dire as you suggest, even for the few men who might be prone
to congestion: after all, in those cases, a second procedure involving
reopening the closed vas tubes could be performed. So if congestion is
discovered after a conventional vasectomy, it is not necessarily "too
late."
Anyway, good luck on your procedure--and I wish open ended would become
more common. (By the way, it would be interesting if you could find
out from the doctor who performs your procedure if he ever performs
open ended vasectomies to relieve pvp due to congestion either after
conventional vasectomy or due to other causes.)
trifold
www.vasectomy-information.com
oldsport
typically doing open-ended. He mentioned he just recently operated on a
patient who had an open ended vasectomy and removed a plum sized
granuloma at 8 months post vaectomy. His argument against it was not
increased risk of recanalization, but increased risk of painful
granuloma. This sounds reasonable to me and I wonder what the incidence
of PVP being caused by granuloma vs congestion. As I mentioned I am
aware both methods have pros and cons and one must weigh which risk
they which to deal with. However I have not been able to find any
postings individuals complaining about pain resulting from granuloma
after an open ended vasectomy. I have found many postings detailing
pain from congestion. One has to take Internet postings with a grain of
salt as who knows the exact reason for someone's pain, and a well done
vasectomy of any method is the best insurance against problems, still
the volume of closed ended complaints vs open ended is telling.
trif...@netscape.net
>still
> the volume of closed ended complaints vs open ended is telling.
It's interesting re: the granuloma incidence after open ended. Still,
comparative data (closed vs. open ended) of any sort is probably hard
to get, since so few open ended vasectomies are being performed.
trifold
www.vasectomy-information.com
trif...@netscape.net
>still
> the volume of closed ended complaints vs open ended is telling.
It's interesting re: the granuloma incidence after open ended. Still,
David
> I have found many postings detailing
> pain from congestion. One has to take Internet postings with a grain of
> salt as who knows the exact reason for someone's pain, and a well done
> vasectomy of any method is the best insurance against problems, still
> the volume of closed ended complaints vs open ended is telling.
Isn't remarking on the number of complaints as posted to newsgroups and
saying the proportions are "telling" rather contrary to saying you need to
take them with a grain of salt??
To be honest, I think the scientific studies are probably a better guage
than a straw poll of postings here. I take it you have done a search on
medline http://www.ncbi.nlm.nih.gov/entrez/query.fcgi for open ended
vasectomy?
There has been a reasonable amount of research done into the open ended
technique - enough at least to indicate that despite the increased risk of
sperm granuloma, the incidence of pvp is lower than conventional techniques.
Unfortunately it hasn't really caught on. My feeling is that physicians are
worried about a) the increased incidence of granuloma, and b) a percieved
higher risk of failure. One UK specialist I am aware of was performing open
ended, but stopped them for the granuloma reason. He switched to performing
standard NSV.
Giraud
>>I have found many postings detailing
>>pain from congestion. One has to take Internet postings with a grain of
>>salt as who knows the exact reason for someone's pain, and a well done
>>vasectomy of any method is the best insurance against problems, still
>>the volume of closed ended complaints vs open ended is telling.
>
>
> Isn't remarking on the number of complaints as posted to newsgroups and
> saying the proportions are "telling" rather contrary to saying you need to
> take them with a grain of salt??
I read his message as noting that the *ratio* of closed ended complaints
vs open ended is telling. This is not necessarily contrary, I don't
think, asuming he meant that the thing which which you have to take a
grain of salt is the shear number of problem postings vs. no problem
postings. Even though the Internet postings are very biased toward the
problem cases, the ratio of those with problems that had open vs. closed
may still be somewhat valid, if enough samples exist. However, another
bias may be in the fact that open-ended are more rare and "specialized,"
and since there is much talk about them here, those who read the group
may be more aware or likely to have open-ended than the general
population (or vice-versa), especially if they chose that method due to
problems or research.
Sorry of the above sounds like gibberish - I just woke up...
--Giraud
oldsport
Oaks California. It's very late and I need to go to bed but I will give
a report tommorow. Thus far I am satisfied and glad I went with the
open ended NSV.
zimmerman
Sorry for the partial previous post..
I saw this message just today. Dr. Patrick Wherry in san
jose does
, open-ended. drwherry.com
did not help you, but might for someone else..
take care..
zimmer
oldsport
opening til Mid-March. That's why I went to Dr. L