Comprehensive Urology

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The daVinci System

Delta Medix Patient General Information

Vasectomy

Definition

Vasectomy refers to voluntary or "elective" surgical sterilization in men. In certain states, there is a mandatory waiting period from the time that you sign consent. In other states, you may have the procedure at any time after signing an informed consent. The waiting period is for your own protection to ensure that you and anyone else involved in the decision have thought about this carefully. In states that do not have a waiting period, you should take a little time to ensure that this decision is right for you. Vasectomy may be reversible, but it considered a permanent form of sterilization. Reversal is technically difficult, has a moderate to low success rate, and is quite costly.

The vas deferens are small tubes that transport sperm from each testicle to the urethra where the sperm combines with the remainder of the contents (made in other glands) of ejaculation. After vasectomy, the ejaculate fluid should appear unchanged in amount and consistency to the naked eye, but it will contain no sperm. Only under a microscope is the change perceptible. The sensation of orgasm and ejaculation are unaffected, and the operation does not affect libido (sex-drive) or erections.

Preparation

We ask that you purchase a scrotal support (jock strap) and bring it that day. You should have ice ready at home. The procedure cannot be done if you are currently on, or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners").We will have reviewed all of your current medications with you during the consultation, but please tell us if anything has changed since your previous visit. The most common of these medications are aspirin and all related pain reliever or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past 10 days. If your new medication is not on the list, mention it anyway so that we may ensure it is not a blood thinner. Lastly, you will be asked to shave the hair of your scrotum (as instructed) either that day or the day prior to the procedure.

Procedure

A vasectomy typically takes less than 30 minutes. Variations in time will depend on your particular anatomy. When performed in a hospital or surgical center, it is possible to have an anesthesiologist give you heavy sedation. In this regard, you would be asleep and have no awareness of the procedure. A small amount of medication will be injected intravenously (in the vein) to make you sleepy. Your position will be supine (flat on your back), possibly with your legs in stirrups (holsters), much like a woman during a gynecological examination.

Local anesthesia (numbing medicine) is injected into the area of the scrotum where the procedure is performed. Although you might feel some pressure during the procedure, you will not experience any pain.

In most instances, very small incisions (one centimeter or less) are made on the left and right side of the scrotum respectively. Some surgeons prefer one incision in the middle of the scrotum. Each vas deferens is located, separated from surrounding tissue, and divided. According to the surgeon's preference, a short segment of the tube can be removed as well. The ends are then either tied with suture or secured with a small clip. Sometimes a surgeon will cauterize (electrically burn) the lumen (center hole through which the sperm flow) as well. The ends of the vas are placed back into the scrotal sac and the incisions are closed. The suture material used on the skin is self-dissolving and will just fall out on their own after 1-2 weeks. It is not necessary to place a dressing over the incision sites, but placing a clean gauze or pad against the scrotum will help to keep your underwear or scrotal support clean.

Post Procedure

After the vasectomy, you will have one to three small sutures on each side or just in the midline as previously discussed. They will dissolve over the following 1-2 weeks and need not be removed. Every patient has some degree of swelling, and it is not possible to predict who might have minimal versus significant swelling. It is very important that you apply ice to the area as soon as you return home for several hours as instructed and wear a scrotal support (or jockey shorts) for several days. We strongly encourage you to take the following day off of work and perhaps more if your occupation requires strenuous activity or heavy lifting. In the first 24 hours, it is to your advantage to minimize activity and spend a lot of time lying down. The more swelling you prevent in the first two days, the better off you are. Some patient shave almost no discomfort while others are somewhat uncomfortable for a few days to a week. Severe pain is unlikely but possible. We may provide you with a prescription for pain medication but you certainly may take an over-the-counter medication to which you are not allergic. Just like variation in swelling, the scrotum and surrounding areas can have a variation of bruising. This will typically resolve with time. You may shower the following day. Some surgeons will ask that you not take tub baths for a few days while others will recommend warm baths a couple of times per day.

Expectations of Outcome

The effects of a vasectomy at resulting in sterilization are not immediate. Despite a successful procedure, you are not considered sterile until two semen analyses (under the microscope) demonstrate no evidence of sperm. Do not make the assumption that you are sterile just because time has elapsed or because the first semen analysis demonstrated no sperm. You must wait for us to tell you, following the second semen analysis, that it is safe for you to have unprotected intercourse. Sometimes, it can take months for you to clear all of the sperm out of your tracts. Please make sure to keep all follow up appointments as they are scheduled. While rare, a vasectomy can fail. We will have discussed the possible explanations for this.

Possible Complications of the Procedure

ALL procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may generate questions if you are still concerned. We think it is important that every patient be made aware of all possible outcomes. "An educated patient is the best patient."

  • Failure: As mentioned, a vasectomy may fail. This is rare and probably only occurs1-2% of the time by national average. In immediate failure, the patient never has a semen analysis that demonstrates "no sperm".
  • A delayed failure would mean that at one time, there were no, or few sperm but subsequently there were increased sperm again in the ejaculate. There are different reasons for each. Failure requires that the procedure be repeated.
  • Inability to Complete: There are rare instances when a patient's anatomy makes it impossible to continue with an intended procedure (in the office) without causing too much discomfort or compromising the success or safety of the procedure. In this instance, we would stop and recommend that the procedure be rescheduled to be done in a different setting (i.e. in the hospital) with anesthesia.
  • Hematoma: This is when a small blood vessel continues to ooze or bleed after the procedure is over. The result is greater swelling and bruising. Intervention (opening the incision to evacuate the blood ) is very rarely necessary and it almost always resolves over time with compresses...much like any bad bruising or swelling. If this happens, i tis usually in the first day after the procedure.
  • Sperm Granuloma: A local blowout of sperm in the scrotal cavity may result in a painful swollen nodule. Usually pain resolves over time, but in rare instances may require surgery.
  • Infection: Infection is possible in any procedure. Usually, local wound care and antibiotics are all that is necessary. Opening the wound to drain the infection may be necessary if more conservative measures fail.
  • Hydrocele: Fluid may accumulate around the testicle. If this results in a lot of swelling or pain, surgery may need to be considered.
  • Chronic Pain: As with any procedure, a patient can develop chronic pain in an area that has undergone surgery. This is rare and would tend to disappear with time. If persistent, further evaluation may be necessary.
  • Testicular Ischemia/Loss: This is quite unlikely but could theoretically occur. If the testicle has inadequate blood supply, it would shrink and lose ability to function. While most urologists have never experienced this complication or know of any urologist that has, it is theoretically possible.
  • Prostate Cancer: Most recent medical research suggests minimal associated risk between vasectomy and prostate cancer.

We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).

The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.

Delta Medix, P.C.