The Urology Place No-Scalpel, No-Needle Vasectomy and More

Why no scalpel?  The no scalpel approach results in less bleeding, infection and pain. It can be quicker. Click here for a comprehensive review. The technique takes time to learn and Dr Kella has been committed to bringing it to hundreds of patients at The Urology Place.

We use techniques approved by the American Urology Association to keep failure rates less than 1%. We offer an open ended technique to further reduce the risk of pain. Learn more here.

At The Urology Place, we want you to feel relaxed and get back on your feet as soon as possible. We have invested in a nitrous gas system that make the vasectomy as anxiety-free and PAINLESS as possible. Also, it is very safe. You can drive home afterwards. The nitrous is available for approximately $100. No one else in South Texas or Austin takes these steps to make your vasectomy as comfortable as possible.

What happens during the vasectomy procedure?

Keeping it Pain Free

To begin, we numb the area with lidocaine. With our no-needle technique, we use what’s called a MadaJet to actually spray on a local anesthetic. Sometimes, we may elect to use injected lidocaine. We use a very tiny needle to minimize discomfort. In addition, those wanting the least painful route should ask about nitrous gas. The process take a couple minutes and patients have been very happy with using the nitrous/oxygen mix.

The Opening

Next, a special instrument is used to make a tiny opening in your scrotum the size of this dash —. At The Urology Place, we specialize in performing your entire procedure through this single tiny opening. We gently move around your blood vessels and nerves to locate and then isolate your vas deferens, or “vas” for short. Some doctors cut across your blood vessels and nerves to speed up the procedure; we disagree with this technique.  The no scalpel approach usually does not even need a stitch afterwards. The elasticity of the skin closes the opening naturally.

Sealing Off your Vasa 

Once we have located your first vas, we carefully cut it. We then use pinpoint heat cautery to seal off your vas deferens tube. Dr Kella uses an open ended procedure, meaning we only seal off the upper portion of the vas, leaving the lower half of the divided vas deferens open. Next, we do an “interposition” or put the ends of the vasa into separate compartments. Usually, we can locate your second vas deferens via the same tiny hole and repeat the procedure without any additional openings.

What is a vasectomy?

A vasectomy is a minor surgical procedure where a doctor disconnects the tubes (called the vas deferens) that carry a man’s sperm from his testicles to his ejaculatory ducts. This prevents his sperm from mixing with his semen during orgasm. The good news? You will not notice any changes in your orgasm as a result of a vasectomy procedure. Further, your ejaculate flow rate and volume remains the same. Your semen just no longer contains the sperm cells that allow for pregnancy. Although reversals are sometimes possible, a vasectomy is considered a permanent contraceptive procedure and is one of the safest and most effective contraceptive options. In fact, one out of every six men over the age of 35 in the U.S. has had a vasectomy.

Does insurance cover the cost of a vasectomy?

Most insurance plans cover the cost of a vasectomy. They typically require you to have one pre-procedure office visit and then a second appointment on a different day for the actual procedure. If you are committed to a vasectomy and don’t want to deal with your insurance rules, we have a convenient same day self pay option.

How much does a vasectomy cost?

If you are paying out of pocket for your vasectomy, we can provide you with both the consultation and the procedure on the same day for a prompt-pay price of $750. Insurance otherwise covers a vasectomy but you usually are required to have your consultation separate from the procedure. There is a $75 deposit required to secure an appointment for the procedure. We keep the deposit if your do not cancel a week ahead of the appointment. This is because we have dedicated our time slot to you and your procedure.

Concierge Executive Vasectomy

We offer after hours and weekend vasectomy for our patients through Invita Clinic. We understand you may be extremely busy. The no scalpel, no needle vasectomy is done with nitrous gas to give you as painless of a vasectomy as possible while getting you back on your feet fast. We offer the convenience of same day consult and procedure after hours or on weekends. Our facility is modern and discreet. Contact us now for your concierge executive appointment.

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No scalpel, no needle vasectomy with nitrous gas. We strive to make it as painless as possible and to get you back on your feet quickly. We are different than the other providers out there.

Questions and Answers:

  • No aspirin or blood thinners for the week prior.
  • Clipper (razors cause infection) all around your scrotum the day of the appointment.
  • Bring supportive underwear (spandex athletic shorts) and wear them for 3-5 days afterwards.
  • Frozen bag of peas for 15 minutes on and off for the first couple hours afterwards.
  • Headphones if you want to listen to music. Otherwise, we will have some background music playing to help increase your comfort level.
  • Bringing your spouse is optional.
  • Minimal to no pain. The anesthesia takes an hour to wear off
  • No antibiotics
  • Tylenol or advil if needed.
  • Written instructions for after care and the semen sample.
  • You usually can drive yourself home.
  • Shower after 24 hours.
  • No baths for 48 hours
  • Sex and working out is okay after 1 week. Stop if it is uncomfortable.
  • Remember the spandex underwear and the frozen peas.

Men sometimes worry that they won’t ejaculate after a vasectomy procedure. They will be “shooting blanks.” In fact, the volume and appearance of semen will be exactly the same. Only about 1 percent of the ejaculate comes from sperm. Related to this is the idea of losing your sexuality or libido. There is absolutely no link between vasectomy and loss of sexual function. In fact, there is a small increase in testosterone after vasectomy! Also, there hasn’t been any research that indicates a link between the increased risks of certain cancers or of heart disease.

  • About 1 in 1,000 men experience ‘chronic pain syndrome’ after the procedure. One cause of pain is the continued production of sperm post-procedure. Usually the sperm just breaks down in the body, but sometimes the sperm builds up and causes pressure as they travel out of the testicle in a long, coiled tube called the epididymus. As they leave the epididymus, the sperm enter a straighter tube, which is the vas. Pressure can build up and cause pain, especially if the tube is tied off. Our technique is to do an ‘open ended’ vasectomy where the tube coming from the testicle is left open, allowing sperm to be harmlessly reabsorbed by the body. The other side of the vas is sealed off.
  • Infection, bleeding or pain are risks. The chances are very low. We would estimate less than 5%. Wear spandex-type athletic shorts afterwards and enjoy your couch for the next 8-12 hours after your procedure. Tylenol (if any) is all you need for discomfort.
  • Pregnancy. The vas can find its way back to reverse itself. This can happen even after your sample says you are good to go. Vasectomy is over 99.8% successful.
  • Removal of testicle. Yes, it could potentially happen. It is rare. We have never had to perform this procedure after a vasectomy.

Most patients fear the knife and the needle. We usually avoid both. In addition, we offer nitrous gas, which is an excellent way to reduce anxiety and any sensation of pain. It is very safe.

We tell men to “clean out the ducts” of preexisting sperm in the vas. About 25 ejaculations and 2-3 months of time will usually do the job. Men should confirm a negative semen analysis or men can order SpermCheck. The semen analysis is the best way, but patients who cannot make it to the lab can do the at home test, which is 98% accurate. The test, which is FDA-approved for monitoring sperm after the procedure, detects SP-10, a protein present at constant levels in each sperm nucleus. The test is available from SpermCheck.

Vasectomy is the most effective contraceptive available. Vasectomy failure can occur if sperm recreate a channel through the vas. Vasectomy is over 99.8% successful. Vasectomy failure is most frequent in two situations:

  • Patients do not ejaculate at least 25 times before unprotected sex.
  • Patients do not confirm lack of sperm with a semen analysis.

A man should be certain that he does not want to reproduce ever again before deciding to get a vasectomy procedure. To be honest, we prefer not to have the reversal discussion as we tell men to have the mindset that a vasectomy is a permanent solution. Reversal success depends mostly on time and surgeon experience. It is a successful procedure in the right hands about 80 percent of the time if done soon.

Insurance may cover the vasectomy cost in San Antonio. If you would like to be cash pay, we have a prompt pay discount covering the office visit and the procedure for approximately $750. This covers the no scalpel procedure. This increase the chance for a fast recovery. Remember, you should get a semen sample later.

We will request a $75 nonrefundable deposit. The practice has to reserve time and equipment for your procedure and that is why a deposit is enforced. Once you have the procedure, the deposit can be refunded or applied to your procedure.

The Holy Grail. The dream. No one can promise a completely painless procedure. However, we strive to offer you everything possible. We offer nitrous gas before any of our procedures. Nitrous eliminates anxiety and reduces pain. It is very safe. You can drive afterwards. This is the same type of anesthetic at your dentist’s office. There is an out of pocket fee of approximately $100. If you want it to be painless as possible, consider nitrous as the way to go. Let our staff know.

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