Dr.Jayaram Reddy, MS, MCh Professor, Dept of Urology, Hyderabad

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• Dr.Jayaram Reddy, MS, MCh Professor, Dept of
  Urology, Hyderabad
• Dr. Sasikala Kola,
• Consultant Obs- Gyn Hyderabad

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NO SCALPEL VASECTOMY
WHY VASECTOMY

• CONVENIENT
• SAFE
• MORE EFFECTIVE IN POPULATION STABILISATION.

• RELIABLE
• NO MORBIDITY

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WHY IS IT NOT ACCEPTED READILY

• MISCONCEPTIONS LIKE
• SEXUAL DISABILITY
• PHYSICAL DIABILITY
• FEAR OF CUTTING / SUTURES
• MALE PREDOMINANCE.

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NO SCALPEL VASECTOMY

• FRIST DEVELOPED IN CHINA BY DR.LI -1974.
• OTHER DEVELOPED COUNTRIES 1988.
• Acceptance for vasectomy progressively increasing
  after introduction of NSV.
• Office procedure.
• No incision / suturing.
• No morbidity.
• No bleeding.
• Minimal physical discomfort.

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COUNSELLING

• Discuss Family Welfare chances.
• Assess his contraceptive knowledge.
• Provide him with accurate unbiased information.
• Encourage him ask questions.
• Correct his misunderstanding.
• Assess clients decision to have vasectomy.
• Does he know.

NSV is a terminal method. NSV is a surgical
procedure.
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• ASSESS
• Family size.
• Support from wife.
• Realistic expectations.
• ENSURE
• Stress free.
• Confident.
• Well informed.
• Inform about the procedure
• Explain procedure in simple language.
• Stress need for additional post operative
  contraception.
• Explain no protection against HIV / STD.
• Take informed consent.

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INSTRUMENTS
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EXTRACUTANEOUS VAS FIXATION CLAMP
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VAS DISSECTING FORCEPS
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SCISSORS
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ANAESTHESIA

• LOCAL ANAESTHESIA

• VASAL BLOCK

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LOCAL ANAESTHESIA
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VASAL BLOCK
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STEPS OF OPERATION

• Site middle of 1/3 of scrotum on median raphe for
  skin puncture.
• 3 Finger technique for vas fixation
• Holding with ringed clamp
• Piercing the skin with dissecting forceps
• Spreading tissues with forceps.

• Delivery of vas
• Vas occlusion
• Ligature Cautery Haemoclips
• Facial interposition
• Dressing

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3 Finger technique for vas fixation
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Holding with ringed clamp
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Piercing the skin with dissecting forceps
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Delivery of vas
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Vas occlusion Ligature Cautery Haemoclips
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Dressing
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POST OPERATIVE INSTRUCTIONS

• Antibiotics.
• Analgesics.

• Scrotal support for 7 days.
• Rest.

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POST OPERATIVE INSTRUCTIONS

• Resume light work immediately.
• Avoid heavy work for 2 days.
• Discontinue cycling for 7 days.
• Dont kick start scooter for 2 days
• can ride one.

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POST OPERATIVE INSTRUCTIONS

• Keep operated site dry for 2 days.
• Can take bath.
• Remove dressing yourself on 3rd day at home.
• Return if there is any fever, discharge or
  swelling that increases in size.

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POST OPERATIVE INSTRUCTIONS

• Use additional contraception for 3 months or 20
  ejaculations whichever is earlier.
• Then, report for semen analysis to verify
  azoospermia.

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RELATIVE CONTRAINDICATIONS

• INGUINAL HERNIA /
• SCROTAL MASS.
• BLEEDING DISORDERS

• LARGE HYDROCELE.
• ELEPHETIASIS.

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COMPLICATIONS

• SPERM GRANULOMA
• ANTISPERM ANTIBODIES.

• INFECTION
• HEMATOMA

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Thanks to all contributors.

• Dr Adarsh Bhargava.
• Dr Ashwini Bhalerao.
• Dr Alka Kriplani.
• Dr. Kalpana Apte.
• Dr Mala Arora.
• Dr.Meenakshi Bharath.
• Dr. Mandakini Parihar.
• Dr.Nozer Sheriar.
• Dr.Parikshit Tank.
• Dr. Roza Olyai.
• Dr.Sasikala Kola.
• Dr.Sujata Mishra.