Urology Book

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Vasectomy Counseling

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  1. See Also
    1. Vasectomy Postoperative Counseling
    2. Vasectomy Patient Education Handout
      1. UrologyEdVasectomyJmg.htm
    3. Choosing Vasectomy Movie (Requires Flash)
      1. VasIntro.html
  2. Indications
    1. All Vasectomy patients 2-4 weeks before procedure
  3. Risk factors for regretting Vasectomy
    1. Age under 30 years
    2. Few if any children
    3. Relationship not stable
    4. Religious affiliation prohibiting Vasectomy
    5. Pressure from partner to have procedure
    6. Vasectomy performed during time of personal crisis
    7. Lack of discussion with partner regarding Vasectomy
    8. Hope Vasectomy will solve sexual and marital problems
    9. High interest regarding reversibility issues
      1. Vasectomy Reversal
      2. Sperm banking
  4. Obtain pertinent history
    1. Marital status
    2. Number of children
    3. Reason for choosing Vasectomy
    4. Medical History
      1. Diabetes Mellitus
      2. Hypertension
      3. Bleeding Disorders
      4. Sexually Transmitted Disease
      5. Other genital infection or Urinary Tract Infection
      6. Genital trauma
      7. Chronic Pain in genitalia
    5. Surgical history
  5. Describe procedure anatomically
    1. Using diagram to show normal sperm course
    2. Show seminal vessicles produce ejaculate
    3. Show location of incision in scrotum
  6. Describe benefits (compared with Tubal Ligation)
    1. Lower risk procedure compared with Tubal Ligation
      1. Tubal Ligation is intra-abdominal procedure
    2. Postoperative recovery is much faster for Vasectomy
    3. Vasectomy is more effective than Tubal Ligation
      1. Tubal Ligation long-term failure: 18.5 per 1000
      2. Vasectomy long-term failure: <2.5 per 1000
    4. Vasectomy efficacy more easily confirmed
      1. Semen Analysis confirms Vasectomy efficacy
      2. Pregancy (often ectopic) confirms tubal failure
  7. Defuse misnomers
    1. Vasectomy minimally affects semen volume (5-15%)
    2. Vasectomy does not affect male characteristics
    3. Vasectomy does not increase the following risks
      1. Vasectomy should not affect libido and sexuality
      2. No increased risk of cardiovascular disease
      3. No increased risk of Testicular Cancer
      4. No increased risk of Prostate Cancer
      5. Cox (2002) JAMA 287:3110
  8. Discuss potential complications (11%)
    1. Failed Vasectomy (or unwanted pregnancy)
      1. Failure within first year: 0.15% (1 in 400)
      2. Longterm failure rate: 0.04% (1 in 2300)
    2. Infection (4%)
    3. Epididymitis (2%)
    4. Sperm granuloma (1%)
    5. Hematoma (<1%)
  9. Examination
    1. Scrotal and perianal skin
      1. Dermatitis
      2. Infection
    2. Testes
      1. Testicular Pain or tenderness to palpation
      2. Testicular nodularity
      3. Hydrocele
    3. Vas deferens
      1. Vas mobility (ease of isolation)
      2. Congenital absence of vas deferens (single vas)
        1. Associated with renal anomalies
      3. Accessory vas deferens or duplicated vas (rare)
    4. Miscellaneous
      1. Varicocele
      2. Inguinal Hernia
  10. Obtaining Consent
    1. Emphasize need for post-Vasectomy Semen Analysis
      1. Temporary Contraception used until Semen Analysis
      2. High rate of no follow-up for Semen Analysis (45%)
    2. Emphasize permanence of procedure
    3. Answer any related questions
    4. Read and sign consent form
  11. Review preoperative instructions
    1. Give Vasectomy preoperative handout
    2. Consider Conscious Sedation (e.g. Valium 5-10 mg)
    3. Patient has transportation if premedication is used
    4. Partner clips hairs on anterior scrotum
    5. No Aspirin 2 weeks before procedure
    6. No NSAID or platelet inhibitor 4 days before procedure
    7. Wear athletic supporter (jock strap) to appointment
    8. Shower and clean scrotum on surgery day
  12. References
    1. Alderman (1991) J Fam Pract 33(6):579
    2. Haws (1995) Am Fam Physician 52(5):1395
    3. McDonald (1997) Br J General Practice, p.381-6

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