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General Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Rebecca Fish, Aisling Hogan, Aoife Lowery, Frank McDermott, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Yew-Wei Tan, Thomas Tsang
A 35-year-old man attends your outpatient clinic requesting a vasectomy. What specific assessments do you make?Assess the patient's contraceptive needs and discuss alternative methods of contraception (i.e. whether he has completed his family, number of children, likelihood of wanting more children, age of partner, previous urological history which may influence surgery [e.g. if he had undescended testis and was brought down in a two-stage procedure, then ligation of vas may compromise blood supply to testis]).Assess co-morbidities and fitness for surgery.Perform a clinical examination to assess ease of palpability of vas; this determines a recommendation of LA or GA procedure.Undertake a general discussion of the surgical technique, tailored to the individual (LA vs. GA).Undertake a frank and honest discussion of the risks and specific complications associated with vasectomy.
Gynaecology: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
It is important to provide information to women about other long-term reversible methods of contraception, e.g. Mirena, Implanon, Depo-Provera and copper intrauterine devices. This should include the advantages, disadvantages and relative failure rates of each method (1). Verbal counselling should be supported by accurate leaflets and information that the woman can take away and read prior to surgery (1). The patient should be informed that if her partner opts for a vasectomy, that procedure has a lower failure rate (1 in 2000), has less morbidity and can be performed under local anaesthetic (1).
Male methods
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
A vasectomy involves cutting the vas deferens, which is the tube that transports sperm from the epididymis in the testes to the seminal vesicles. By cutting the vas deferens sperm is unable to be ejaculated and a man will become infertile once the vas deferens is clear of sperm, which takes about three months.
Will Men Use Novel Male Contraceptive Methods and Will Women Trust Them? A Systematic Review
Published in The Journal of Sex Research, 2021
John J. Reynolds-Wright, Nicholas J. Cameron, Richard A. Anderson
There are currently far fewer contraceptive options for men than for women, and none could be described as modern. Currently, male contraceptive methods consist of condoms, vasectomy, and withdrawal. However, the limitations of these methods mean that they are not suitable for many men and women of reproductive age. Vasectomy is designed to be permanent and reversal of vasectomy has a low success rate. So although it is a highly effective method, it is an unsuitable option for many men who are younger or who wish to have children in the future. Condoms are very widely used and promoted as they are the only method that also provides protection against sexually transmitted infections but are often avoided by people in longer-term relationships as they are perceived to decrease sexual pleasure, and as such are associated with low levels of satisfaction (Buck et al., 2005). Condoms and withdrawal have relatively low success rates among typical users (Trussell, 2011). The clear drawbacks of currently available male contraceptive options mean that the majority of contraceptive responsibility (including the resulting risk of side-effects) must be shouldered by women who are already disproportionately affected by the consequences of unintended pregnancy and whose acceptance of female contraception is taken for granted (Kimport, 2018; Littlejohn & Kimport, 2017). More male contraceptive options would give the opportunity to ease this burden while also allowing men to have greater control over their own fertility.
Non-pharmacological treatments for chronic orchialgia: A systemic review
Published in Arab Journal of Urology, 2021
Kareim Khalafalla, Mohamed Arafa, Haitham Elbardisi, Ahmad Majzoub
A distinct subset of patients with CO are those who develop their symptoms following a vasectomy procedure for elective sterilisation. Chronic pain following this procedure, termed PVPS, has been identified as a late complication occurring in up to 15% of cases [51]. It is defined as intermittent or constant scrotal pain that occurs after a vasectomy procedure and stays for >3 months. The pain is typically aggravated with ejaculation, physical activity, and with pressure over the testis. Conservative measures of treatment can be tried first; however, if the pain persists for a long duration and affects the patients’ daily activities, then a vasectomy reversal procedure should be considered. A total of five studies including 131 patients who underwent vasectomy reversal due to PVPS were identified [36–40]. Overall, the reported improvement in pain after surgery was 69–93%. Lee et al. [38] linked pain improvement with the patency rates after surgery. In all, 22 patients who underwent vasectomy reversal for PVPS completed a study questionnaire and were assessed with a VAS pain score before and after the operation. The patency rate was 68.2% and the pain reduction was significantly more meaningful in the patent group, with a VAS mean (SD) difference of 6.0 (1.25) vs 4.43 (0.98) in the non-patent group (P = 0.014). This result highlights the relationship between vasectomy and the development of pain after the procedure and hints that an obstructive pathophysiology is the most likely mechanism for PVPS.
Post vasectomy chronic pain: are we under diagnosing vasitis? A case report and review of the literature
Published in The Aging Male, 2020
Adam Jones, Mahmood Vazirian-Zadeh, Yih Chyn Phan, Wasim Mahmalji
A 52-year-old man presented with acute-on-chronic left testicular pain. There was a past surgical history of vasectomy, followed by reversal of vasectomy, and subsequent re-do vasectomy. There was also history of complex regional pain syndrome affecting his left hand and right foot. Clinical examination of his scrotum revealed an exquisitely tender left vas deferens. Inflammatory markers were normal. An urgent scrotal ultrasound scan (USS) was performed that reported left vasitis (Figures 1 and 2). He was successfully treated conservatively with oral ciprofloxacin 500 mg twice daily for 10 days.