Indications

• Male sterilisation (between 28-45) with stable marriage with family of 2+ children

Considerations -

1. Irreversible (reversal can be attempted in first 5 years but cannot always restore fertility - production of antisperm autoantibodies)
2. Sterilisation not immediate - must provide x2 post op negative counts (at 3 and 4 months), so must continue with barrier contraceptives
3. Recanalisation can occur; unpredictable fertility 1/1000 cases

[Contents of spermatic Cord]

• 3 Nerves: genitofemoral, autonomics, cremasteric [NB ilioinguinal nerve lies on outside]
• 3 Arteries: Testicular, ductus, cremasteric
• 3 Other: Vas, pampinoform plexus, lymphatics

Procedure

1. LA, supine position
2. Locate and fix vas (grab scrotum and roll between fingers)
3. Infiltrate local anaesthetic
4. 1cm incision into scrotum (Skin, Dartos, ExtSpFasc, Cremaster, IntSpFasc, Tunica, Testis) in direction of vas
5. Dissect out vas with tissue forceps, pass forceps under vas to separate from coverings
6. Divide vas, turn ends backwards and tie ends
7. Bury lower end deep in scrotum to minimise risk of re-joining
8. Close with interrupted stitches