Male Contraception 3

Question 1

List the types of vasectomy procedures.

Answer 1

• “No Scalpel” Vasectomy
• Minimally Invasive Vasectomy
• Conventional Vasectomy

Question 2

What are some of the common complications that can arise from a vasectomy?

Answer 2

• Hematoma Formation
  
  • incidence is approximately 2%
  • most common complication
  • directly correlates with annual number of procedures performed by surgeon
  • scrotum is expandable and as poor tamponading capability
• Infection: Incidence is approximately 1.0%.
• Chronic Pain: Incidence is approximately 0.1%; congestive epididymitis; elevated back pressure behind vasectomy occlusion site +/- inflammation. Most men respond to treatment with anti-inflammatory agents; rarely vasectomy reversal or epididymectomy can be employed.
• Sperm Granuloma: Inflammatory response to extravasation of sperm; feels like a pea or marble at the vasectomy site; typically does not cause bother, and usually it does not require therapy.
• Recanalization/Vasectomy Failure: Approximately 1/1000 rate. Simple division and ligature of vas deferens associate with ~ 8.7% failure rate. With addition of fascial interposition, failure rate drops to ~ 0.3%. Fascial interposition is the key step to decreasing the risk of vasal recanalization.
• Vasectomy is NOT causally linked to prostate cancer, testicular cancer, atherosclerosis, coronary artery disease, or dementia.

Question 3

After a vasectomy, when is a patient cleared to resume sexual activity without contraception?

Answer 3

• First semen test is performed at 8-16 weeks (or > 20 ejaculations) after vasectomy.
• 80% of men will have no sperm or rare nonmotile sperm by 12 weeks after the procedure.
• Clearance given if a single semen sample shows no sperm; OR
• A fresh, well-mixed, noncentrifuged sample shows no sperm or < 100,000 nonmotile sperm/mL.
• If any motile sperm persist at > 6 months post vasectomy, the procedure should be deemed a failure and a repeat vasectomy should be offered.