Technics and Complications of Elective Vasectomy: The Role of Spermatic Granuloma in Spontaneous Recanalization

Abstract

Reports of a series of patients having elective vasectomy a compari son of complications after the use of various techniques and an explanation of the basic role of spermatic granuloma in the process of spontaneous recanalization are presented. 432 patients who underwent vasectomy were observed for a period of 5 months or longer. 417 of the patients were followed for more than 1 year. In 288 operations the vasa were divided and the cut ends were doubly ligated with cotten; in 144 operations the vasa were divided and the cut ends were not ligated but were fulgurized with a needle electrode introduced 2 mm into the lumen of the vas. In 155 operations the cut ends of the vasa were dropped back into the wound after ligation or fulguration; in the other 277 the sheath was closed over the distal stump of the vas so that a barrier of fascia was placed between the cut ends. 1 patient requested reanastomosis during a subsequent marriage. Pain prevented only 1 man from returning to work promptly after operation. Spermatic granuloma arising from the cut end of the proximal vas occurred in 4.9% of the patients and hematomas occurred in 1.9%. Spermatic granuloma may occur at the cut end of the vas or in the epididymis shortly after or years after vasectomy. It is recommended that vasectomy be done through bilateral incisions that both ends of the sectioned vas be fulgurized and that the sheath of the vas be closed over the cut end of the distal vas. This technique should be employed in both elective and prophylactic vasectomy. Recanalization or reanastomosis occurs most frequently if the cut ends of the vas are ligated rather than fulgurized. It was noted that most psychological complications can be prevented if the patient and his wife both want the operation done if they are fully informed of the steps in the procedure before it is done and if they are assured that spermatogenesis continues and that reanasto mosis is possible.