General Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
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.
Azoospermia
Botros Rizk, Ashok Agarwal, Edmund S. Sabanegh in Male Infertility in Reproductive Medicine, 2019
The decision to proceed with microsurgical reconstruction for vasectomy reversal is based upon past surgical history, prior fertility, and the female partner age and fecundity because sperm recovery in the ejaculate may take a year or more. According to the obstruction level, those men can undergo a vaso-vasostomy or a vaso-epididymostomy. Patency rate is almost 100% with vaso-vasostomy when sperm are found in the vas before anastomosis. While with vaso-epididymostomy, the patency rate is between 50% and 80%. Pregnancy rates after vaso-vasostomy can reach 63% without assisted reproduction, which would decrease to 43% after a vaso-epididymostomy. Predictors of microsurgical reconstruction outcomes include intraoperative vasal fluid quality and sperm granuloma presence, vasal obstructive interval, and surgeon experience [8,43].
Chronic pain after surgery
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Most people expect to have some pain after an operation. This represents the same process within the organism as pain after any injury. The pain caused by an injury does not bear a simple relationship to the severity or “size” of the injury and in the same way the size of the operation does not neatly correlate to the severity of the chronic pain that follows. An example would be to compare vasectomy with total hip replacement or sternotomy. Vasectomy is an operation carried out for social rather than medical reasons, on fit men, and is minimally traumatic. However, in a proportion of men, the pain suffered after surgery can be severe and cause considerable disability. The prevalence of chronic pain after vasectomy varies between studies from 516 to 15 percent.17, 18 In contrast, total hip replacement is a major operation on patients who have normally long-standing and painful pathology. This is a lengthy procedure that involves cutting and reaming bone, injury to muscles and other soft tissues, and a large incision which must inevitably cut some nerves. Nikolajsen et al.19 found a prevalence of chronic pain of 28 percent at 12–18 months following total hip arthroplasty, which caused sleep disturbance in 9 percent and moderate, severe, or very severe impact on daily life in 12 percent. In this group of 1048 patients, only one did not have pain prior to the operation, the majority had severe pain. After sternotomy, another traumatic procedure, about 28 percent of patients report chronic pain, with about 13 percent overall experiencing moderate or severe pain.20, 21
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.
SCAD: a gendered cardiac threat
Published in Journal of Obstetrics and Gynaecology, 2020
Matteo De Martino, Abha Govind
Given the pathophysiological theory outlined above, contraception for these women means avoiding exogenous exposure to systemically absorbed hormones containing oestrogen and progesterone, such as the COCP/POP, progesterone implant or Depo injection. This would suggest the best options may be Vasectomy for their male partner, Copper IUD or tubal ligation, however each of these have their downsides. Vasectomy assumes a long-term partner which may not fit everyone within the typical SCAD demographic. Copper IUD though an effective contraceptive, is known to increase menstrual bleeding and in many SCAD patients Heavy Menstrual Bleeding (HMB) is a problem due to the aspirin and dual antiplatelet therapy taken. Tubal ligation on the other hand brings with it a permanence and 1 in 200 failure rate, plus SCAD patients are an increased anaesthetic risk.
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.
Related Knowledge Centers
- Animal
- Birth Control
- Elective Surgery
- Sperm
- Sterilization
- Urethra
- Vas Deferens
- Fertilisation
- Sexual Intercourse
- Physician