Vasectomy
Elective interruption of both vasa deferentia, with occlusion method and the requirement for post-procedure semen clearance made explicit.
Interactive 3D Interactive vasectomy (no-scalpel) Open the 3D animation Teaching catalogue only. This coverage record is not a patient pathway or operative instruction.
Typical place in practice
Permanent contraception after informed consent about irreversibility, alternatives, failure and the need to continue contraception until clearance.
Alternatives and neighbouring procedures
Reversible contraception, partner sterilisation, sperm storage before vasectomy, or no procedure.
Same procedure family, explicit technique branches
These are variations of this canonical operation. Complication modules below identify whether they apply to all branches or only to named approaches.
No-scalpel vasectomy
Uses a small scrotal puncture with a selected occlusion method.
Conventional incisional vasectomy
Exposes and divides each vas through a skin incision.
Occlusion-method variants
Combines access with a locally governed method intended to reduce recanalisation.
High-level sequence
Coverage outline only; not a step-by-step technical guide.
- Confirm consent, identity of both vasa and contraceptive plan
- Isolate each vas separately
- Divide and occlude using the selected validated method
- Secure haemostasis and close the access site
- Provide semen-analysis and ongoing-contraception instructions
Operative notes
Concise operative notes covering the key steps, landmarks and watch points, in the order you encounter them.
Fertility surgery
What it does: operations to find and fix blocked pipes, or to fetch sperm.
Varicocele (open routes; coils via radiology)
- Palomo (high, back of tummy): whole pedicle tied. Artery may go with it. Collaterals save the testis. Fewer veins. More hydroceles. ~15% back if the artery is spared.
- Ivanissevich (groin canal): cord lifted. Separate artery (papaverine, Doppler) and lymphatics from the ~3 veins. Artery NOT tied here. Cut the cremaster vein too, or it recurs.
- Marmar (below the canal, at the ring): no fascia opened. Many veins, branched artery. The confident microsurgeon's route.
Vasography (blocked vas, before repair)
- Transverse nick in the vas. Do not divide it.
- Fluid to a slide. No sperm = block is on the testis side.
- Saline flush runs free = open beyond. Or blue dye + catheter in bladder: blue urine.
- 0.5 mL X-ray contrast down the vas maps the level.
Vasovasostomy (rejoin the vas)
- Trim to healthy ends. Both bleed.
- 2-layer micro join: 3 x 10/0 stitches in the lining, turn 180, 3 more. 9/0 in the muscle. Then sheath layers.
Vaso-epididymostomy (join vas to epididymis)
- Fat-to-thin tube change marks the block.
- Open 1 tube. Sperm confirmed on a slide.
- Vas fixed to the sheath, 6/0. Lining joined 10/0.
- Sperm back in ~70%. Later narrowing common.
TURED (ejaculatory duct)
- Scan rectally first. Dye + contrast into ducts.
- Resect the veru. Spare neck and sphincter.
- Dye in the bed = in the duct.
- Sperm back ~50%. Risks: reflux, dry ejaculation.
MESA / PESA (sperm retrieval)
- MESA: open an epididymal tube. Pipette the fluid. Blocked system: best sperm sit HIGH (unusual).
- PESA: 27G butterfly into the head of the epididymis, held between fingers. Gentle pull. Press firmly 5 min after.
- 2026 update: micro-TESE is the standard for non-blocked azoospermia. Name it in vivas.
From the UroRef Operative Quick Guide. Open the note page →
Every failure mode is its own module.
Timing and variation coverage are recorded for each module.
Bleeding or scrotal haematoma
Cord or skin-vessel bleeding can cause painful swelling and delayed recovery.
Applies to: All variantsWound or epididymal infection
Local infection may involve the skin, vas or epididymis.
Applies to: All variantsChronic post-vasectomy scrotal pain
Persistent pain may relate to congestion, nerve injury, granuloma or other scrotal pathology.
Applies to: All variantsSperm granuloma
Extravasated sperm can produce a palpable inflammatory nodule that may be painful.
Applies to: All variantsEarly technical failure or late recanalisation
Persistent or renewed vas continuity can result in sperm in semen and unintended pregnancy.
Applies to: All variantsWrong-structure or unilateral procedure
Failure to identify and occlude both true vasa produces immediate procedural failure.
Applies to: All variantsSources for this module
Penile prosthesis, Peyronie disease, priapism and reproductive surgery.
Accessed 2026-08-03 · opens source British Association of Urological Surgeons Patient information leaflets by procedureUK patient-facing procedure, alternatives, recovery and complication framing.
Accessed 2026-08-03 · opens source