Urology Book

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Vasectomy Postoperative Counseling

Aka: Vasectomy Postoperative Counseling
  1. Management: Clinic Follow-up
    1. Postoperative Care Handout describing below
    2. Call patient to check on status on day 1 or 2 post-op
  2. Management: Analgesics
    1. Wear athletic supporter (jock strap) for first 3-4 days
    2. Medications
      1. NSAID (e.g. Ibuprofen) for daytime use
      2. Consider Opioid (e.g. Hydrocodone with Acetaminophen) for night pain
  3. Management: Postoperative Activity
    1. Off Work for 1-3 days
      1. Day 1: Supine with ice on Scrotum for 20 minutes/hour
      2. Day 2: Minimal activity but patient may shower
      3. Day 3: Activity as tolerated
    2. Limited activity for 2 weeks
      1. No strenuous Exercise or risk of local Trauma
      2. Sexual activity no more than twice per week
  4. Indications: Call office
    1. Pain not relieved with Analgesics given
    2. Scrotal swelling beyond expected
    3. Persistant scrotal Bruising beyond 2 weeks
    4. Stitches still present beyond 2 weeks after procedure
    5. Signs of scrotal infection
      1. Redness
      2. Swelling
      3. Tenderness
      4. Fever
      5. Pustular discharge from incision site
  5. Labs: Post-Vasectomy Semen Analysis
    1. Findings with successful Vasectomy
      1. Median time to loss of Sperm Motility: 3 weeks
      2. Median time to azoospermia: 10 weeks
      3. Rare non-motile sperm after 12 weeks
    2. Precautions
      1. Non-compliance with post-vasectomy Semen Analysis is common (up to 19% fail to return with sample)
    3. Sample timing
      1. Three months and at least 11-20 ejaculations after Vasectomy
      2. Obtain sample 2-7 days following abstinence and keep sample at Body Temperature bring to lab within 1 hour
    4. Persistent non-motile sperm on initial 3 month sample
      1. Repeat Semen Analysis monthly until
        1. No sperm on at least one sample OR
        2. Less than 100,000/ml non-motile sperm on 2 consecutive samples at 7 or more months since Vasectomy
    5. Persistent motile sperm on initial 3 month sample
      1. Suspect failed Vasectomy
      2. Confirm motile sperm present on repeat Semen Analysis in one month
      3. Repeat Vasectomy if motile sperm confirmed on second sample
  6. References
    1. Pfenninger (1984) Am Fam Physician 30(4):177-84 [PubMed]
    2. Rayala (2013) Am Fam Physician 88(11): 757-61 [PubMed]

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