Vasectomy

How many SA should be performed? When should it be performed?

2 3 and 4 months post vasectomy

Indication of vasectomy failure?

Any motile sperm Large numbers of immotile sperm (>100 000)

What vas occlusion methods should be used?

Cautery or fascial interposition Cautery has been shown to be greater than fascial interposition

What technique does the literature support?

Cochrane review shows that NSV has: Lower risk of postoperative hematoma Lower pain during surgery Lower postoperative scrotal pain Lower wound infection Faster with no difference in effectiveness *NSV recommended, associated with lower risk of complications*

What 2 approaches exist for vasectomy?

Conventional No-scalpel vasectomy

What complications must patients be counselled on?

Early: Bleeding or hematoma (4-20%) Infection (0.2-1.5%) Primary surgical failure (0.2-5%) Late: Chronic scrotal pain (1-14%) Delayed failure (0.05-1%)

What urological problem requires special consideration before and during vasectomy and why?

History of varicocele repair or planned varicocele repair Because the deferential veins may be only venous outflow or testicular artery may have been injured during repair Isolate VD carefully and exclude associated deferential arteries and veins

What anesthesia should be used?

Local Anxious or complicated anatomy may require GA/sedation

What is the significance of immotile sperm following vasectomy ?

No significance, not associated with pregnancies

What is the rate of late failure and what's it defined as?

Presence of motile sperm after documented azoospermia in 2 post vasectomy specimens 0.04-0.08% (1 in 2000)

What is early failure defined as and what's the rate? Explanations?

Presence of motile sperm at 3-6 months post vasectomy 0.3-9% Technical failure or recanalization of vas

What do you need to counsel the patient on preoperatively?

Procedure itself Complications (early and late) Permanent form of contraception (sperm banking and vas reversal can be discussed) Reassurance that data does not support an increased risk of PCa *Ongoing need for contraception until post vasectomy SA has confirmed no motile sperm (pregnancy risk is ~0.1%)*

What is considered a successful vasectomy ?

Singe azoospermic sample 2 SA with <100 000 immotile sperm

How should the post vasectomy semen analysis be performed?

The lab should assess freshly produced seminal fluid under direct microscopy, if negative then proceed with centrifugation and reexamine

What should a male be counselled on postoperatively?

Wait in clinic for 15-20 mins to rule out bleeding/vasovagal Short term physical limitations and wound care Proper semen collection Reminder to use contraception