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"No-Scalpel" Vasectomy
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WebMD Feature

Jan. 28, 2002 -- Couples who've seen enough of the stork have two basic choices: birth control or sterilization.

Birth control can be very effective but has its drawbacks. Condoms and diaphragms get in the way, and health risks haunt users of the pill, implants, or IUDs. For those who've had enough little bundles of joy for one lifetime, sterilization is an attractive option.

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The downside: somebody has to take responsibility. Usually it's the woman. In the U.S., female sterilization is more than 2.5 times more common than male sterilization. Yet a woman who has her tubes tied faces a far more complex, risky, and expensive operation than a man who has a vasectomy.

New, "no-scalpel" vasectomies have made male sterilization simpler. Will it ever get simple enough for more men to step forward? Maybe.

"With the current incisionless approach, one still has to make a puncture in the skin," Nathaniel M. Fried, PhD, tells WebMD. "We are trying to take things one step further. We want to completely avoid bleeding and scrotal pain."

Fried, an assistant professor of urology at Johns Hopkins University, leads a research team working on an ultrasound vasectomy machine. It's not ready for prime time -- animal studies continue -- but a technology firm is backing the approach with an eye to eventual human tests.

How does it work? A vasectomy cuts a piece out of the tube -- the vas deferens-- that lets sperm leave the testicles and enter the semen. This is why a man with a vasectomy is said to be "shooting blanks." His sexual function and semen production is otherwise normal -- except that he can no longer get a woman pregnant.

The ultrasound device has three parts. One is a water balloon that covers the skin. Chilled water runs through the balloon to keep the skin from burning. The second part is a clamp that holds the vas deferens in place. The third part is an ultrasound machine that focuses sound waves on the vas deferens. At the point of focus, the ultrasound energy creates intense heat.

"The idea is to heat up or cook the vas," Fried says. "It immediately cooks the tissue so that the vas closes. Then healing of the tissue creates scar tissue that further blocks the vas."

In theory, this would be more palatable to men than the current no-scalpel technique. Invented in China, the procedure first numbs the scrotum with an injection of local anesthetic into the skin. With a needle-like tool, the doctor makes a small hole in the scrotal sac. The flexible skin around the puncture is stretched, and the doctor uses a small instrument to pull the vas from each testicle through the opening. The vas is then severed and closed, often with a cauterizing tool that seals the vas shut. If done on a Friday, a man can go back to work on Monday -- and play sports the next weekend.

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