Topic: tubectomy and vasectomy
Question:Describe the surgical procedure for vasectomy. What are the complications?
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Vasectomy is a surgical procedure performed in men who desire permanent contraception. It involves occluding or severing the vas deferens to prevent sperm from entering the ejaculate. Vasectomy is a very effective form of contraception with a failure rate of less than 1% and provides contraceptive coverage for life.
Indications for vasectomy include:
• Desire for permanent male contraceptive method: Vasectomy should only be considered by men who do not wish to father children in the future.
• Partner with contraindications to female contraceptive methods: If female sterilization or hormonal contraception are not options due to health conditions, vasectomy can provide effective contraception.
Vasectomy Procedure:
1. The patient is placed in a supine position with the scrotum externally accessible. The scrotum is shaved and cleaned with an antiseptic solution.
2. Local anesthesia is injected into each spermatic cord to numb the area. A 1-2 cm incision is made in the scrotum over each vas deferens.
3. The vas deferens is grasped and lifted out through the incision. A small section (approx. 1 cm) of the vas is removed or occluded using clips or cautery. This severs the connection between the testicle and the urethra, blocking sperm from entering the semen.
4. The remaining ends of the vas deferens are sealed and slipped back inside the scrotum. Dissolvable sutures are used to close the minor incisions.
5. Patients remain on oral pain medications and apply ice/compression to reduce swelling over the next few days. Most men require 1-2 days off from normal activities as the incision sites heal.
Potential complications include:
1. Infection: Minor infection of the incision sites or scrotum. Usually treated with oral antibiotics. Major infections that spread to the epididymis are rare but may require hospitalization and IV antibiotics.
2. Bleeding into the scrotum: Usually minor and resolves with ice, rest and scrotal support. Major hematomas may require needle aspiration to drain the blood.
3. Persistent or worsening pain: normal discomfort from the procedure usually improves over 7-10 days. See your doctor if severe pain persists for more than a week.
4. Congestive epididymitis: Swelling and pain of the epididymis due to back pressure from sperm production. Treated with rest, ice, scrotal support and anti-inflammatory medications. Usually resolves once sperm production decreases over 6-12 weeks.
5. Recanalization: Rarely (1 in 2000), the severed ends of the vas deferens can rejoin or form collateral channels, allowing sperm to again enter the semen. This may lead to an unwanted pregnancy if contraception is not continued. Follow up semen analysis is done at ~3 months to confirm absence of sperm.
6. Post-vasectomy pain syndrome: Chronic scrotal pain that can occur due to entrapment of nerves in scar tissue or other causes. Treatment options include medications, counseling and in severe cases surgical options like denervation of the spermatic cord.
Vasectomy is a very effective and safe method of permanent contraception for men. However, it should only be considered by those who do not wish to father children in the future, as reversal success rates are limited. Patients must continue other contraception for 3 months until clearance is given based on semen analysis confirming absence of sperm.
