Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.
PIP: In this discussion of vasectomy, attention is directed to preoperative counseling, performance of vasectomy as an office or clinic procedure -- anesthesia and surgical techniques, and postoperative care. Vasectomy requires preoperative counseling. Every man is aware of the effects of castration, and it is essential to explain to a man how and why vasectomy differs. He also must understand that sterility is not immediate. The couple's every question must be answered. Although counseling may take the form of movie, booklet, or conversation with a trained counselor or the surgeon, or any combination of these, preoperative contact with the surgeon is very important. Patient confidence is essential. In the US, vasectomy for sterilization is generally legal, but this does not protect the surgeon from malpractice suits. The patient should sign a written consent containing the following points: that the patient requests the operation for the purpose of preventing him from fathering further children; that he realizes that the operation could fail to produce sterility; and that he agrees to submit semen specimens for testing and to use contraception until testing has shown that he is sterile. A number of local anesthetics may be used when performing a vasectomy. Both procaine, which takes effect in 1 minute, and lidocaine, effective in 5 seconds, are safe and given anesthesia for at least 1 hour in 1% strengths. The most common vasectomy technique worldwide is that of dividing the vas, removing a segment, and either ligating the cut ends of the vas or closing them with metal clips. This usually fails in 1-3% of patients, either initially or by subsequent recanalization of the vas. Regarding postoperative care, the patient should apply an icebag over the bandages for the 1st several hours with the scrotum immobilized and abstain from sexual activity for the first 2 days. To ensure that a spontaneous anastomosis has not occurred, this surgeon requests 2 semen specimens, 1 month apart. The complications of the operation are largely preventable. Preoperative counseling has prevented most psychological complications. The specific complications of vasectomy include spermatic granulomas of the vas and epididymis, and antisperm antibodies. Numerous studies have reported no deleterious effects upon the patient's general health.