InformationaboutyourprocedurefromTheBritishAssociationofUrologicalSurgeons(BAUS)

Published:June2017 LeafletNo:16/049Page:1Dueforreview:April2020 ©BritishAssociationofUrologicalSurgeons(BAUS)Limited

Thisleafletcontainsevidence-basedinformationaboutyourproposedurologicalprocedure.Wehaveconsultedspecialistsurgeonsduringitspreparation,sothatitrepresentsbestpracticeinUKurology.Youshoulduseitinadditiontoanyadvicealreadygiventoyou.

Toviewtheonlineversionofthisleaflet,typethetextbelowintoyourwebbrowser:http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Vasectomy.pdf

Whatdoesthisprocedureinvolve?Vasectomyisthemosteffectivemethodofmalesterilisation.Itinvolvesremovalofasmallsectionofvasfrombothsideswithinsertionoftissuebetweenthedividedendstostopthemre‑joining.

Whatarethealternatives?• Otherformsofcontraception–bothmaleandfemale

Youshouldregardvasectomyasan“irreversible”procedure.Ifyouhaveanydoubtaboutwhetheritistherightoptionforyou,youshouldnotgoahead.

KeyPoints• Vasectomyisthemosteffectivemethodofmalesterilisation• Itshouldalwaysberegardedas“irreversible”• Youwillnotbesterileimmediately,butwillneedtocontinuealternativecontraceptionuntilyouhavebeengiventhe“all-clear”fromyourpost-operativesementestsafteratleast12weeksand20ejaculations

• Latefailure,duetotheendsjoiningthemselvesbacktogether,occursin1in2000men

• Thereisnoevidencethatvasectomycausesanylong-termhealthrisks(e.g.testicularcancer,prostatecancer)

• Troublesomechronictesticularpainisreportedinupto15%ofpatientsandcanbesevereenoughtoaffectday-to-dayactivitiesinupto5%

Published:June2017 LeafletNo:16/049Page:2Dueforreview:April2020 ©BritishAssociationofUrologicalSurgeons(BAUS)Limited

Undernormalcircumstances,vasectomyisnotappropriateduringpregnancyorwithinthefirstsixmonthsafterthebirthofachild.

Whathappensonthedayoftheprocedure?Yoururologist(oramemberoftheirteam)willbrieflyreviewyourhistoryandmedications,andwilldiscussthesurgeryagainwithyoutoconfirmyourconsent.

Ifyouarescheduledtohaveyourvasectomyundergeneralanaesthetic,ananaesthetistwillseeyoutodiscusstheoptionsofageneralanaestheticorspinalanaesthetic.Theanaesthetistwillalsodiscusspainreliefaftertheprocedurewithyou.

WeusuallyprovideyouwithapairofTEDstockingstowear.Thesehelptopreventbloodclotsfromdevelopingandpassingintoyourlungs.Yourmedicalteamwilldecidewhetheryouneedtocontinuetheseafteryougohome.

Detailsoftheprocedure• wenormallyuselocalanaestheticbut,ifyourtubesaredifficulttofeel,generalanaestheticispreferred

• localanaestheticcausessomediscomfortwheninjectedandtheneedleprickispainful(likea“beesting”)

• youwillneedtwoinjectionsoflocalanaesthetic,oneoneachside• oncethishasworked,yourskinwillbenumbandyouwillnotfeelanythingsharporpainful;youwillstillfeelsensationsoftouch,hotandcold

• whenthesurgeonpicksupeachtubeinturn,youmaygetalittlediscomfort;thiscanmakeyoufeellight-headed,sweatyandslightlysickbutsubsidesveryquickly

• weuseabsorbablestitchestoclosethescrotalskinwhichdisappearwithintwotothreeweeks

Arethereanyafter-effects?Thepossibleafter-effectsandyourriskofgettingthemareshownbelow.Someareself-limitingorreversible,butothersarenot.Wehavelisted

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someimportantbutveryrareafter-effects(occurringinlessthan1in250patients)individually.Theimpactoftheseafter-effectscanvaryalotfrompatienttopatient;youshouldaskyoursurgeon’sadviceabouttherisksandtheirimpactonyouasanindividual:

Whatismyriskofahospital-acquiredinfection?Yourriskofgettinganinfectioninhospitalisapproximately8in100(8%);thisincludesgettingMRSAoraClostridiumdifficilebowelinfection.Thisfigureishigherifyouareina“high-risk”groupofpatientssuchaspatientswhohavehad:

• long-termdrainagetubes(e.g.catheters);• bladderremoval;• longhospitalstays;or

After-effect RiskMildbruisingandscrotalswellingwithseepageofclearyellowfluidfromthewoundafterafewdays

Almostallpatients

Bloodinyoursementhefirstfewtimesyouejaculate

Between1in2&1in10patients

Troublesomechronictesticularpainwhichcanbesevereenoughtoaffectday-to-dayactivities

Between1in7&1in20patients

Significantbruisingandscrotalswellingrequiringsurgicaldrainage

Between1in10&1in50patients

Epididymo-orchitis(infectionorinflammationofyourtesticle)

Between1in10&1in50patients

Earlyfailure(post-operativesemenanalysisshowspersistentmotilesperms)sothatyouarenotsterile

1in250patients

Latefailure(re-joiningoftheendsofthetubesafterinitialnegativespermcounts)resultinginfertility&pregnancyatalaterstage

1in2000patients

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• multiplehospitaladmissions.

WhatcanIexpectwhenIgethome?• thelocalanaestheticwillwearoffafterfourtosixhours• itisadvisabletotakesimplepainkillerssuchasparacetamol,beforethelocalanaestheticwearsoff,tohelpkeepdiscomfortatbay

• youwillgetsomeswellingandbruisingofthescrotumwhichmaylastseveraldays

• youmaybegivenascrotalsupportwhichyoushouldwearforthefirstfewdaystoreduceanyswellingorbruising

• yourstitchesdonotneedtoberemovedandusuallydisappearaftertwotothreeweeks,althoughthismaysometimestakeslightlylonger

• trytoavoidanyheavyliftingorstrenuousexertionforthefirstfewdays.

• youwillbegivenadviceaboutyourrecoveryathome• youwillbegivenacopyofyourdischargesummaryandacopywillalsobesenttoyourGP

• anyantibioticsorothertabletsyoumayneedwillbearranged&dispensedfromthehospitalpharmacy

• wewillgiveyouinformationaboutyourfollow-upappointmentsandpost-vasectomyspermcounts

Itisessentialthatyouunderstandyouarenotsterileimmediatelyaftertheoperation.Thisisbecausesomespermshavealreadypassedbeyondthesitewherethetubesaretiedoff.Thesespermsneedtobeclearedbynormalejaculation.Onaverage,youwillneed20to30ejaculationstoclearthem.

Atleast12weeksafteryourvasectomy,youwillbeaskedtoproduceaspecimenofsemenforexaminationunderamicroscope.Pleasereadtheinstructionsforproducinganddeliveringthespecimenverycarefully.

Ifnospermsarepresent,youwillbegiventhe“all-clear”thatyouaresterile.Ifthesamplestillcontainssperm,youwillbeaskedtoproduceafurthersampleafewweekslatertoensurethatyouareclear.

Moreinformationisavailableintheinformationleafletaboutpost-vasectomyspermcountsontheBAUSwebsite.

Published:June2017 LeafletNo:16/049Page:5Dueforreview:April2020 ©BritishAssociationofUrologicalSurgeons(BAUS)Limited

IMPORTANTINFORMATIONABOUTSPERMCOUNTS

Untilyougetnotificationthatyouare“allclear”onyoursemensample,youMUSTcontinuewithyourcontraceptiveprecautions;untilyouhavereceivedthisnotification,youcannotrelyonyourvasectomybecauseyoumaynotbesterile

GeneralinformationaboutsurgicalproceduresBeforeyourprocedurePleasetellamemberofthemedicalteamifyouhave:

• animplantedforeignbody(stent,jointreplacement,pacemaker,heartvalve,bloodvesselgraft);

• aregularprescriptionforabloodthinningagent(warfarin,aspirin,clopidogrel,rivaroxabanordabigatran);

• apresentorpreviousMRSAinfection;or• ahighriskofvariant-CJD(e.g.ifyouhavehadacornealtransplant,aneurosurgicalduraltransplantorhumangrowthhormonetreatment).

QuestionsyoumaywishtoaskIfyouwishtolearnmoreaboutwhatwillhappen,youcanfindalistofsuggestedquestionscalled"HavingAnOperation"onthewebsiteoftheRoyalCollegeofSurgeonsofEngland.Youmayalsowishtoaskyoursurgeonforhis/herpersonalresultsandexperiencewiththisprocedure.

BeforeyougohomeWewilltellyouhowtheprocedurewentandyoushould:

• makesureyouunderstandwhathasbeendone;• askthesurgeonifeverythingwentasplanned;• letthestaffknowifyouhaveanydiscomfort;• askwhatyoucan(andcannot)doathome;• makesureyouknowwhathappensnext;and• askwhenyoucanreturntonormalactivities.

Wewillgiveyouadviceaboutwhattolookoutforwhenyougethome.Yoursurgeonornursewillalsogiveyoudetailsofwhotocontact,andhowtocontactthem,intheeventofproblems.

SmokingandsurgeryIfyouarehavingalocalanaesthetic,stoppingsmokingwillhavenoeffectonthisprocedure.Smokingcanworsensomeurologicalconditionsand

Published:June2017 LeafletNo:16/049Page:6Dueforreview:April2020 ©BritishAssociationofUrologicalSurgeons(BAUS)Limited

makescomplicationsmorelikelyaftersurgery.Foradviceonstopping,youcan:

• contactyourGP;• accessyourlocalNHSSmokingHelpOnline;or• ringthefreeNHSSmokingHelplineon08001690169.

DrivingaftersurgeryItisyourresponsibilitytomakesureyouarefittodriveafteranysurgicalprocedure.YouonlyneedtocontacttheDVLAifyourabilitytodriveislikelytobeaffectedformorethanthreemonths.Ifitis,youshouldcheckwithyourinsurancecompanybeforedrivingagain.

WhatshouldIdowiththisinformation?Thankyoufortakingthetroubletoreadthisinformation.Pleaseletyoururologist(orspecialistnurse)knowifyouwouldliketohaveacopyforyourownrecords.Ifyouwish,themedicalornursingstaffcanalsoarrangetofileacopyinyourhospitalnotes.

Whatsourceshaveweusedtopreparethisleaflet?Thisleafletusesinformationfromconsensuspanelsandotherevidence-basedsourcesincluding:

• theDepartmentofHealth(England);• theCochraneCollaboration;and• theNationalInstituteforHealthandCareExcellence(NICE).

Italsofollowsstyleguidelinesfrom:• theRoyalNationalInstituteforBlindPeople(RNIB);• thePatientInformationForum;and• thePlainEnglishCampaign.

DisclaimerWehavemadeeveryefforttogiveaccurateinformationbuttheremaystillbeerrorsoromissionsinthisleaflet.BAUScannotacceptresponsibilityforanylossfromactiontaken(ornottaken)asaresultofthisinformation.

PLEASENOTEThestaffatBAUSarenotmedicallytrained,andareunabletoanswerquestionsabouttheinformationprovidedinthisleaflet.Ifyoudohaveanyquestions,youshouldcontactyoururologist,specialistnurseorGP.