LESSON 3: Procedures in Genitourinary Surgery

Section v: operations on the scrotum, penis, and urethra

3-32

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3-32. VASECTOMY

a. General. This operation involves the excision of a section of the vas deferens. This is done electively as a permanent method of sterilization or birth control and also prior to prostatectomy to prevent spread of infection from the urethra to the epididymis.

b. Patient Preparation. The patient usually lies in the dorsal supine position, although the operation can be done in the lithotomy position prior to transurethral surgery. The procedure may be done with either local or general anesthesia.

c. Operative Procedure.

(1) The vas is located by palpation in the upper part of the scrotum. A small incision is made in the skin over the vas (see figure 3-11 A).

 

(2) An Allis forceps is inserted to grasp the vas and bring it to the surface of the wound (see figure 3-11 B). The vas is denuded of surrounding tissues of the cord, and straight clamps are placed on either side of the Allis to crush the vas.

 

(3) The vas is cut between the clamps and a section removed (see figure 3-11 C). The cut ends are doubled back and ligated with silk-or cotton number 3-0.

 

(4) The clamps are removed, and the skin incision is closed with plain gut #3-0 on a needle. Acollodion dressing and scrotal suspensory may be applied.

Figure 3-11. . Vasectomy (vas ligation)

A-Vas grasped between thumb in front and first and second fingers behind. Incision 2 cm long is made over vas.

B-Vas grasped with Allis clamp and incision deepened into it.

C-Vas clamped with two hemostats and incised between them.

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