Tell patient that it is permanent and irreversible.
for a man in a stable relationship who has completed his
procedure there is an initial failure rate (due to not
excising the vas or early re-canalization about 1:100) and
there is a late failure rate (due to recanalization) of about
spermatozoa remain in the ductal system for several months and
that other contraception will be required until clear.
The operation cannot be considered a
success until two negative sperm counts one month apart
(initially at 3 and 4 months) are clear.
complications: infection, bleeding, scrotal haematoma or
abscess (which may need further surgery).
complications: failure to achieve azoospermia, Sperm granuloma
(tender swelling at the cut end of vas) which may need to be
excised, chronic testicular pain develops in 20% of men.
area in operating room. Time out. Sterile prep and drape. I
perform under GA. No IV Abx are required.
Grasp vas (hard
palpable cord) at the neck of scrotum and work it towards the
Hold the vas
close to the skin using non-dominant hand
Place two Allis
forceps either side of a 1cm segment of vas to be excised.
Make a vertical
incision of the skin between the Allis forceps.
the coverings layer by layer using the scalpel in the line of
wound until the glistening white muscular coat of the Vas is
Allis to grasp the Vas and free it to deliver a segment about
3cm in length and deliver into wound.
Both ends of the
vas are clamped with artery forceps and the vas cut between
the ties and a short segment sent for histology. Each end is
tied with 2/0 Vicryl and then stump of vas doubled over and tied again to
form a loop.
I push the lower
end back into the scrotum.
I close the
incision with 2/0 Vicryl interrupted sutures.
the upper end into the subcutaneous tissues to keep the ends
I perform the
same on the opposite side and apply a scrotal support.