Prior to a vasectomy, the patient should be counseled to consider vasectomy as a permanent form of surgical contraception. It must be emphasized that although vasectomy reversal is often successful, it is costly, and not 100% effective in restoring fertility to the man who has undergone a vasectomy. Although not required, involvement of the spouse or partner in the decision-making and in witnessing the consent is highly recommended. In New York, a minimum 30-day period is required between the time initial consent for the vasectomy is signed and the operative procedure is performed.
A medical history and physical examination should be performed. The patient should be questioned regarding medications, drug allergies, and any history of bleeding disorders. Prior scrotal surgery, such as orchiopexy or hydrocelectomy, should be noted, because this may make the procedure more difficult. Any history of testicular or scrotal pain should also be clearly documented.
Physical examination of the genitalia should be performed in a warm room to allow for relaxation of the scrotum and detection of any anatomic abnormalities or unusual tenderness. Since men who request vasectomy usually have no specific complaints, it is tempting to perform a cursory exam to simply document the presence of two vasa. This temptation must be resisted. Many men requesting vasectomy are in the age group for which the incidence of testicular cancer is the highest. Furthermore, hernias, hydroceles, or symptomatic varicoceles that need repair should be diagnosed, so that treatment can be offered concurrently with the vasectomy.
Any abnormalities on scrotal examination or unexplained testicular symptoms should be evaluated with a scrotal ultrasound. If one of the vasa is congenitally absent, an abdominal ultrasound should be obtained, because these patients have a high incidence of renal agenesis (absent kidney on the same side). A vas that is difficult to palpate may require performance of the vasectomy in the operating room. Penile or scrotal infections should be diagnosed and treated prior to the vasectomy. Routine laboratory testing is unnecessary in most cases, and should only be obtained for specific indications. A semen analysis could be considered prior to vasectomy in men who have not had children or a documented pregnancy, or who have undergone chemotherapy, radiation therapy, or hernia repairs.
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