Vasectomy Procedure Instructions
Important notice: Please be advised that vasectomy appointments must be cancelled or rescheduled with a minimum
of 3 business days' notice, or the full amount ($485) will be payable. (We only book a small number of vasectomies
each clinic and we are not able to get patients to fill in on short notice due to planning that is required for rest time
after surgery). If you do need to make a change to your appointment time, kindly give us as much notice as possible.
On exceedingly rare occasions (just 2 or 3 patients per year), we see a patient in our clinic that cannot
have the vasectomy under local anaesthetic due to his particular anatomy. When this occurs, we will
book you a priority appointment with our urologist at Guelph Hospital. We ensure you get the
appointment, understand the preparation, and we follow up with you about after care and semen analysis
testing. We give you all the supplies you need for the procedure and after care before you leave our
clinic. When this occurs, we do not provide a refund of the fees paid, because we cannot replace your
appointment with another patient, and we have spent time with you and provided supplies. By signing the
consent form, you indicate that you understand this policy and acknowledge that there is a small chance
that the vasectomy cannot be performed as scheduled and that a refund is not provided.
PREPARATION:
Here are the instructions for patients to prepare for the procedure:
1. Shower. Shower on the day of the vasectomy, wash the penis, scrotum and groin areas
thoroughly with soap and water.
2. Shaving. On the day of the vasectomy, shave the hair on the full front area of the
scrotum from the base of the penis down or clip it very short. The purpose is simply to
make the vasectomy easier and safer, reducing the risk of infection. Also, the EMLA
patch is “stuck” to the scrotum, and it will be easier to peel it off if the hair has been
removed. Do not use a beard trimmer as these have been found to cut the skin more
than shaving. We strongly advise patients to avoid using depilatory products like "Nair"
which dissolve the hair but can be extremely irritating to the skin.
3. EMLA patch. You will be supplied with an Emla patch in the clinic. This is a circular
patch which contains a numbing agent. This is placed directly onto the skin and
minimizes the discomfort as the doctor applies the local anesthetic using the jet spray.
4. Sedative. A sedative can be taken here at the clinic to help you
relax. The medication is particularly useful for men with general anxiety. Please note
that this medication is not necessary. It can be taken at least twenty minutes before
the procedure to help with any anxiety. It may also help the skin of the scrotum to
relax, making the procedure technically easier to perform. If you plan to take this
medication, you must notify us as soon as you arrive at the clinic to allow enough time
for proper absorption.
5. Transportation home. Most men drive themselves home afterward without difficulty.
However, if the sedative is taken, patients must arrange for a driver as it can cause
drowsiness and create a risk. We want to make sure the ride home is safe for you and
for everyone on the road.
6. Time off work. While it is ok to go to work earlier on the day of the vasectomy, do not
plan to go back to work on the same day following the vasectomy. Do plan to rest.
Most men with jobs that are not very physical can work the next day, but, if possible, it is
a good idea to take the next day off work.
7. Athletic support/Jock strap. We provide the athletic support at the clinic and other
supplies which are included in the fees when paid. Wearing the jock strap supports the
scrotum, reduces discomfort from the operation and may decrease the chance of
bleeding. They tend to fit smaller so if you are in between sizes (for example, between
a medium and a large), choose one size up.
8. Aspirin. Avoid taking any aspirin product (e.g., ASA, 222, Anacin, etc.) or blood
thinners for at least 10 days (about 1 and a half weeks) prior to the procedure as this can
cause excessive bleeding. If you are not sure what you are taking, be sure to give us a
list of your medications when you arrange your appointment for us to check over.
9. What to wear: Wear loose trousers such as track pants and tight-fitting underwear
(speedos/boxer briefs or the like). Please avoid wearing boxer shorts. This helps to
accommodate the ice pack and hold the dressing in place.
10. You may have a light meal prior to the procedure.
11. Please arrive on time. If a patient is late, we may have to cancel or postpone the
procedure. A cancellation may result in a cancellation fee.
12. Please bring your health card and the remainder of the payment (if any). We accept visa,
master card or debit. Please note, we DO NOT accept cash/American Express.
CONSENT:
You will be sent a consent form to complete by email. This gives the doctor legal permission to
perform the vasectomy. It states that all the information needed to make an informed decision
has been provided and that informed consent is being given. Please be sure to read over the
consent form before your appointment and scan it back to us after signing it.
WHAT IS INVOLVED WITH THE VASECTOMY PROCEDURE:
The No-Scalpel No-Needle Vasectomy begins with the patient lying on the table and lowering
his pants, jock strap and underwear to his ankles. There is no need to take them right off.
The doctor cleans the whole genital and groin area with an antiseptic. Some shaving or
clipping of hair may be necessary. A sterile drape is placed over the area and the scrotum is
gently drawn through a hole in the drape. The penis is kept out of the way under the drape.
The local anesthetic is applied using a high-pressure jet spray and/or needle. You might feel a
brief sting on the skin although the EMLA patch should minimize this. A mild aching during the
application to each vas may be felt, but this also is brief and is a good sign that the freezing is in
the right place. The freezing takes effect immediately. The doctor then makes a small opening in
the skin less than a centimeter in diameter by piercing the skin and spreading it open with a
special instrument. This is just enough to allow access to the vas, which is then lifted slightly out
of the scrotum. The sheath surrounding the vas is pulled back and the upper end of the vas is
cauterized (burned) to allow it to scar shut for several millimeters as it heals. The vas is then
cut and sealed with titanium clips. The titanium clips seal the vas and act as a barrier,
separating the two ends. This keeps sperm from reaching the upper cut end and it reduces the
chance of the ends reconnecting. After this, a close check is made for any bleeding and the
vas is allowed to slip back deep into the scrotum. The procedure is then repeated on the other
side through the same opening in the skin. Once both sides are done and the doctor is confident
that there is no bleeding, antibiotic ointment is applied to the opening in the scrotum and gauze
is placed over it. The procedure is now finished. The patient pulls up his underwear and then
his jock strap over it. This keeps the scrotum supported and applies gentle pressure. An ice
pack is placed between the underwear and jock strap to reduce the risk of bleeding.
You will be given information on post-procedure care, as well as lab information for later testing
for absence of sperm.
Most men feel fine afterwards and are pleasantly surprised at how quick, simple and painless it
has all been. Patients usually spend a total of 60-90 minutes at the clinic.
POSSIBLE COMPLICATIONS:
The no-scalpel vasectomy has been found to have 10x less risk of complications than occur
with the traditional approach.
The problems that can occur with any vasectomy include:
- Aching, pain and/or tenderness. This is usually mild and temporary. To help reduce any pain,
discomfort or swelling, the patient is advised to wear athletic support and take an anti-
inflammatory drug if needed. Pain can be treated with Advil and/or Tylenol as instructed in the
aftercare instructions.
- It is extremely rare for discomfort and/ or tenderness to remain unresolved (1/10,000),
resulting in chronic pain. It is extremely unlikely with this method as very little tissue is handled
or affected, but it is still a remote
possibility. (http://www.hsc.stonybrook.edu/som/urology_cp_vasectomy.cfm)
- A sperm granuloma, which is a small pea-size tender lump, may develop at the site of the
vasectomy deep inside the scrotum. It can occur in up to 60% of vasectomies. It is caused by
buildup of sperm that seeps (extravasates) out of the cut end of the vas. It usually resolves on
its own in a few weeks or may remain indefinitely. It is often a normal part of the healing
process and is not harmful. If there is discomfort or swelling around the lump, simply call the
clinic or your family doctor. Generally, only 3% of these cases require treatment (usually
simple treatments such as antibiotic medication). A small non-tender lump at that location is
the normal scar which is to be expected.
- Bleeding within the scrotum leading to swelling can occur in the hours following the operation
(called a "hematoma") 0.9% (1/100). There is less chance of this when the patient rests after
the vasectomy, using athletic support and ice packs. Bruising of the skin is not uncommon and
by itself is not a problem.
- Blood may appear in the semen, but this is usually old blood from the time of the procedure
and is not serious.
- Infection can occur after any operation. To reduce the chance of infection even further, an
antibiotic ointment is applied when the procedure is finished and should be applied for the
next few days. Also, keeping the area dry and clean is important. No swimming or taking
baths for 2 weeks. Shower 24 hours after the vasectomy.
- If severe pain, swelling and/or fever develop, call the Clinic during clinic hours or else go to
your local emergency department.
FERTILITY:
There is a very small chance, on average about 0.1%, that the vasectomy will not be successful
in producing permanent sterility. Nature can create a connection between the ends of one vas,
allowing sperm to pass through again.
We strongly advise couples to plan to use alternative methods of birth control until they
have received the all-clear from the clinic. The semen analysis is done as noted above to
confirm the success of the operation. A container and instructions for this are provided by
the clinic. The results are sent to the clinic, and we will call you with the results or send an e-
mail to you. It is important to wait for the results and get the final "all clear" from us. After
this, no other form of contraception is needed. Recurrence of fertility is so rare after the "all
clear" that it is not necessary to have further semen analyses done but testing certainly is
possible if people want to check periodically for reassurance. Contact us or your family doctor to
get a lab requisition first. Patients are welcome to return for a follow-up visit, but this is not done
routinely as the vast majority do very well and a follow-up office visit is not necessary.
USEFUL LINKS:
1. http://www.engenderhealth.org/wh/fp/cnsv.html: EngenderHealth publishes a wide range
of materials, including training curricula, clinical guidelines, instructional videos, brochures,
working papers, articles, and online information. Their publications provide guidance to
field programs and are frequently cited as authoritative sources.
2. www.VasectomyMedical.com: One of the most informative sites on the web for vasectomy
and vasectomy reversal. VasectomyMedical.com walks the reader through the decision-making
process, explaining in simple, understandable language what the prospective patient can expect
from the procedure.
3. http://www.maleinfertility.org/nsv.html: CORNELL NO-SCALPEL VASECTOMY
CENTER. (Warning: graphic pictures included that may disturb you)
4. www.Vasectomy-Information.com
5. http://www.repromedltd.com/: Interested in sperm banking? Check out Repromed.
