ABOUT DR. JOSEF VLADARS

Dr. Vladars has been performing vasectomies in London since 1995.

As of 2020 he has performed approximately 12,000 vasectomies and is currently performing over 1000 vasectomies yearly.

Dr. Vladars utilizes the ‘NO SCALPEL’ vasectomy technique for which he was originally trained.

This technique has been shown in follow-up studies to have the highest success rate, lowest incidence of side effects and lowest risk of subsequent failure.

Since 2005, Dr. Vladars has also been utilizing the jet injector spray technique to provide ‘NO NEEDLE’ local anaesthesia for his procedures.

Dr. Vladars is a family physician and since 2014 has devoted his entire practice to vasectomies only.

VASECTOMY

What is a Vasectomy?

A vasectomy is a minor operation that makes a man permanently sterile (unable to make a woman pregnant). The doctor cuts and blocks two tiny tubes (vas deferens) in the scrotum.  After the tubes are cut, sperm produced in the testicles can no longer travel through these tubes to mix with semen (see drawing)

How is a vasectomy done?

A vasectomy can be performed in your doctor’s office.  Before the surgery, local anaesthetic will be used to make your scrotum numb.    Your doctor will then make a small puncture opening in the front of the scrotum.  Through this small opening, your doctor lifts out each vas deferens and cuts out a small section.  The flow of sperm is stopped by sealing the loose end of one of the tubes by cauterization.  The procedure usually takes less than 30 minutes and causes little pain. After the vasectomy, you should rest and limit your activities for 48 hours.  Most men can return to work on the third day.  You will have a very small scar on the scrotum, which will be nearly invisible when it is healed. 

Are there any risks to the operation?

Vasectomy has some risks.  However, most men have no problems and most of the problems that may occur are not serious and can be treated.  Common problems that may occur include the following: 

            –  mild swelling or bruising of the scrotum

            –  mild discomfort

Will I be sterile right after the vasectomy?

No.  You won’t be sterile right away.  It takes approximately 20 ejaculations after the vasectomy to empty storage sacs for sperm.  Wait until your doctor tells you that your semen is free of sperm.  You must continue to use reliable birth control until that time. 

Will a vasectomy change my sexual ability?

No.  A vasectomy won’t change your sexual ability or pleasure.  Some men report a better sex life because they don’t have to worry about an unwanted pregnancy. Vasectomy does not affect erections, your ability to ejaculate or the amount of ejaculate.  There is also no effect on your ability to urinate.  You may notice blood in the ejaculate with the first few ejaculations after surgery. 

 

 INSTRUCTIONS TO FOLLOW  BEFORE AND AFTER VASECTOMY

Please read these instructions carefully.  You should discuss any concerns about the vasectomy with Dr. Vladars.  Remember, vasectomy should be thought of as permanent procedure.

Before vasectomy:

            – Shower the morning before your procedure

–  If you are very anxious about medical procedures Dr. Vladars will discuss giving you a mild sedative to take prior to the vasectomy

–  You will need someone to drive you both to and from the office for your surgery if you are given a mild sedative before your surgery

–  Do not forget to shave scrotal hair prior to surgery as per your doctor’s instructions

-Please make the doctor aware if you get faint with medical procedures

– For safety reasons it is strongly recommended that everyone have someone accompany them to the office on the date of their surgery

After vasectomy:

  • Keep an ice pack on your scrotum for 10-15 minutes every hour for most of the first day after surgery and the next day if you find this helpful
  • Stay off your feet as much as possible the first one to two days after surgery
  • Wearing snug fitting underwear for a few days as it will be more comfortable
  • Limit your activities during the first two days, because this will help reduce swelling, discomfort and bleeding. (No lifting over 25 pounds or heavy pushing or pulling for the first 5 days after surgery)
  • Call Dr. Vladars if you notice painful swelling on either side of the scrotum
  • Call Dr. Vladars if your pain is not relieved by pain medication.
  • You may shower the evening after surgery as the small surgical opening is closed with skin glue which is waterproof
  • You may start having sex again 3-4 days after surgery, but use birth control until the Doctor tells you that you are sterile.
  • Talk to your doctor about when it is safe to return to work if you have a job that requires manual labor (heavy lifting and exertion)
  • Most men may return to light duty work two days after a vasectomy

            –    No sports for one week after surgery

  • Bring a semen sample to a lab when your doctor tells you to, so it can be  checked for sperm. This is normally done after 20 ejaculations or 3 months after surgery. The sample will be looked at under a microscope and you

      will be told about the results once the test results are returned to the doctor.

FURTHER INFORMATION ABOUT NO SCALPEL VASECTOMY MAY BE OBTAINED BY CLICKING ON DR. VLADARS NAME ON THE FOLLOWING WEBSITE

www.thompsonmedical.ca

BACKGROUND

Vasectomy is a minor surgical procedure that will provide men with a permanent method of birth control. The procedure will block the flow of sperm from the testicle to the penis. You and your partner would only choose to proceed with this procedure if you feel that your family is complete. Vasectomy should be considered an irreversible procedure. Technically vasectomies can be reversed but this involves a more complicated procedure performed in a hospital under general anaesthetic with less than 100 percent success rates. If there is any doubt that you may want to have more children I would recommend that you consider postponing having a vasectomy and utilize alternate methods of contraception.

If you are interested in sperm banking prior to your vasectomy please refer to the attached websites in the FAQ section for further information.

If you have decided to proceed with a vasectomy make an appointment with your primary health care provider to discuss your decision. They will then forward a consultation request to my office. On receipt of the consultation request, my office staff will contact you to make a consultation appointment so that I can discuss the procedure with you prior to booking your surgery. Your consultation appointment is normally done weeks prior to your actual surgery date. Fees for your consultation visit, procedure, and post vasectomy sperm test are covered by OHIP.

PRIOR TO THE VASECTOMY

Once you have decided to proceed with having a vasectomy please follow these important instructions before your vasectomy.

  • If you are normally anxious prior to medical procedures I will offer to provide you with a mild tranquilizer (Lorazepam) to be taken 90 minutes prior to the procedure. This medication may cause drowsiness therefore you will need to have someone drive you both to and from the office. It is not safe to drive on the day of surgery if you have taken this medication.
  • At the time of the consultation visit, I will instruct you to shave off the hair from the front of the scrotum below the penis prior to the procedure. The shorter you trim the hair the better! This may be done using foam or soap and a normal razor. I would advise against using creams such as ‘Neet’ on the scrotum due to the risk of a chemical reaction.
  • If your job involves heavy physical labour you may need to take some time off work after the vasectomy or request lighter duties, if these are available, for the first few days back to work.
  • It’s ok to eat and drink prior to your operation unless you get nauseated with medical procedures.
  • Wear clothing that you don’t mind getting mildly stained with iodine that is applied to the scrotal area prior to the surgery.

PROCEDURE

The vasectomy procedure is performed in the doctor’s office. Normally the entire time spent in the office for the procedure will be less than thirty minutes. Initially, the tube that carries sperm (vas deferens) is frozen with a device called a jet injector. This device is a small metal tube that uses air pressure to inject small amounts of anaesthetic through the skin into the vas deferens. Most men describe the sensation like being lightly snapped against the skin with an elastic. This is more comfortable than having a needle block which had been the traditional method to provide anaesthesia for a vasectomy. Each testicle has a vas deferens therefore each side needs to be anaesthetized. The anaesthetic begins working almost immediately. A small number of men may not be adequately frozen using the jet injector in which case a needle block will need to be performed. While we are waiting for the freezing to work, I will be setting up the rest of my equipment and discussing postoperative care with you.

With one vas deferens pulled up under the surface of the scrotal skin beneath the penis, a small puncture hole will be created with special vasectomy instruments. Once the vas deferens is exposed a small portion of the tube will be pulled out of the scrotum. After being cut the end of the tube that goes to the penis will be cauterized (burned) with a handheld cautery instrument (NOT A LASER). Once the cauterized vas has healed this will scar the end of the tube closed. This end of the vas deferens will then be covered with a portion of the tube’s sheath or covering using a titanium clip. This will reduce the risk of the cut ends of the tubes developing a reattachment between them in the future. The end of the tube that goes to the testicle will be left open and not cauterized. This is also known as the ‘open ended vasectomy’. This will allow the sperm that are being produced by the testicle not to be blocked at the end of the tube and risk causing increased pressure to be built up in the tube and testicle. Open ended vasectomy is also felt to reduce the risk of post vasectomy pain syndrome.

Once surgery on the first tube is completed it is placed back into the scrotum. Using the same hole that was initially created in the scrotum the opposite vas deferens is delivered out of the scrotum. The same procedure is performed on the opposite vas deferens. Once both tubes have been returned to the scrotum the small puncture hole that was created is sealed closed with a special skin glue. This will prevent any oozing from the hole after the procedure. The glue will waterproof the puncture hole and normally peels off by itself in 3-4 days after surgery. You may shower the night of or following morning after your procedure. Sometimes the glue does not stick well and can fall off in 1-2 days. When this happens the small puncture hole may still be open. If this occurs do not panic. You may experience mild oozing from the wound. My advice is to place a small bandaid over the hole and it will seal up by itself in a few more days.

 

POSTOPERATIVE INSTRUCTIONS FOR YOUR VASECTOMY

 

DR J. VLADARS

THOMPSON MEDICAL CENTRE

130 THOMPSON ROAD

LONDON, ON N5Z 2Y6

PHONE 519-601-8621

After your vasectomy you should go home and rest for the rest of the day. Put your feet up. Apply ice (ice pack or frozen vegetables) to the top of the scrotum for ten to fifteen minutes each hour for the next 6 – 8 hours. Freezing from the anaesthetic will wear off over the next 2 hours.

I suggest taking ADVIL/IBUPROFEN/MOTRIN  800 MG. immediately after the procedure and then taking 400 mg every 4 hours as needed.  You may require this medication for the next 1-2 days after surgery. If you are unable to use ibuprofen I suggest Tylenol/acetaminophen 1000 mg every 4-6 hours instead. If this medication does not provide you with effective pain relief I have also provided you with a prescription for a stronger pain killer which you may also use as prescribed.

 

AVOID strenuous activities over the next few days after your surgery. This will reduce your risk of developing complications. No lifting over 25 pounds or heavy pushing/pulling for 5-7 days.

You will feel more comfortable wearing snug fitting underwear or an athletic support for the next week.

You can shower within a few hours after the procedure to wash off the iodine used during the procedure or wait until the next morning.

 

The scrotal puncture will be sealed closed with skin glue. This will waterproof the incision and no oozing should occur after surgery. Do not pick off the glue. It will take approximately 3-4 days to come off by itself. Do not apply antibiotic ointment on the skin glue as this will cause it to come off quicker. If the glue falls off and the puncture site is still open cover it with a small bandaid for a few days and it will seal up without the risk of infection.

 

You may resume intercourse 3-4 days after surgery. Do not be alarmed if you notice blood in your ejaculate off and on for a few weeks after surgery. This is normal.

 

Expect to have some swelling, bruising and discomfort after your surgery. This is NORMAL. Bruising or black marks on the scrotum and penis in the week following your vasectomy is expected and not dangerous.

 

If you are experiencing:

  • severe pain not relieved by strong painkillers
  • severe swelling of the scrotum (it looks like your scrotum has doubled in size)
  • pain that is worsening during the week after surgery

please notify me. I can be reached by calling 519-601-8621

It is IMPORTANT to remember that you are still fertile immediately after the vasectomy and it takes approximately 20 ejaculations to clear remaining live sperm from the storage reservoirs. For this reason you and your partner will need to continue to use reliable birth control to prevent pregnancy until you are told that you are sterile.

Once you feel you have ejaculated at least 20 times or it has been 3 months since your surgery produce a semen sample by withdrawal during intercourse prior to ejaculation or by masturbation and catch it in the container provided.

 

Produce the sample on a weekday in the morning and within 2 hours take it to one of the laboratories listed in this pamphlet along with the supplied lab requisition. For patients outside of London I will likely have given you instructions as to which lab to take your sample during your surgery.  I will receive the results from the lab within a few days and my office will notify you of the results. Please call my office if you haven’t been notified of your results in 2 weeks. Once you are sterile you and your partner may discontinue using birth control. At this time you have a risk of approximately 1 chance in a 2000 of the operation reversing itself spontaneously and regaining your fertility. This risk is highest in the first year after your vasectomy.

If you are interested in repeating your sperm test I suggest doing this

6 to 9 months after your surgery when I feel that this small risk is greatest. Use the additional supplied container and take the sample to the same lab which performed your first test.

 

If your sample does not indicate that you are sterile you may use the second supplied container for your next sample. I will instruct you as to when to produce the next semen sample. The lab requisition you used initially will be kept on file at the lab for six months and you do not need another form.

 

I have not arranged a follow-up visit with you but I am willing to see you again at any time if you are experiencing problems related to your vasectomy. If I am unavailable and you feel your situation is urgent try contacting your own family physician or attending your nearest emergency department or urgent care clinic.

 

LABORATORIES

 

LIFE LABS

746 BASELINE RD. E.

LONDON

MON.– FRI. 7 AM – 3 PM

 

LIFELABS ST. THOMAS

ELGIN MALL                                                          ELMDALE HEALTH CTR.

417 WELLINGTON ST. UNIT 55                          25 ELM ST.

ST. THOMAS   MON- FRI 7:30 AM – 3:30 PM    ST. THOMAS. M-F 9:00 AM

 

RISKS OF VASECTOMY

It is normal in the week after the vasectomy to experience some mild bruising and swelling of the scrotum. Significant bleeding into the scrotum after surgery causing a hematoma (blood clot) is uncommon and in my experience occurs in approximately 1 in every 500 men that I operate on. This results in increased scrotal pain after the procedure and a delay in recovery from the vasectomy. If you suspect that you are developing a hematoma after surgery you should attempt to contact your surgeon or go to the emergency department of your nearest hospital if you are unable to contact your doctor. Almost all hematomas are treated with pain medication, rest, and time without the need for further surgery.

There is also a risk of epididymitis (tender swelling of the portion of the vas deferens that attaches to the testicle) in the weeks and months after the vasectomy. This may occur in up to 3% of men postoperatively in my experience. Most men will describe sudden onset of pain in one of the testicles with pain and swelling localized to behind the testicle. This will require treatment with antibiotics and anti-inflammatories.

Up to 20% of men after vasectomy may develop a small nodule, smaller than a pea size, at the end of the vas deferens attached to the testicle, where sperm are building up after vasectomy. This is called a sperm granuloma. Most men will be unaware of its presence, however, in a very small percentage of men the granuloma may become painful after vasectomy and require treatment with anti-inflammatory medication. It is very uncommon to require surgical removal of the granuloma in symptomatic men. If you become aware of this swelling in the scrotum between the testicle and base of the penis after vasectomy and there is no associated discomfort, treatment is not required.

There continues to be concern that having a vasectomy will increase a man’s future risk for prostate cancer. Review of recent studies looking at this concern has shown no substantive evidence that there is a serious risk. The American Urologic Association feels that due to the lack of evidence, this topic does not need to be discussed with prospective vasectomy candidates. I suspect that this will continue to be an area of ongoing research into the future.

Uncommonly, some men may experience chronic pain/ache in their testicles after their vasectomy. Studies have difficulty stating the exact incidence of chronic testicular pain but it may affect 1-2 /1000 men after surgery. The cause is likely due to chronic inflammation in the epididymis after surgery. Performing an open ended vasectomy where the end of the vas deferens attached to the testicle is not sealed closed (procedure performed by Dr. Vladars) should theoretically partially reduce the risk of post vasectomy pain syndrome. Treatments can include medication, nerve blocks and in the most severe cases, vasectomy reversal. It has been my experience that a large number of men with lingering discomfort lasting longer than six months after surgery will eventually experience improvement in their discomfort over time.

FAQ’s

  • Can I store sperm before my vasectomy?

Occasionally I am asked by men if they can store sperm for future use in the event that something unforeseen occurs in their life and they may want to father more children in the future. In London contact the Omega Fertility Center (omegafertility.ca) for further information.

Repromed is a clinic in Toronto that also offers this service. Access their web site for further information – www.repromed.ca

  • What happens to sperm production after vasectomy?

Sperm will continue to be produced in the testicle after your vasectomy. They will travel along the vas deferens to the site of the surgery. At this point the sperm will die and the body will reabsorb the sperm fragments so that there will not be a continual buildup of sperm.

  • Will I still ejaculate after vasectomy?

Sperm only contribute approximately 5% to the total ejaculate volume. Most of the ejaculate is produced by the prostrate gland which is unaffected by the vasectomy. You should not notice a change in your ejaculate after vasectomy.

  • When can I resume sexual activity after a vasectomy?

I recommend waiting at least three to four days after surgery to allow some healing to occur. Don’t resume sexual activity until you feel comfortable.

  • Is laser used during the operation?

No. Laser vasectomies are not commonly performed in Canada. It does not appear to provide any advantage over the ‘no scalpel’ technique.

  • Will vasectomy affect my sexual desire?

Some men are concerned that the operation will have a negative effect on their sexual desire. Vasectomy does nothing to affect the production of the male hormone, testosterone, and therefore should not result in any change in sexual drive. Men should not fear any change in erectile function after vasectomy due to the surgery. Also men that are experiencing erectile difficulties prior to vasectomy should not expect to experience any changes after their procedure.

  • Will I need to use birth control after the operation?

YES. It takes most men approximately twenty ejaculations after surgery to clear live sperm that are stored in the seminal vesicles. Do not stop using birth control with your partner until your sperm sample indicates that you are sterile.

  • Where can I take my sperm sample for testing?

 In London you may take your sample Monday to Friday with your laboratory requisition to:

  • Gamma Dynacare Laboratories at 230 Victoria St. and Richmond (Advanced Medical Group Bldg.)
  • Life Labs at 746 Baseline Rd. E. (at Wellington St. behind National Sports and Staples)
  • Lab Locations outside of London

St. Thomas – Lifelabs (Elgin Mall) 417 Wellington St. Unit 55

                      Lifelabs (Elmwood Health Centre) 25 Elm St.

Strathroy – Gamma Dynacare – 74 Front St. East, Upper Level

                  (Shoppers Drug Mart/ Strathroy Medical Clinic)

Aylmer – Lifelabs – 424 Talbot St. West, Suite L8

Woodstock – Lifelabs – 510 Ingersoll Avenue West or

        959 Dundas Street, Unit 206

Ingersoll – Lifelabs – 45 King St. East

Tillsonburg – Lifelabs – 86 Brock St. East

Chatham – Gamma Dynacare – 20 Emma St. Suite 107

                   Lifelabs – 857 Grand Avenue West

Windsor – Gamma Dynacare – 22-3176 Dougall Ave.

              -Lifelabs- 6505 Tecumseh Rd. East

Kingsville – Lifelabs – 54 Main St. East

 

Sarnia – Lifelabs – 481 London Rd.

 

Stratford – Lifelabs – 342 Erie St.

             

Further information on these locations can be obtained by accessing the Gamma Dynacare or Lifelabs websites.