UroToday - Of American married couples, 7% to 10% choose vasectomy as their form of birth control. This has made vasectomy the most common urologic procedure in North America with more than 555,000 being performed in the U.S and Canada each year. The new no-scalpel and no-needle vasectomy, a unique and nearly painless technique for anesthetizing the scrotal skin and vas, has been recently described. The report, by M.A. Monoski and colleagues from Cornell, is published in the July 2006 issue of Urology.

The procedure utilizes a jet injector (Madajet) which sprays an anesthetic solution through the skin and around the vas using a high-pressure injector that patients have described as a “gentle snap of a rubber band” against the scrotal skin. The authors believe that this technique may reduce men’s fear of the pain associated with the needle puncture involved in vasectomy and, in conjunction with the no-scalpel vasectomy, will likely enhance the popularity of vasectomy worldwide.

The procedure involves bringing one vas to the scrotal surface at the median raphe using the three-finger technique to stabilize the vas. For right-handed surgeons, the left thumb is placed on the median raphe and the left middle finger finds the vas on its posterior surface and brings it up to the median raphe and the index finger stabilizes the vas on top of the scrotum. The injector has a grove which stabilizes the device as anesthetic is sprayed through the skin to provide rapid anesthesia with a low volume of solution used. Both vasa are anesthetized as the onset of the procedure. No wheel is appreciated due to the low volume of solution required (2 to 3 sprays on each side of 0.1 ml/each). The absence of the wheel allows for easier palpation of the vas and completion of the procedure. The injection sites are recognized by small blanched discolorations of the skin.

Visual analog pain scales for the jet injection on a scale of 1 to 10 was a mean of 1.71 and the pain score for the subsequent vasectomy was 0.66. Of 1,391 no-needle vasectomies performed by the developer of the technique, Dr. Ronald Weiss, no hematomas occurred which differs from the nearly 2% incidence seen during standard vasectomies and the 0.5% seen with the no-scalpel vasectomy. The technique described has the ability to eliminate the needle-phobia many men have and can potentially increase the popularity of this procedure to new heights.

Urology. 2006 July;68(1):9-14
Reviewed by UroToday Contributing Editor Michael J. Metro, MD

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