Vasectomy

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence-based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrooke's. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

Removal of a small section of vas from both sides with interposition of tissue between the divided ends to prevent re-joining.

What are the alternatives to this procedure?

Other forms of contraception (both male and female).

Vasectomy should be regarded as an “irreversible” procedure. If you have any doubt about whether it is the right option for you, do not proceed with the operation. Under normal circumstances, vasectomy will not be considered during pregnancy or within the first six months after the birth of a child.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery whether the procedure is being performed under local or general anaesthetic. Please note: Sperm storage prior to vasectomy, for those who wish to consider this, is not available on the NHS and will need to be arranged separately with the Bourn hall clinic in Cambridge.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• a coronary artery stent
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for warfarin, aspirin, rivaroxaban, dabigatran, apixaban, edoxaban or clopidogrel, ticagrelor or blood thinning medication
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)

What happens during the procedure?

Vasectomy is usually performed under local anaesthetic, primarily for your own safety. If the tubes are difficult to feel, it may be necessary to carry out the procedure under a brief general anaesthetic. The injection is always uncomfortable but, thereafter, the skin is effectively numbed. The procedure itself cannot be made totally painless and the process of picking up the tubes, in order to tie them, can cause a variable degree of discomfort; this may make you feel slightly sick, sweaty or light-headed.

What happens immediately after the procedure?

It is essential to have someone with you to drive you home after the procedure.

You are advised to take the following day off work and sit quietly at home. The local anaesthetic will wear off after a couple of hours and the area may ache for 24 to 72 hours; this can usually be relieved by taking Ibuprofen or Paracetamol. Vasectomy, whether under general or local anaesthetic, is normally carried out on a "day case" basis with a length of stay of less than one day.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than 1 in 10)

• A small amount of bruising and scrotal swelling is inevitable for several days
• Seepage of a small amount of yellowish fluid from the incision several days later
• Blood in the semen for the first few ejaculations
• The procedure should be regarded as irreversible. Although vasectomy may be reversed, this is not always effective in restoring fertility, especially if more than seven years have lapsed since the vasectomy
• Sufficient specimens of semen must be produced after the operation until they have been shown to contain no motile sperms on two consecutive specimens
• Contraception must be continued until no motile sperms are present in two consecutive semen samples

Chronic testicular pain (10-30%) or sperm granuloma (tender nodule at the site of surgery)

Occasional (between one in 10 and one in 50)

• Significant bleeding or bruising requiring further surgery
• Inflammation or infection of the testes or epididymis requiring antibiotic treatment

Rare (less than one in 50)

• Early failure of the procedure to produce sterility (one in 250 to 500)
• Re-joining of vas ends, after negative sperm counts, resulting in fertility and pregnancy at a later stage (one in 4000)

No evidence that vasectomy causes any long term health risks (eg testicular cancer, prostate cancer)

What should I expect when I get home?

Over the first few days, the scrotum and groins invariably become a little uncomfortable and bruised. It is not unusual, after a few days, for the wound to appear swollen and slightly weepy. If you are at all worried about this, you should contact your GP. The skin sutures do not need to be removed and will usually drop out after a couple of weeks; occasionally, they may take slightly longer to disappear.

What else should I look out for?

If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.

Are there any other important points?

Many people ask if they are “too young” to be accepted for vasectomy. There are no rules about how old you should be and each individual case will be considered on its own merits. However, vasectomy is not a suitable form of contraception for a single man because of the poor success rates of reversal; it might be considered if there were specified (and very rare) medical conditions such as a severe inherited disease.

You are not sterile immediately after the operation, because some sperms have already passed beyond the site where the tubes are tied off. These sperms are cleared by normal ejaculation; it takes, on average, 20 to 30 ejaculations before you are likely to be clear. At 16 and 20 weeks after the operation you will be asked to produce specimens of semen for examination under a microscope; please read the instructions for production and delivery of these specimens very carefully. If no sperms are present, you are sterile and we will write to tell you so. If there are still a few non-motile or dead sperms, you may be regarded as sterile but, if there are large numbers of motile sperms, further specimens will be required until you are clear. Until you get the “all clear” you must continue with your contraceptive precautions.

Vasectomy is only available on the NHS via discussion with your GP. Vasectomy may also be available through the Marie Stopes Foundation or through designated GP surgeries licensed to carry out the procedure. If you wish to pursue these options, you should contact your GP who will be able to put you in touch with the appropriate agency.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your surgery.

You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and/or specialist one to one care is required.

Hair removal before an operation

For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery. Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.

References

NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)

Is there any research being carried out in this field at CUH?

There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist: 01223 586748
Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG): 01223 274608
Prostate cancer nurse practitioner: 01223 274608 or 01223 216897
Surgical care practitioner: 01223 348590 or 01223 256157

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients): 01223 274608
Urology nurse practitioner (stoma care): 01223 349800
Urology nurse practitioner (stone disease): 07860 781828

Patient advice and liaison service (PALS)

Telephone: 01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email PALS
PALS, Box No 53, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ

Chaplaincy and multi faith community

Telephone: 01223 217769
Email Chaplaincy
PALS, Box No 53, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ

MINICOM System (‘type’ system for the hard of hearing)

Telephone: 01223 217589

Access office (travel, parking and security information)

Telephone: 01223 596060

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please do so below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or specialist nurse know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

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