![]() Men require instruction that they will continue to ejaculate and produce semen but it will be devoid of sperm and that generally, no difference is noted in the ejaculate volume as sperm only make up about 10% or less of the semen. Sperm granulomas occur less than 5% of the time, and even fewer are symptomatic. The risk of chronic scrotal pain is believed to be about 1% requiring further management, and the risk of epididymitis is also approximately 1%. The risk of hematoma and infection is about 1% to 2%, with very rare cases of Fournier gangrene. Risks of the procedure as well as the alternatives The following are key concepts that require consideration: The scrotum gets evaluated with a focus on the tolerability of the exam, the vas deferens mobility, the presence of hernias, varicoceles, spermatoceles, testicular masses, or testicular tenderness.Īfter the provider evaluation, a frank discussion regarding the risks, benefits, and alternatives to vasectomy should be performed, allowing informed consent. Next, a physical exam should follow, focusing on the genitalia. Social history should include consideration of their partner and pregnancy potential, prior pregnancies, and previous difficulties with pregnancy. Hematologic issues, including anticoagulation or medical coagulopathy, require discussion. The medical history should focus on genitourinary problems, scrotal pain, trauma to the genitals, surgery to genitals, sexual function and any testicular malignancy. This consultation should begin with a complete medical, sexual and social history. It is imperative for the provider who will be performing the vasectomy to meet and discuss the vasectomy with the patient before the procedure. Venous drainage is through the pampiniform plexus, with innervation by short adrenergic neurons. It then travels through the prostate and enters the urethra at the seminal colliculus and ejaculatory duct. It is covered by a vas sheath with its own arterial blood supplied by the artery of the vas deferens. The vas deferens enters the ejaculatory duct where it meets with the seminal vesicles. ![]() The vas deferens or ductus deferens starts at the tail of the epididymis and runs superiorly and medially with the spermatic cord through the external inguinal ring and the inguinal canal, then into the peritoneum through the internal inguinal ring. The epididymal body is between the head and tail. The epididymis is on the posterior aspect of the testicle with the head on the superior aspect and the tail on the inferior aspect of the testicle. The tissues that will be encountered, superficial to deep, include the skin, Scarpa’s fascia, dartos, external spermatic fascia (continuation of external oblique), cremaster muscle (continuation of internal oblique), internal oblique fascia (continuation of transversalis fascia), tunica vaginalis (derived from peritoneum), tunica albuginea, and the testicle. Multiple layers of the scrotum must be entered to gain access to the vas deferens. The majority of the pertinent anatomy encountered during a vasectomy is within the scrotum.
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