Male Contraception 3 Flashcards

The learner will be able to describe the risks and benefits associated with a vasectomy procedure.

1
Q

List the types of vasectomy procedures.

A
  • “No Scalpel” Vasectomy
  • Minimally Invasive Vasectomy
  • Conventional Vasectomy
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2
Q

What are some of the common complications that can arise from a vasectomy?

A
  • Hematoma Formation
    • incidence is approximately 2%
    • most common complication
    • directly correlates with annual number of procedures performed by surgeon
    • scrotum is expandable and as poor tamponading capability
  • Infection: Incidence is approximately 1.0%.
  • Chronic Pain: Incidence is approximately 0.1%; congestive epididymitis; elevated back pressure behind vasectomy occlusion site +/- inflammation. Most men respond to treatment with anti-inflammatory agents; rarely vasectomy reversal or epididymectomy can be employed.
  • Sperm Granuloma: Inflammatory response to extravasation of sperm; feels like a pea or marble at the vasectomy site; typically does not cause bother, and usually it does not require therapy.
  • Recanalization/Vasectomy Failure: Approximately 1/1000 rate. Simple division and ligature of vas deferens associate with ~ 8.7% failure rate. With addition of fascial interposition, failure rate drops to ~ 0.3%. Fascial interposition is the key step to decreasing the risk of vasal recanalization.
  • Vasectomy is NOT causally linked to prostate cancer, testicular cancer, atherosclerosis, coronary artery disease, or dementia.
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3
Q

After a vasectomy, when is a patient cleared to resume sexual activity without contraception?

A
  • First semen test is performed at 8-16 weeks (or > 20 ejaculations) after vasectomy.
  • 80% of men will have no sperm or rare nonmotile sperm by 12 weeks after the procedure.
  • Clearance given if a single semen sample shows no sperm; OR
  • A fresh, well-mixed, noncentrifuged sample shows no sperm or < 100,000 nonmotile sperm/mL.
  • If any motile sperm persist at > 6 months post vasectomy, the procedure should be deemed a failure and a repeat vasectomy should be offered.
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