Vasectomy: What are the problems?
Complications that may occur after vasectomy and their management ar e discussed. Local infections and systemic blood disorders are the majo r contraindications to vasectomy. Inguinal hernia, orchiopexy, hydrocel e, variocele, preexisting scrotal lesions, or a thick, tough scrotum may make vasectomy difficult to perform. Skin discoloration, swelling, and pain are the most common, and the least serious, complications associated with vasectomy. Postoperative pain and swelling can be reduced by prior treatment with steroids. Treatment with an oral enzyme (Chymoral) has markedly reduced bruising, edema, hematomas and postoperative disability. The operative technique used may affect the degree of swelling and pain. Hematoma develops in less than 4% of all vasectomy patients. Hematoma is best prevented by paying careful attention to hemostasis during the operation. The application of ice packs usually stops the bleeding, though reopening of the scrotum and tying of the bleeding vessel may be required. Infection generally occurs in 1-7% of all vasectomy patients. It is estimated that the incidence of sperm granulomas, which are caused by leakage of sperm into surrounding tissues may be as high as 20% in the vas and 15% in the epididymis. Vas fulguration apparently decreases the incidence of sperm granulomas. Epididymitis can be treated by the application of heat and the wearing of a suspensory. Vasectomy has no permanent systemic effects and does not markedly alter testicular function of hormone levels. 50-70% of vasectomized men develop antibodies to sperm through an autoimmune response. These antibodies are of either the agglutinating or immobilizing type. However, some patients develop a cell-mediated immunity to sperm. Failure rates for vasectomy have been as high as 4%, though more effective and less traumatic operative techniques have reduced this rate to less than 1%. Spontaneous rejoining of the ends of the vas is the most common cause for failure of vasectomy. Crushing and tying of the vas may increase the likelihood of recanalization, while the use of tantalum clips may reduce the incidence. Fulguration may be more effective than vas ligation. Vasectomy failure may also result from occlusion of the wrong structure, inadequate occlusion, unprotected coitus following the operation, or an undetected 3rd vasa. There is no physiological evidence that vasectomy affects the body in general or sexual capability. However psychological problems may contraindicate vasectomy. Studies of sexual response after vasectomy are reviewed and tabulated.