Vasectomy

VASECTOMY, the excision of the vas deferens. Usually, a segment 1–1.5 cm long is removed from the easily accessible part of the duct between the root of the scrotum and the inguinal ring. The operation is performed under local anesthesia. An incision is made through the skin and the vaginal tunic of the spermatic cord. The vas deferens, which can be felt as a dense cord in the posterior part of the spermatic cord, is dissected out, tied with two ligatures, and the part between both ligatures is excised. The skin is sutured tightly. Vasectomy causes the death of spermatogenic elements in the testicles and the development of interstitial tissue—Leydig cells. Steinach calls this internal secretory part of the testicle the puberty gland and attributes to it the formation of specific sexual hormones. The general condition of individuals who have undergone vasectomy, according to Steinach's data, improves, causing a revitalization and renewal not only of faded sexual characteristics but also of physical and spiritual strength. Steinach's observations did not subsequently find full confirmation. In some cases, vasectomy caused not only physical and mental weakening but even various forms of psychosis, and in some cases, complete atrophy of the testicle. Vasectomy is used in the Steinach rejuvenation operation, in so-called prostate hypertrophy, in recurrent epididymitis resulting from a focus of infection in the seminal vesicle, and for prophylactic purposes in tuberculosis of the prostate or seminal vesicle, to protect the epididymis from disease. In the latter two diseases, vasectomy is undertaken with the aim of interrupting the communication between the seminal vesicle and the epididymis. In the treatment of prostate hypertrophy, vasectomy pursues the same objective as castration, which was first successfully applied for this purpose in 1886 by Sinitsyn. The clinical effect of castration was explained by the reduction, mainly, of the glandular part of the prostate, which Deryuzhinsky managed to confirm experimentally in animals. Vasectomy was intended to replace castration, as it also causes atrophy of the prostate gland. Recently, vasectomy has begun to find wide application in prostate hypertrophy, since, according to the observations of a number of foreign and Russian authors, clinical recovery and improvement are obtained in half of the cases (Haberer, Werwath, Nikitin, Irger, Dunaevsky, and Temkin). Vasectomy usually yields success in the first and second stages of the disease. The reason for the favorable effect of vasectomy in prostate hypertrophy remains as yet unexplained. In those cases of hypertrophy where improvement from vasectomy does not occur, this operation is still indicated as a prophylactic measure against epididymitis, which may form as a result of catheterization.