Vasectomy

Vasectomy is a simple, safe, and reliable sterilization procedure that is one of the main operations for family planning. The vasectomy only blocks the sperm delivery channel, causing the sperm to accumulate in the tail of the fall of the testis and later liquefied. After more than 10 years of vasectomy, the patient can still restore fertility, which proves that the operation of the seminiferous tubule epithelium has no effect, and the male hormone secretion of interstitial cells is not hindered, so the second sex of the postoperative male is not It will change and will not affect sexual function and physical strength. Treatment of diseases: lack of vas deferens, such as vas deferens Indication 1. Perform vasectomy for blindness. If there is chronic prostatitis, it can be treated after surgery to stabilize the condition; if there is chronic epididymitis and severe neurasthenia, other contraceptive measures should be taken. If there is testicular hydrocele, inguinal hernia or severe varicocele, surgery can be performed at the same time. Patients with scrotal skin disease should be treated after the cure. 2. Perform vasectomy due to other conditions. If one side of the epididymal tuberculosis is not expected to be born, the contralateral vas deferens can be ligated when the diseased side epididymis is removed to prevent the lesion from spreading to the contralateral epididymis. In the case of prostatic resection of prostate hypertrophy, in order to prevent postoperative epididymitis, bilateral vasectomy can also be performed. Preoperative preparation 1. Explain to the operator, explain the importance of family planning, the physiological knowledge of male sexual function, and the safety, reliability and simplicity of vasectomy, and eliminate ideological concerns. 2. If there is rural housing surgery, dust and fly-proof facilities are required. 3. Prepare a blade, 5ml syringe, 1 small needle for skin test, 4 small gauze, 1 separate forceps separation pliers (with mosquito-type hemostasis to remove the clamp teeth, the end sharpening tip), vas deferens fixed clamp 1 (Or use a straight hemostatic forceps to grind the jaws, the end thickness is 1.2mm, bend into a circular hole with an inner diameter of 2mm and an outer diameter of 3.5mm. You can also narrow the front end of the tissue clamp and keep two teeth.) Put (sharp the wire, bend it into a hook, and put it on the handle). 4. Cut or shave the pubic hair, wash the penis and scrotum with soapy water for 5 minutes, and disinfect the skin with a 1:1000 benzalkonium solution 3 times before surgery. Surgical procedure 1. Position: supine position, the two lower limbs are slightly separated. 2. Manipulative fixation of the vas deferens: the surgeon stands on the right side of the subject, fixes the vas deferens with the left thumb, food and middle finger, opens the scrotal skin, and pushes the spermatic vessels. First ligation on one side and ligation on the other side. During anesthesia and separation, keep your fingers fixed to prevent the vas deferens from slipping. 3. Select the puncture site and anesthesia: the puncture site is selected on the upper part of the scrotum, and is far away from the tail of the epididymis. Puncture the scrotal skin with a fine needle, inject 0.5% to 1.0% procaine solution, then inject into the vas deferens, infiltrate the surrounding tissue. 4. Splitting the skin: Using a vas deferens separation forceps, puncture the skin layers of the scrotum by local anesthesia needles, and open the separation forceps to expand the puncture hole to 0.3-0.4 cm. 5. Fix the vas deferens: Insert the vas deferens fixed forceps from the skin rupture, open the clamp ring, touch the vas deferens, and tighten the vas deferens into the clamp ring with the cooperation of the left middle finger. 6. Proposed vas deferens: the vas deferens is proposed to be ruptured, and the fascia of the spermatic cord and the outer membrane of the vas deferens are cut longitudinally to expose the milky white vas deferens wall. Use a vas deferens to lift the hook out of the outer membrane incision. 7. Separate and ligature the vas deferens: Separate a 1.5cm long vas deferens, taking care to avoid damage to the vas deferens; if there is damage, it should be ligated. The proximal end of the vas deferens (near the epididymis side) was ligated with a 1-0 silk thread. The ligation should be loosened properly to avoid loosening or severing the wall of the tube, allowing the sperm to overflow and causing the vas deferens to recanalize. The ligature line is not cut yet. At the distal end of the vas deferens, another line is wound, and no ligation is temporarily performed. 8. Injection of spermicidal solution: cut the vas deferens between the two ligatures, insert the pedicle lumen into the seminal vesicle with a flat needle, and clamp the wall and needle with a hemostat, and slowly inject the spermicidal solution (such as 1:10000 phenylmercuric acetate or 1:3000 Xinjieer solution 3ml. The person who has the injection has a sense of urine; if there is no urine, it should be noted whether the injection has spillage. 9. The distal end of the vas deferens is reflexed and ligated: the distal end of the vas deferens is ligated, and the thread ends are not cut first. A hemostat is clamped below the ligation site to cut the vas deferens between the two. Hold the hemostatic forceps and fold the proximal (or distal) end of the vas deferens. Use the proximal (or distal) ligature to re-ligature at the reflexed point, and remove the excess vas deferens from the reflexed end by about 1 to 1.5 cm. 10. Incision treatment: Lift the ligature line at both ends of the vas deferens, and after reviewing no bleeding, cut the ligature line and then return the vas deferens to the scrotum. Use two fingers to squeeze the puncture hole to make the skin fit, cover the small gauze, and fix it on the wall of the scrotum with a square tape. complication 1. Formation of painful nodules: After vasectomy, due to the tissue reaction caused by surgical injury, small nodules can be formed locally. Generally, the nodules gradually shrink within 1 to 2 months after surgery, leaving no symptoms. However, there are also painful nodules, mostly due to the formation of hematoma, infection, thread foreign body, neurofibromatosis or sperm granuloma. Therefore, aseptic operation, perfect hemostasis (avoid damage to the vas deferens artery), ligation of the vas deferens in the adventitia (to avoid misplacement of the peripheral nerves), and proper ligation and tightness (to avoid loosening or splitting the sperm wall after the wall) are all matters needing attention during the operation. . Long-term unhealed painful induration, can be treated with drugs, hot compresses and physiotherapy. If you do not see improvement, you can consider resection of the nodules. 2. Epididymal deposition: a small number of subjects in the postoperative episodes of epididymal swelling and pain, may be related to sperm deposition, most of them can self-heal. The prevention method is to choose a vas deferens that is away from the epididymis at the time of surgery, leaving room for buffering. 3. Sexual dysfunction: This type of complication is extremely rare. It is of utmost importance to popularize scientific knowledge before surgery, to relieve ideological concerns, to explain correct sexual knowledge, and to do a good job in family work. Once there are some symptoms, you should understand the specific analysis of the situation, carefully do the ideological work, eliminate misunderstandings, and add treatment with integrated Chinese and Western medicine to solve. If there is organ disease such as chronic prostatitis, it should be treated. When it is absolutely necessary, it is also feasible to use vasectomy, as a kind of psychotherapy, often works. 4. Re-fertility: Recurrence after vasectomy, more related to the following factors: (1) The residual sperm was not carefully treated after ligation, and no short-term contraception was made. (2) The operator was mistaken for other tissues at the time, but the vas deferens were not ligated. (3) The vas deferens that are ligated and cut off are reconnected. (4) Congenital vas deferens abnormalities, in addition to the normal vas deferens, there are also sub-vas deferens. 5. Hematoma formation: due to improper hemostasis or damage to blood vessels, it can cause scrotal incision, spermatic cord hemorrhage or extensive hemorrhage in the scrotum, most of which occur within 24 hours after surgery. Incision oozing is caused by imperfect hemostasis of small blood vessels at the edge of the skin incision. Generally, after dressing, the dressing is pressure-wrapped, or if necessary, a needle can be used to stop it. The intraspinal hematoma of the spermatic cord is caused by intraoperative injury of the venous plexus. Generally, cold compress, compression dressing and hemostatic drugs can be used to stop bleeding. Severe extensive hemorrhage in the scrotum, mostly caused by damage to the spermatic artery or vas deferens artery when separating and searching for the vas deferens, the amount of bleeding is extremely large, up to 1000 ~ 2000ml, so that the scrotum is extremely swollen, the surface is blue-purple, shallow along the abdominal wall The deep sac (scarpa) extends to the lower abdomen and perineum, extending along the perineal fascia to the external genitalia [Figure 26-5]. Surgery must be performed immediately to stop bleeding, correct blood loss, clear blood clots and drain completely to prevent other complications after surgery. 6. Infection: Many are not properly prepared before surgery, the sterilization is not strict enough (including surgical field, surgical instruments, sutures, etc.), rough operation, imperfect hemostasis, postoperative dressing shedding, wound contamination, etc. Cases are associated with potential infections in the reproductive tract. The infection can be limited to the incision, or it can be extended to spermatic inflammation, epididymitis, prostatitis or seminal vesiculitis, and should be treated according to the situation.