Vasectomy
Technique for no-scalpel vasectomy:
[edit | edit source]- Three-digit grasp of cord
- Vas forceps around cord
- Sharp arteries to dissect onto cord
- Keep alternating sharp arteries and ring forceps until you can pull the vas free
- Artery across vas
- Sharp monopolar diathermy into superior end of vas, coagulate
- Divide and send some for histo
- Suture superior end into u-shape then bury in fascia
- Ligate inferior end
Follow-up:
[edit | edit source]- Semenalysis 3/12
- Phone clinic 14/52
- Give them a slip for a second semenalysis too, in case it's needed
Post-op confirmation of sterility:
[edit | edit source]- Semenalysis at three-month mark (should've had at least 20 ejaculates since vasectomy)
- >80% are azoospermic after 3/12 and 20 ejaculations
- Time to azoospermia decreases with increasing ejaculations and increases with age
- Azoospermia is definitive evidence of infertility
- Motile sperm at three months: repeat in another 1-2 months
- If motile sperm are still present, and it's been three months, and >20 ejaculations, vasectomy is considered a failure. Potentially needs repeat.
- Non-motile sperm is a less definitive sign of infertility - may reflect death of recently motile sperm due to delays or problems in lab - needs to be examined in less than 4 hours from production. Repeat testing in another 1-2 months may show more non-motile sperm, or may show azoospermia.
- Persistent rare non-motile sperm is probably clinically insignificant, and according to UTD these men can be given cautious assurance of success
- British Andrology Society suggests if rare non-motile sperm are still present after 7 months, patients can be given clearance
- American Urologic Society says you can clear patients on one sample, as long as it was fresh and <100,000 non-motile sperm per mL based on examination of at least 50 HPFs