Robert Pugach, MD featured on KTLA, Channel 5 (Los Angeles, CA) . News segment on the remarkable No Needle No Scalpel Vasectomy. Interview with Health Reporter, Leila Feinstein

Three-decade old techniques and new ideas combine to create pain-free vasectomies. (November 18, 2009)

When it comes to permanent birth control, a woman is more than twice as likely as a man to have surgery. But female sterilization is much more complicated and dangerous than the comparable surgery in a man–a vasectomy. But what if a vasectomy was done with no needle, no scalpel, and no pain? It’s happening in southern California.

Orange County urologist Dr. Robert Pugach says the no-scalpel vasectomy isn’t new; it’s just new in the U.S.

“About 35 years ago the Chinese figured out how to do what’s called a no-scalpel vasectomy,” says Dr. Pugach. “And unfortunately it stayed there, and in a few other parts of the world. It’s taken a long time to come over here.”

During a vasectomy, the tubes that carry sperm to the penis are cut. In the no-scalpel version, instead of an incision to get to the tubes, doctors pull-apart the skin of the scrotum just three-sixteenths of an inch. Why doesn’t it hurt?

“What we added in North America was the no-needle part,” says Dr. Pugach. Instead of a needle filled with numbing agent, a small sprayer has made the difference. “The novacaine is in here and you just prime it and fire it. And that comes out so quickly, that it penetrates the skin. There is literally nothing sharp,” says Dr. Pugach. “If I put this on your skin your skin would go numb in a second.”

As patient David Hiveley waits for the procedure to start, he’s not sure he believes Dr. Pugach’s claims. “I think it’s natural to have some anxiety about things being done down in that area,” says David, a forty-five year old father of two, who with his wife, decided he would be the one to have surgery to prevent future pregnancies.

There is a flat-screen television on the ceiling above David in the procedure room. But Dr. Pugach says he won’t even get to finish his favorite program, since the procedure will be done before the show ends.

Fifteen minutes to prep the patient, fifteen minutes for the surgery, and we check back in with David, who appears to be in no pain whatsoever.

“It was not painful,” he tells us. “Amazingly enough. I was pleasantly surprised that it was nothing. You have these thoughts in your mind what it could be. I feel great.”

David is told to rest for the next two days, and then he can resume normal activities, including sex. When we checked back in with him a few days later, he said the recovery was uneventful, not painful, and that he has been able to resume all activities, except jogging.

The urologist who performed the no-needle, no-scalpel vasectomy on David, Dr. Robert Pugach, doesn’t just ‘talk the talk’. He’s had a no-scalpel, no-needle vasectomy too, performed by another urologist. If you are considering a vasectomy, make sure you are done having kids. The procedure is reversible in most cases, but it means more surgery.

Besides the pain, Dr. Pugach says many men are concerned a vasectomy will affect their sexual performance. Dr. Pugach says it will only affect performance for the better, since sex can now be more spontaneous.

Copyright © 2009, KTLA-TV, Los Angeles

Undergoing a Delicate Surgery to Become a Father Again
by Yvette M. Manard, MPH

When you read a headline about a “miracle” baby, it’s typically about a woman overcoming infertility and giving birth.  But for men, the circumstances are reversed, as approximately 40,000 men each year change their minds and decide to have their vasectomy reversed.  This was the case for Troy, aged 45, who wanted to become a father again.

In 2002, Troy, a business owner and father of four children, felt that his family was complete and he had a vasectomy. However, like 5% of United States’ men who undergo a vasectomy, Troy’s life circumstances changed.  He fell in love, remarried and as the years passed, Troy and his wife, Jessica, wanted to have a baby.  They began their research to explore options to restore Troy’s fertility.  Their Internet research gave them a basic understanding of the different procedures and the success rates, ranging from vasectomy reversal to assisted reproductive technologies like IVF (In Vitro Fertilization).  “After looking at the statistics, I was concerned that my vasectomy reversal might not be successful because 7 years had passed, and the odds seemed against me that I would be able to father a child again,” Troy explains.

While the couple was doing their Internet research, Troy and Jessica narrowed down the list of urologists they wanted to consult with who specialize in vasectomy reversal.  In October, 2009, the couple selected Dr. Robert Pugach, Medical Director of West Coast Urology, and scheduled a consultation.  Even though Troy and Jessica live in Lancaster they didn’t mind the long drive to Dr. Pugach’s Los Alamitos office.

While a vasectomy reversal seems to be a rather straightforward procedure, because it just requires suturing the ends of the vas deferens back together again, it’s far more complex than that.  As Dr. Pugach says, “A vasectomy reversal isn’t as simple as it sounds.”  The procedure is a 3 to 4 hour delicate surgical procedure that uses precise microsurgical techniques with a  special operating room microscope.  During the operation, the urologic surgeon has to carefully stitch together the cut ends of a patient’s vas deferens.   “An exact alignment is needed for a successful operation,” says Dr. Pugach. “This is difficult because the inside of the vas deferens is very tiny – just one-third of a millimeter in diameter.  The best way to envision this is to think of putting the ends of 2 paper clips together.  In that tiny area, up to 24 stitches are required on each side to obtain the most precise alignment possible.”

After discussing it over, Troy and Jessica decided they wanted to try.  “We understood that there is no guarantee in life, but we very much wanted to have a baby,” says Troy.  In November of 2009, Troy underwent the procedure at a local community hospital.  “I was discharged home the same day with minimal pain and advised to take it easy for 72 hours,” continues Troy.

After six months had passed, Troy and Jessica returned to Dr. Pugach for a follow-up semen analysis and were thrilled to be given the good news that Troy’s sperm count was good.  The couple didn’t have to wait long as Jessica’s pregnancy test was positive. Their miracle baby, Jillian, was born January 4, 2011.  “Bringing Jillian home to meet her four siblings, aged 18 to 10 years, was the best New Year’s gift we could ask for,” says Jessica.

But wait! The story doesn’t end here.  With their family now complete, Troy has once again opted for a vasectomy.  This time, Dr. Pugach will be performing a No Needle, No Scalpel vasectomy.  Unlike a vasectomy reversal, the vasectomy will only take 15 minutes while Troy watches a television mounted on the ceiling and surfs through his favorite channels.  Nothing sharp is used for numbing – a jet spray of Novocain numbs the area instantly and no stitches are required!  Dr. Pugach is one of a select group of urologists who perform this remarkable procedure.

Call, 888.735.4336, to schedule a consultation with Dr. Robert Pugach.

As reported by ABC News, “Vasectomy Increase Reported” 

March 23, 2009 (WLS) — The recession may be causing more people to decide that they don’t want to have children. Doctors around the country are reporting a sharp increase in the number of vasectomies performed since last year. Researchers are concluding that the trend is due to a decreased desire to have children because of the expense involved and more people may be having medical procedures before their jobs and health insurance disappear.