Epididymal Vasectomy

Male family planning surgery is mainly to prevent the discharge of sperm, that is, vasectomy. In addition, it also includes the treatment of re-cultivation after infertility or sterilization, that is, vas deferens anastomosis and vas deferens epididymal anastomosis. Vas deferens surgery refers to the use of surgical or non-surgical procedures to cause spermatic tract blockade. After the testis can still continue to produce sperm, mature sperm dissolved in the epididymis, there is still a normal ejaculation process during sexual intercourse, but there is no sperm in the semen. The vas deferens sterilization is simpler, safer, and has no complications of abdominal surgery than the fallopian tube birth control. The postoperative recovery is also faster. Therefore, it is currently the main birth control measure. The vas deferens sterilization includes cutting off the vas deferens, occluding the vas deferens by means of chemical or electrocoagulation, blocking the vas deferens in the lumen, or closing the vas deferens outside the tube. Currently, the most commonly used is vasectomy, followed by vas deferens occlusion. Due to azoospermia caused by obstruction of the spermatic tract, the general obstruction usually occurs in the tail of the epididymis, and can be used for anastomosis of the vas deferens. The success rate of this procedure is far less than that of vas deferens. Treating diseases: azoospermia Indication Epididymal vas deferens anastomosis is suitable for spermatozoa in the semen, obstructive lesions in the tail of the epididymis, and normal testicular biopsy. Contraindications 1. Hemorrhagic disease, mental illness, severe neurosis, sexual dysfunction, acute or severe chronic disease. 2. Acute or chronic inflammation of the genitourinary system should be cured before surgery or other birth control measures. 3. Scrotal skin acute or chronic inflammation, lymphedema or other skin diseases that interfere with surgery should be cured before surgery. 4. Intra-scrotal diseases, such as inguinal hernia, hydrocele, varicocele, etc., should be treated after surgery, or vaginal canal ligation at the same time as surgery in the scrotum. Preoperative preparation 1. Testicular biopsy and sperm angiography. If the testicular biopsy is normal and the spermatic tract is obstructed by the epididymal tail lesion, the operation can be performed. 2. Patients with prostatitis should be treated first, and antibiotics should be applied before surgery. 3. Acute and chronic infection of the urinary tract, scrotal skin disease and scrotal disease, after the cure, then vasectomy. 4. Pay attention to the history of drug allergy and do a procaine skin test. 5. Bathe before the operation, clean the vulva, and replace the cleansing pants. Shave the pubic hair before surgery. 6. Dip the penis scrotum with 1:1000 benzalkonium solution for 5 min before surgery, then dry it, then disinfect the skin with 1:1000 thiomersal or 75% ethanol; or disinfect it 3 times with 1:1000 chlorhexidine. Surgical procedure 1. Incision and exploration of the contents of the scrotum to make a longitudinal incision in the anterior midline of the scrotum. Cut the skin, the membrane, and the fascia until the testicular sheath wall. The blunt dissection is performed outside the parietal layer, and the testicular sheath is extruded along with the contents of the scrotum, the testicular sheath is incision, the testis and epididymis are exposed, and the epididymis vas deferens is isolated to check whether the testis, epididymis, and vas deferens have lesions. 2. The seminal vesicle vas deferens injection test puncture the vas deferens lumen at the corresponding position above the obstruction of the epididymal lesion, and inject 5 ml of isotonic saline into the seminal vas deferens. If there is no resistance to water injection, the patient has a sense of urinary sensation, indicating that the seminal vesicle is patency. 3. Cut the head of the epididymis to the upper part of the epididymal lesion, make a longitudinal incision in the epididymis, and cut off the small tube in the epididymis. If there is liquid overflow, collect it with sterile slides, plus isotonicity. Brine, placed under a microscope to observe the presence or absence of sperm. If there is no sperm, the incision is extended in the direction of the epididymis head, and the liquid is collected for microscopic examination until sperm is found. 4. Cut the vas deferens into the vas deferens at the corresponding site above the obstruction of the epididymis of the epididymis and make a longitudinal incision, the length of which is equivalent to the longitudinal incision of the head of the epididymis. The 3-0 nylon thread was inserted into the lumen from the upper end of the longitudinal incision of the vas deferens through the injection needle, and then passed through the wall of the tube and pulled out of the skin. 5. The vas deferens epididymal anastomosis with 8-0 nylon line vas deferens epididymal side anastomosis. The upper and lower ends were sutured first, and the tail was pulled after ligation, and the lower end of the nylon support wire was taken out from the lower corner of the anastomosis through the anastomosis, and then the suture was made on both sides of the anastomosis of the vas deferens. Finally, the lower end of the nylon support wire is pulled out of the scrotum skin. 6. Perform contralateral surgery with the same method. 7. Suture the incision to check that there is no bleeding in the incision, place the rubber drainage strip, and suture the scrotal incision with a thin silk thread. Finally, the lower two ends of the nylon support line are ligated and fixed outside the skin. complication 1. Bleeding: Most of the causes of bleeding are caused by rough operation and incomplete hemostasis during surgery. Most of the bleeding occurred within 24 hours after surgery. Generally, cold compress, pressure dressing, application of hemostatic drugs and antibiotics can be used. If hematoma has formed, hemorrhage can be extracted after a few days, and hyaluronidase and intramuscular injection of chymotrypsin can be injected to promote hematoma liquefaction. If the hemorrhage has not stopped, the hematoma rapidly increases within 48 hours, then surgery should be performed immediately to remove the hematoma. Stop bleeding and place drainage. Apply hemostatic drugs and antibiotics and prevent other complications. 2. Infection: The cause of infection is often the original scrotal infection and genitourinary infection, the scrotum is not cleaned and disinfected as required before surgery, the surgical instruments and dressings are not aseptically required, the operation is rough, the tissue damage is excessive, and the bleeding is stopped. Incomplete and postoperative dressing shedding, wound contamination, etc. Postoperative infection can be divided into two categories, namely, shallow infection of the scrotum incision and deep tissue infection such as spermatic cord. The former is limited to the scrotal incision and subcutaneous tissue, the latter deep into the spermatic cord and other tissues, the infection can make the spermatic cord thick and hard, pain and tenderness, and even develop into a spermatic abscess, causing epididymis, testis and seminal vesicle, prostate infection. If infection has occurred, use effective antibiotics, local hot compresses, spermatic cord closure and other treatments. If abscesses are formed, drainage should be cut in time to prevent acute infections from becoming chronic infections. 3. Sperm granuloma formation: more semen overflow after incision of the epididymal vas deferens, during the placement of the vas deferens support or after the removal of semen can also be formed by semen overflow, nodules small and asymptomatic can not be treated, nodules and symptoms Severe cases can be considered for surgical resection. 4. Failure of anastomosis: 1 year after vasectomy, if sperm is not found in semen, it is considered unsuccessful, and surgery can be considered after 1 year.