Download vasectomy - Urology Team

VASECTOMY
CONSULTATION INFORMATION
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
A PERMANENT DECISION
About 500,000 men get a vasectomy every year. A vasectomy is a simple, safe, easy, and inexpensive
procedure done in your doctor’s office. There are several choices available for contraception, and each
couple must choose the method which suits their needs. Temporary and reversible methods of birth control
include condoms, spermicides, a diaphragm, IUD, the pill, the patch and Depo-Provera. Permanent methods
include tubal ligation and male sterilization by vasectomy. These procedures are generally considered
irreversible. There are reversal procedures, but they are not 100% successful. In addition, these reversal
procedures are generally not covered by any insurance and can be quite expensive. While no one can
predict the future, you must take into consideration the possibility of unforeseen changes in your life or in the
lives of your partner and children. A man can bank (i.e. freeze) his sperm before his vasectomy is
performed, but it is expensive and most men do not do so.
ANATOMY
Each testis (testicle) is a smooth, oval shaped gland, which rests in the sack like scrotum and is connected by
its blood vessels, nerves and vas deferens, which all run in the spermatic cord. The testis contains several
long tubes in which sperm are made and channeled into the epididymis, a soft, comma shaped attachment on
the top and back of each testis. The testes also have the important function of producing testosterone and
other male hormones. These hormones are transported out of the testes through the blood vessels, so this
function is not affected by vasectomy which interrupts only the sperm flow. The sperm are produced on the
inside of the testicles in specialized rows of cells. The sperm maturation cycle is about 90 days. This means
that the sperm that are produced today will not be ready for ejaculation for about three months. The
epididymis collects the sperm, which eventually travel through the narrow vas deferens to join the seminal
vesicle. Sperm can be stored toward the end of the vas deferens for many weeks before being released
during ejaculation. Both left and right seminal vesicles empty through the single prostate gland and out of
the penis through the urethra.
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
Remember that the organs are paired left and right from the testes to the seminal vesicles so both vas
deferens must be interrupted for a successful vasectomy.
CONSULTATION
A vasectomy is an outpatient procedure that can be done in the office in greater than 95% of the cases when
the anatomy is favorable. On occasion, individuals with certain medical problems or a history of previous
scrotal surgery may require vasectomy under a general anesthetic in hospital or in an outpatient setting.
The preoperative consultation will consist of an interview, medical history review, and physician
examination. The operation will be described completely to the patient's satisfaction. If both the patient and
the physician are in agreement, the vasectomy will be scheduled at their mutual convenience.
THE PROCEDURE
The vasectomy will take about 10- 30 minutes to perform. A local anesthetic is injected into the scrotal skin
adjacent to the vas deferens. This affords almost immediate anesthesia. A small incision is made in the
scrotum, the vas deferens is exposed, and a small portion is removed. The severed ends are then either tied
with suture or cauterized. The skin incisions are usually closed with one suture, which dissolves in seven
to ten days. You may notice a small open gap at the site of the incision after the sutures fall out. This
will close up over time. You may notice some firmness in and around the incision site. It will soften,
flatten and return to normal within a few weeks.
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
RISK INVOLVED WITH THE PROCEDURE
In general, a vasectomy is a very safe procedure with very low risk or complication.
What complications can occur?
What treatment is required?
Three or four times out of one thousand, one or both ends of
the severed vas deferens will rejoin and re-canalize.
Those individuals will not be able to attain two negative semen
samples after their procedure. Therefore, contraception must
be used until two semen samples are determined to be clear of
sperm, which usually takes two or three months.
Usually no treatment is required: it resolves spontaneously
over time.
Sperm granuloma, a tender knot in the scrotum where sperm
has leaked out of the vas deferens, may develop. Avoiding
ejaculation during the first week after vasectomy usually averts
this problem, but it can occur at later times as well.
A sensitive scar or neuroma may form along the vas at the site
of vasectomy.
Infection of the scrotum: This may cause drainage of yellowish
fluid, pain, redness, and heat around the area of incision
accompanied by a temperature above 101.5F.
Bleeding can occur at the vasectomy site but is usually only
enough to cause some bruising of the skin.
Scrotal Hematoma is a large collection of blood inside the
scrotum, where a blood vessel has continued to leak. A
swelling in the scrotum would occur within 48 hours after the
vasectomy.
Allergic reaction or other unusual reactions to anesthetics or
medications can occur even without a history of a drug allergy.
These reactions are often serious.
Inflammatory reaction in the epididymis or vas deferens is
defined as inflammation of the epididymis, the tightly coiled
segment of the spermatic duct that connects the efferent duct
from the posterior aspect of each testicle to its respective vas
deferens.
Emotional reactions that could interfere with normal sexual
function. Although a vasectomy does not in any way physically
impair sexual function, some men report having difficulty
achieving and maintaining an erection after undergoing the
procedure.
Impaired blood flow resulting in loss of a testicle. Rarely, the
testicles may be injured during a vasectomy as a result of
injury to the testicular artery.
Chronic testicular pain. Occasionally, chronic pain may
develop after the vasectomy and be exacerbated by
ejaculation. This pain is thought to be the result of back
pressure building up in the epididymis and is known as “post
vasectomy pain syndrome”.
Round Rock: 512-828-5522
Rarely bothersome enough to require injection with medicine
or surgical removal.
This usually responds to local hygiene and oral antibiotics. Call
the office immediately.
Controlled with direct pressure.
Please call the office immediately and get instructions from
Triage department at 512-231-1444 extension 292 or after
hours 512-231-1444 and get connected to physician on call.
Medications will be prescribed.
Please call Triage at 512-231-1444 ext 292. •In addition to
antibiotics (except in viral epididymitis), the mainstays of
supportive therapy for acute epididymitis is reduction in
physical activity, scrotal support and elevation, Ice packs, Antiinflammatory agents, Analgesics, including nerve blocks and
Sitz baths.
Please call Triage at 512-231-1444 extension 292
Please call Triage at 512-231-1444 ext 292 or after hours 512231-1444 and get connected to physician on call.
Please call Triage at 512-231-1444 ext 292.
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
COMMON QUESTIONS AND IMPORTANT FACTS ABOUT VASECTOMY
IS VASECTOMY A SURE THING?
Vasectomy is the most effective of all the methods of birth control. It also ranks among the safest and most
effective of surgeries. The failure rate for vasectomy is 0.4% or about four out of 1000 men would remain
fertile, even several months after the vasectomy. Failure can occur due to reconnection of the cut ends
during healing, formation of a new channel through the sperm granuloma, failure to identify and cut the vas,
or duplication of the vas on one side. If you follow the post vasectomy instructions and complete your
semen analysis within the three months required, and your semen test remained positive, we would repeat the
vasectomy procedure at no cost to you.
WILL IT HURT?
Local anesthetic is used if the procedure is performed in the office. Some discomfort may be felt when the
local anesthetic is injected or when the tubes are brought into the incision. As with most surgery, there is
some discomfort after the operation. There may or may not be a dull aching in the testicle or the abdomen
after the anesthetic has worn off. This ache, if it occurs, is usually mild and may be felt from time to time
over the first few days, especially with activities such as getting up or moving quickly. There may be a small
amount of oozing from the incision for a few days. There is commonly a temporary bruised color on the
scrotum after 2-3 days. It will be different for each man. Athletic support, ice pack, and an over the counter
analgesic are the best medicine for your discomfort.
WILL VASECTOMY AFFECT MY SEXUAL ACTIVITY?
Your erections, orgasm, and ejaculations will very much be the same. Most men say they have greater sexual
pleasure because they no longer have to worry about an unwanted pregnancy. Remember that sterility is not
impotence. The hormones that affect masculinity are still made in the testicles. They still flow throughout the
body in the blood stream. Ask your doctor when you can resume sexual activity. Remember that you must
use another form of birth control until your doctor says you are completely sterile.
WHEN I HAVE AN ORGASM, WILL I STILL EJACULATE?
Yes. The amount of semen a man ejaculates after the vasectomy is only decreased by about 5%. Without a
microscope, you could not notice the absence of sperm in the fluid.
WHAT HAPPENS TO THE SPERM AFTER THE VASECTOMY?
The testes continue to produce sperm cells that go through the same life cycle as before. The unused sperm
cells are reabsorbed naturally as are other unused or old cells in the body. Sperm antibodies may form to help
in the removal process, but these are not harmful to the body.
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
WHY IS VASECTOMY NOT EFFECTIVE IMMEDIATELY?
During the vasectomy the vas deferens from each side is cut. The sperm stored downstream in the seminal
vesicles can still be ejaculated and cause pregnancy. The system needs to be emptied, which is usually
completed after 20-25 ejaculations and at least three months after surgery. If you have a negative semen
check once, there is an exceedingly small chance that you will experience a later failure with spontaneous
reappearance of sperm in the semen. To be sure, it is UTPA policy that you have at least two negative semen
checks within six months of the vasectomy.
CAN I HAVE THE VASECTOMY REVERSED?
Sometimes it is possible to reverse the operation, but there are no guarantees. Vasectomy Reversal is more
expensive than the vasectomy and often not covered by your insurance company. It is a very intricate
microsurgical procedure that is performed by several physicians at The Urology Team. For more
information, visit our Vasectomy Reversal section, www.urologyteam.com.
SHOULD I SAVE SPERM BEFORE VASECTOMY?
Commercial sperm banking, freezing sperm for later use, is available for men that would like to consider this
option. One available company is Fairfax Cryobank @ 512-206-0408.
WHAT ARE THE LONG TERM EFFECTS OF A VASECTOMY?
Vasectomies have been in use since the early 1990s. Over 10 million American men have had a vasectomy
for sterilization. About 40% of patients having a vasectomy develop a rise in sperm antibodies for a period
of up to six months. This immune reaction is not harmful, and the person having the vasectomy will feel no
different. No long term adverse side effects have been proven associated with vasectomies. Studies have
not demonstrated that vasectomies play any role in prostate cancer. According to work done at the National
Institute of Health, men that have had a vasectomy are not more likely to develop heart disease or prostate
cancer than men who have never had a vasectomy. Medical scientists continue to explore the minor changes
in the body associated with vasectomies.
HOW WILL I FEEL ABOUT THE OPERATION AFTERWARD?
Almost all men (99.2%) who have had a vasectomy are completely satisfied with the operation afterward.
They enjoy the freedom from other contraceptive methods, which can interfere with freedom from worry
about an accidental pregnancy and freedom from concern about the effects of the pill or IUD on their
partner’s health. A small number of men later regret having the operation. This is why it is so important to
make the decision carefully, without any outside pressure and without regret. Your satisfaction depends
largely upon your own preparation and thoughtful decision making.
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
WHAT IS THE COST FOR A VASECTOMY?
Depending upon the area of the country, vasectomy charges or cost vary. In general, most insurance
companies will cover a very large portion of this cost, leaving a relatively small co-pay or deductible for the
patient. As a courtesy, The Urology Team will make every effort to contact your insurance company to
verify the services which will be covered prior to your visit. Please call our insurance verification
department at 512-231-1456 if you have not heard from us 24 hours before your procedure. You may also
check with your insurance coverage regarding your financial responsibility. Added cost or billing to your
insurance company may include semen analysis from the lab where the semen is taken. Tissue from
your vas deferens may be sent to pathology, and there may be additional billing from that respective
company. If you are a private pay patient, please call our billing department regarding charges for
the vasectomy services.
HOW CAN I SCHEDULE A VASECTOMY?
You can schedule your appointment at the check out window after your consultation, or you can contact our
office (512-231-1444) for help. If you have an HMO, you may be required to visit your family physician
first. The family physician will then refer you to our office with a referral. If you have a PPO, you can visit
our office directly. Because insurances are so complicated, we encourage you to call the number listed on
your insurance card to verify the process needed to get approval for the vasectomy.
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
VASECTOMY PREPARATION
Five days before your surgery: Avoid all aspirin and aspirin containing products (Bufferin, Excedrin, Alka
Seltzer, Ibuprofen, and any herbal remedies), and blood thinning products for five days before the
vasectomy. You may use Tylenol. Arrange to be off from work for two to three days after the vasectomy.
The night before procedure: Please shave the surgical area. Begin 2” above penis and shave downward to
include entire scrotum (testicles). Do not use electric razors or hair removal products.
Please shave all shaded areas. The area should be free of stubbles.
SOAP AND LATHER THE SCROTUM FOR 10 MINUTES.
USE AN ANTIMIRCROBIAL SOAP SUCH AS DIAL SOAP, ETC.
The day of procedure: Soap the scrotum again for 5 to 10 minutes. Use an antimicrobial soap again.
Please bring an athletic supporter, snug briefs, or biking shorts to wear after
the procedure. The athletic supporter is an added measure to reduce pain and
swelling. Brief and boxer shorts do not provide the same support.
You may eat and drink as you normally do. Follow the preoperative instructions closely and be sure to
bring the required items to the office. The front desk will present you with a consent form to read and sign.
Plan to arrive 30 minutes early should you want to ask your physician for a mild sedative prior to the
procedure. Please bring someone with you to drive you home. You may also be asked to sit in the
waiting room for 30 minutes after the procedure as a cautionary measure. The local anesthetic begins to
wear off after an hour or so. Any discomfort you feel is often mild and should respond to ice packs.
QUESTIONS
PLEASE CALL TRIAGE @ 512-231-1444 Ext. 292 IF YOU HAVE ANY QUESTIONS.
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
Two choices for submitting your specimen
Post Vasectomy Sperm Analysis & Lab Results from www. PVSA.org
Choice # 1:
PVSA
Why Order PVSA?
Increased Post Vasectomy Compliance
Published studies show that up to 46% of vasectomy patients do not submit a semen specimen for post
vasectomy semen analysis (PVSA). This poor patient compliance is attributed to the inconvenience
and discomfort of having to hand-deliver and/or produce a sample for analysis in a doctor's office or a
laboratory.
PVSA™ allows patients to collect a semen sample (via masturbation) in their home and mail it to the
Bedford Research laboratory for a sperm count. Patients only need one PVSA (or lab sperm analysis).
The results must show 0 (zero) sperm or only non-mobile sperm or the test must be repeated one
month later. The patient receives the PVSA kit at their home in a discreet package. Ninety six percent
(96%) of patients surveyed agree PVSA is easy and convenient to use.
You can purchase the PVSA kit for $45.00 on-line via Paypal at www.pvsa.org or by calling 617-623-7447. You will
be asked for your shipping address once inside the PayPal site. You do not need a PayPal account to order - click
"continue" on the left hand side of the PayPal login to bypass it and pay by credit card. If you have any problems or
questions please email us at [email protected], or call 617-623-7447, or fax 617-623-9447, or email
[email protected] with any questions. Results will be mailed to you and the doctor’s office.
IF YOU SELECT PVSA THE RESULTS WILL BE SENT TO YOUR HOME
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14
Choice: #2 -Local Lab Instructions: If you select to use a local lab, the results will be sent to UTPA which can be retrieved
via secure server. Visit www.urologyteam.com for instructions. Please remember there is a $15 dollar charge for each
item (lab slip or lab cup) lost. Please call your insurance company (1 800 #) on the back of your card
to verify their contracted lab company.
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Rev 03/12/14
The Urology Team PA
Vasectomy Consent Form & Responsibilities
I, ______________________________, hereby authorize Dr. ____________________ /and such
associates, technical assistants and other health care providers as they may deem necessary, to
perform a bilateral vasectomy on me. A bilateral vasectomy is a procedure to make a man infertile
(sterile). It is a permanent and irreversible procedure. I understand that this procedure is
performed through small scrotal incisions and that a small portion of each vas is removed and may
be sent for pathological evaluation. I voluntarily consent and authorize the vasectomy.
I agree to the administration of local anesthetic (medicine to numb the area of the surgery) or other
medications before, during, or after the procedure.
I recognize that, as with any operation, there are risks, both known and unknown, associated with the
vasectomy and that no guarantee has been given to me as to the results of this operation. Possible
complications include, but are not limited to, the following: inflammatory reaction in the epididymis or
vas deferens, excessive bleeding into the scrotum (hematoma), painful nodule or scar (sperm
granuloma, neuroma), infection, allergy or adverse reaction to an anesthetic or medication, emotional
reactions that could interfere with normal sexual function, impaired blood flow resulting in loss of a
testicle, failure to achieve or maintain sterility, and chronic testicular pain. As a result of possible
complications, there could be unexpected loss of time from employment and /or additional medical
expenses. I understand and accept that these or other conditions may necessitate further treatment, tests,
another operation, procedure, and /or hospitalization at my own expense. I request and authorize UTPA, the
doctor listed above and other qualified medical personnel to perform such treatment or procedure as required.
Patient Responsibilities
I understand that I am not considered sterile and must use another form of birth control my three month sperm
analysis shows 0 (zero) sperm or only non-mobile sperm. I understand that if sperm is found, it will be
necessary to submit another sperm analysis at a later date per physician’s instructions.
I understand that Urology Team will provide me with collection instructions, lab orders, lab cups, instructions,
lab locations, and how to access my lab results via the Urology Team website. I understand if I lose my
local lab orders or local lab cups there is a replacement fee of $15.00 for each item lost. I agree that I
can charge these fee(s) or I agree to allow them to be charged to my account. I agree to pay this/these
fees. For PVSA specimens I agree to log onto their site to reorder specimens if needed.
I have been given the opportunity to ask questions about the vasectomy, alternative birth control, risks and
hazards, and I request this vasectomy voluntarily, of my own free choice. I have carefully read or had read to
me the above information, and I understand and accept the terms and conditions.
Date: _____________________________ Time: ______________________
_________________________________________________________________________________
Signature
Printed Name
Relationship to Patient
Round Rock: 512-828-5522
North Austin: 512-231-1444
www.urologyteam.com
Westlake: 512-328-1313
Rev 03/12/14