Vasectomy

|Hide
Procedures Consult Mobile
Quick ReviewFull DetailsChecklist
Pre-ProcedureProcedurePost-Procedure
Help  |  Print
SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • A desire to not father a child
  • Pregnancy contraindicated
CONTRAINDICATIONS
  • Bacterial skin infection in the groin/scrotum
  • Coagulation disorders or treatment with anticoagulant or antiplatelet therapy
  • Inability to palpate and elevate both vasa
  • Hypersensitivity to palpation, precluding mobilization of the vas
  • Lack of adequate informed consent
  • Depression, psychosexual impairment, or impaired decision making

Relative Contraindications

  • Impending infertility, such as menopause or hysterectomy in wife
  • Unresolved conflict or stress
  • Inappropriate expectations of vasectomy
EQUIPMENT
  • Vas-fixing forceps (one or two pairs)
  • Sharp dissecting forceps
  • If a scalpel will be used, include a disposable scalpel or a scalpel handle with a No. 15 blade.
  • Cautery unit
  • Three mosquito hemostats
  • Adson tissue forceps (1 × 2 teeth) with suture platform
  • Tissue scissors
  • Method to seal vas sheath (4-0 chromic catgut suture or a hemoclip applicator with clips)
  • A 10-mL syringe (1½-inch, 27-gauge needle) or MadaJet
  • Lidocaine (1%) without epinephrine (10 mL)
  • Sterile sodium bicarbonate solution (add 1 mL to 10 mL of lidocaine)
  • Large pack of 4 × 4 gauze
  • Povidone-iodine or chlorhexidine preparation
  • Fenestrated sterile drape and nonfenestrated drape
  • Sterile gloves and mask
  • Single sterile glove (into which the cautery device is placed)
  • Pair of nonsterile gloves for iodine prep
  • Specimen jar
ANATOMY
  • Scrotum
    • In single-incision vasectomy, the scrotal septum does not present a practical barrier, and bleeding risk is less than with two separate incisions.
  • Vas deferens
    • The vas deferens originates at the inferior pole of the testis. As it courses cephalad, it becomes straight and has a dense, almost gritty texture to palpation.
    • At the level of the internal spermatic fascia, it usually is distinctly palpable and firm, measuring about 3 mm in thickness (can vary from 1.5 to 4.5 mm).

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • No routine post-procedure examination is necessary.
  • Review the sample patient education handout with the patient.
  • Severe pain is rare enough that it should prompt a call to the doctor. NSAIDs such as naproxen sodium or ibuprofen will keep most patients comfortable.
  • A routine follow-up telephone call on the first or second post-operative day is desirable.
COMPLICATIONS

Minor Complications

  • Minor complications occur in 5% to 10% of vasectomy patients.
  • Congestive epididymitis
  • Sperm granuloma
  • Bleeding from the skin incision
  • Extensive ecchymosis
  • Superficial wound infection
  • Suture or clip rejection
  • Skin reaction to the surgical antiseptic solution
  • Neuroma
  • Postvasectomy pain syndrome

Major Complications

  • Major complications occur in less than 3% of patients.
  • Hematoma
  • Scrotal infection
RESULT ANALYSIS

Postoperative Semen Testing

  • Obtain two post-procedure semen tests. Test the first specimen after 6 weeks or 15 ejaculations (whichever is later) and the second after 3 months.
  • Allow the freshly collected specimen to stand until the mucus is autolyzed.
  • Place a drop of unspun ejaculate on a slide with a coverslip, and examine under high power. No sperm should be seen.
  • The author's approach: Examination of 100 high power fields shows no more than two sperm and no motile sperm.

Vasectomy Failures

  • Vas occlusion fails to stop sperm egress in up to 1% of vasectomies performed with cautery.
  • Misidentification of one or both of the vas deferens can be detected by submitting excised specimens for histologic examination by a pathologist.
  • Failure due to supernumerary vasa is extremely rare.
  • Prematurely abandoning other contraception before a clear test is obtained can result in pregnancy.
  • The incidence of late (secondary) recanalization is about 0.05%, or 1 in 2000.

Reversal

  • Reversal results in pregnancy approximately 50% to 80% of the time.
  • Intracytoplasmic sperm injection (ICSI) can be used but is much more costly.
  • The use of previously frozen sperm is the least expensive alternative.
About Procedures Consult | Help | Contact Us | Terms and Conditions | Privacy Policy
Copyright © 2017 Elsevier Inc. All rights reserved.