Vasectomy Flashcards
What kind of initial visit should be done for a vasectomy consult?
A preoperative interactive consultation should be conducted, preferably in person.
If an in-person consultation is not possible, then preoperative consultation by telephone or electronic communication is an acceptable alternative.
What concepts need to be discussed when counseling a patient who wants a vasectomy?
Vasectomy is intended to be a permanent form of contraception.
Vasectomy does not produce immediate sterility.
Following vasectomy, another form of contraception is required until vas occlusion is confirmed by post- vasectomy semen analysis (PVSA).
Even after vas occlusion is confirmed, vasectomy is not 100% reliable in preventing pregnancy.
The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS).
Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
Patients should refrain from ejaculation for approximately one week after vasectomy.
Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization. These options are not always successful, and they may be expensive.
The rates of surgical complications such as symptomatic hematoma and infection are 1-2%. These rates vary with the surgeon’s experience and the criteria used to diagnose these conditions.
Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of
men. Few of these men require additional surgery.
Other permanent and non-permanent alternatives to vasectomy are available.
What is the risk of pregnancy after vasectomy?
The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS).
What is the rate of repeat vasectomy?
Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
What are the surgical risks of the procedure?
The rates of surgical complications such as symptomatic hematoma and infection are 1-2%.
-These rates vary with the surgeon’s experience and the criteria used to diagnose these conditions.
Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1-2% of
men.
- Few of these men require additional surgery
Is vasectomy a risk factor for prostate cancer, coronary heart disease, stroke, hypertension, dementia or
testicular cancer?
Clinicians do not need to routinely discuss prostate cancer, coronary heart disease, stroke, hypertension, dementia or testicular cancer in pre-vasectomy counseling of patients because vasectomy is not a risk factor for these conditions.
What prophylactic antimicrobials are necessary for vasectomy?
Prophylactic antimicrobials are not indicated for routine vasectomy unless the patient presents a high risk of infection.
What kind of anesthesia should be performed for vasectomy?
Vasectomy should be performed with local anesthesia with or without oral sedation.
If the patient declines local anesthesia or if the surgeon believes that local anesthesia with or without oral sedation will not be adequate for a particular patient, then vasectomy may be performed with intravenous sedation or general anesthesia.
How should the isolation of the vas be performed?
Isolation of the vas should be performed using a minimally-invasive vasectomy (MIV) technique such as the no scalpel vasectomy (NSV) technique or other MIV technique.
What are the three divisional methods for occlusion of ends of the vas?
The ends of the vas should be occluded by one of three divisional methods:
(1) Mucosal cautery (MC) with fascial interposition (FI) and without ligatures or clips applied on the vas
(2) MC without FI and without ligatures or clips applied on the vas
(3) Open ended vasectomy leaving the testicular end of the vas unoccluded, using MC on the abdominal end and
FI
OR by the non-divisional method of extended electrocautery.
The divided ends of the vas may be occluded by:
The divided vas may be occluded by ligatures or clips applied to the ends of the vas, with or without FI and with or without excision of a short segment of the vas, by surgeons whose personal training and/or experience enable them to consistently obtain satisfactory results with such methods.
Should you send the excised component of the vas for pathology?
Routine histologic examination of the excised vas segments is not required.
When should men use contraception after vasectomy?
Men or their partners should use other contraceptive methods until vasectomy success is confirmed by PVSA.
Details of the semen sample for post-vasectomy semen analysis
To evaluate sperm motility, a fresh, uncentrifuged semen sample should be examined within two hours after
ejaculation.
Patients may stop using other methods of contraception when examination of one well-mixed, uncentrifuged, fresh post-vasectomy semen specimen shows azoospermia or only rare non-motile sperm (RNMS or ≤ 100,000 non-motile sperm/mL).
When should the post-vasectomy PVSA be done?
8-16 weeks after vasectomy is the appropriate time range for the first PVSA.
The choice of time to do the first PVSA should be left to the judgment of the surgeon.
