Vasectomy

The need for vas deferens intervention is mainly related to vas deferens obstruction, and vas deferens intervention is used to investigate and treat the obstruction. There are many reasons for vas deferens obstruction or stenosis. In any case, the first thing to do is to determine whether the patient needs vas deferens intervention for examination and treatment, and the second thing is to prepare and follow the doctor's instructions.

reason

The causes of vas deferens obstruction are divided into congenital abnormalities, acquired infections, and blockage caused by trauma.

Congenital anomalies

Absence of vas deferens, non-connection of testicle and epididymis, closure of vas deferens and ejaculatory duct, congenital stenosis of ejaculatory duct opening, etc.

Medical Injury

For example, if the vas deferens is accidentally injured during inguinal hernia surgery or cryptic testis surgery, and the vas deferens needs to be recanalized after male vasectomy, these reasons can be solved by surgery. There are in-depth studies on the vas deferens obstruction caused by accidental injury during inguinal hernia surgery or cryptic testis surgery. The vas deferens damaged in childhood can be surgically recanalized using perfect vasectomy examination and microsurgery methods.

Vas deferens infection

The obstruction of the vas deferens caused by tuberculosis will often cause the vas deferens to become thicker and have a less smooth surface. This is a complete blockage of the vas deferens, making it unsuitable for vasectomy and impossible to restore its normal function.

If there is no history of tuberculosis, testicular biopsy is normal, and physical examination of the vas deferens is normal, a vasectomy should be performed. If the site of vas deferens blockage is found during the vasectomy, our hospital will carry out vasectomy interventional treatment. If the vas deferens is found to be blocked in the spermatic cord during vasectomy, interventional methods can be used to restore the blockage in one go.

Causes of sperm infertility

1. Congenital obstruction

The causes of sperm tract infertility are congenital incomplete development of the epididymis, congenital vas deferens occlusion, congenital vas deferens dysplasia, congenital ejaculatory duct obstruction, etc., which can all lead to congenital sperm tract obstruction.

2. Acquired factors

Causes of sperm obstruction include infection, ligation surgery, or other injuries.

Adaptation

The indication for vas deferens intervention is blockage of the spermatic cord of the vas deferens. The lumen of the vas deferens in this area is suitable for interventional treatment. The vas deferens is a tough muscular tube, and intervention will not cause unexpected situations such as vas deferens perforation.

Surgical method

The operation of vas deferens intervention is integrated with vasectomy. After years of clinical experience, we have developed a simple and minimally invasive method:

1. After local anesthesia, use external fixation forceps to clamp the vas deferens together with the tightened scrotal skin into the fixation ring. Make the fixation handle face the lower limb of the patient.

2. The assistant moves the fixed forceps head upward to the fetal top. The operator pinches the two sides of the vas deferens in front of the fixed head with the thumb and index finger of the left hand, and holds the vas deferens puncture needle (No. 8 sharp needle) in the right hand. At the middle of the most protruding part of the vas deferens, puncture the anterior wall of the vas deferens in an approximately vertical direction, about 2mm deep. When puncturing the vas deferens tissue, there is often a sense of "dislocation". During puncture, the bevel of the needle must be consistent with the longitudinal axis of the vas deferens, otherwise there is a possibility of puncturing or cutting the vas deferens.

3. Remove the No. 8 needle, keep the finger holding the vas deferens still, and immediately insert the No. 6 blunt needle into the distal end of the vas deferens along the punctured hole. When the needle enters the hole in the front wall of the vas deferens, there is often a sense of tightening. If you apply a little force, there will be a sense of puncture and emptiness, indicating that it has entered the lumen.

4. To determine whether the puncture is successful, in addition to the operator's subjective feeling, the following methods can be used to identify:

(1) Seminal vesicle perfusion test: The operator gently pinches the vas deferens near the subcutaneous ring with the thumb and index finger of the left hand, connects a 5ml syringe containing 1% procaine to the inserted No. 6 blunt needle holder, and suddenly injects 2 to 3ml. If the needle tip is in the lumen, the finger pinching the vas deferens will feel a sudden swelling, hardening, and increased pressure in the vas deferens. Continue to inject several milliliters. The patient often feels the urge to urinate, but there is no local edema.

(2) Test of blind end pressure injection of vas deferens: The assistant pinches the vas deferens near the subcutaneous ring with the thumb and index finger, and the operator pinches the vas deferens in front of the needle hole in the same way. After aspirating no blood, inject 2ml of air and relax the finger that pushes the injection after a few seconds. If the puncture is successful, the needle core of the syringe will automatically return to the original scale due to pressure. If the vas deferens at the seminal vesicle end is not pinched, air is injected into the seminal tract, and the patient has a strong urge to urinate, indicating that the puncture is successful. On the contrary, if the puncture fails, there will be obvious signs of subcutaneous gas accumulation around the needle tip, and there will be no urge to urinate.

A special instrument is used for vasectomy, which causes little damage to the vas deferens. This instrument is hollow. After the above is successful, contrast agent can be injected into the vas deferens through this instrument, so that the vas deferens can be visualized under X-rays. If the vas deferens is found to be blocked in the spermatic cord, a vas deferens recanalization guide wire can be inserted into the vas deferens through this instrument, and the blocked part of the vas deferens can be recanalized by the power of the guide wire.

Vas deferens blockage is mostly caused by membrane adhesions or sequelae of inflammation. The real inflammation no longer exists. As long as there is no reinfection after interventional recanalization, the chance of reoccurrence is relatively low.