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Vasectomy Preop Evaluations

Initially, a history is obtained to determine if there are any contraindications to vasectomy such as bleeding disorder, intake of anti-coagulants (blood thinners such as Coumadin, Persantine, Ticlid, and Aspirin), or allergy to Lidocaine, a local anesthetic agent used to anesthetize the skin.

Patients need to understand that vasectomy is a rather permanent procedure, although we do have reversal techniques such as vasovasostomy. With a vasovasostomy, the ends of the vas deferens are reconnected-usually with the aid of a microscope. This is a much more involved and costly procedure, so patients should be sure of their decision before proceeding with vasectomy. The risks of vasectomy are discussed thoroughly in the preop evaluation. These risks include the possibility of infection, bleeding, sperm granuloma formation, chronic testicular pain and rare incidence of recanalization (reconnection of the vas).

Infection can present itself as a skin infection or as epididymitis (inflammation of the epididymis, which is the structure where sperm mature upon leaving the testicle). With a skin infection, the incision sometimes separate and there may be drainage, but this usually heals quickly with antibiotics and local wound care. With epididymitis there may be pain and swelling posterior to the testicle. This too, usually heals quickly with antibiotics.

Bleeding can occur with vasectomy but this is usually only enough to cause bruising of the skin since the scrotal skin is so loose. The bruising can rarely turn the whole scrotum black and blue, however, this is of little concern since the body reabsorbs this blood and normal color returns within a couple of weeks. Less commonly, there is enough bleeding to produce a hematoma (blood clot) within the scrotum. This too, is usually self-limited, taking the body a little longer to reabsorb the blood.

Don't let this discussion dissuade you. The chance of developing infection or bleeding with hematoma formation is 1% or 1 in 100 or less. The chance of having a complication that needs further surgery is about .1% or 1 in 1000.

Sperm granuloma occurs when a few sperm leak out around the cut ends of the vas deferens. The body recognizes the sperm as a foreign substance once outside of the vas and an area of inflammation is produced. If this occurs, the patient may always feel a small swollen area around the area of vasectomy. This is not all bad since creation of a sperm granuloma can reduce the pressure of vasectomy, resulting in more normal sperm if vasovasostomy is ever performed to reconnect the ends of the vas.

Chronic testicular pain can occur but is extremely rare, .01% or 1 in 10,000 cases. It is felt that this is related to high pressure caused by blocking of the vas deferens. Rarely is vasovasostomy indicated to relieve chronic pain.

Recanalization occurs when the channel reforms, allowing sperm to leave the testicle and travel through the vas. If this occurs, the patient may become fertile again. That is, he may be able to produce another child with a sexual partner. Incidence of recanalization is extremely low, .1% to .3 percent or 1 to 3 in 1000 cases. All patients need to understand that they are still considered fertile after vasectomy (that is, able to impregnate their sexual partner), until two semen specimens are checked under the microscope and are clear of live or dead sperm. Since recanalization usually occurs between six and twelve weeks post vasectomy, we check a post vasectomy semen sample at six and twelve weeks out.

Contraception must be used until these semen specimens are determined to be clear of sperm.

If live sperm are detected in the post vasectomy semen check at three months, vasectomy has failed and needs to be reperformed. Remember this only occurs in .1% to .3% or 1 to 3 in 1000 cases. It is very rare.

Again, you do not need to be frightened by discussion of the complications of vasectomy, but you do need to be an informed patient, confident in your decision to proceed with vasectomy. The chance of having a complication that could require hospitalization is about .1% or 1 in 1000 cases.

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