John J. Bauer, M.D. www.flinturology.com Urology Services, Inc. G-1121 West Hill Rd. Flint, Michigan 48507 Tel: 810.232.8888 Fax: 810.232.9190 Email: jbauer@flinturology.com [map]

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Contents
General information
Pre-operative instructions
Risks and Complications
Detailed Surgery Description
Family waiting instructions
Post-operative instructions

Printing tip: If you want to print only one portion of this entire document, you should be able to do this depending on your software. To print a selection, highlight the section you want to print using your mouse, then click on print, and then in the print menu, choose "selection."

Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary.

You will need to complete the Vasectomy Questionnaire [printable format] available at this link. It will help us make the proper diagnosis and treatment plan. [You will need Adobe Acrobat Reader to open and print this document. Free version available]

General information to assist in your Vasectomy decisions can be found on these pages:

• Information for Patients Considering Vasectomy
• Vasectomy Surgery with FAQ's
• Vasectomy FAQ's
• No-Incision Vasectomy

Your pre-operative appointments

Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up.

Change In Health Status

Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery.

Pre-Operative Medication Instructions

Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:

1. One Week Prior to Surgery:
   - STOP all aspirin and all aspirin-containing medicines (e.g., Anacin, Excedrin, Pepto-Bismol). Check any cold or pain medication bottles to make certain aspirin is not contained. See additional list at Blood Thinners.

2. Two Days Prior to Surgery:
   - STOP all nonsteroidal anti-inflammatory medications (e.g., etodolac [Lodine], fenoprofen [Nalfon], ibuprofen [Advil, Motrin, Nuprin], ketorolac [Toradol], maproxen [Aleve], meclofenarnate [Meclomen], mefenamic acid [Ponstel], naproxen [Anaprox, Naprosyn].

3. Day Before Your Surgery:
   Normally this is when you would start the pre-operative Bowel Preparation appropriate for this surgery. As this procedure is not close to the bowel and injury is extremely unlikely, there is no bowel prep required for the procedure.

4. On the Morning of your Surgery:
   • DO NOT TAKE digitalis medicines (e.g., Crystodigin, Digoxin, Lanoxin).
   • DO NOT TAKE oral antidiabetes medicines (e.g., chlorpropamide [Diabinese], glyburide [DiaBeta, Glynase, Micronase], glypizide [Glucotrol], tolazamide [Tolinase], tolbutamide [Orinase].
   • DO TAKE one-half of your usual morning. INSULIN dose. DO NOT TAKE your morning INSULIN dose if you are driving a great distance the morning of surgery or if your surgery is scheduled for the afternoon.
   • DO TAKE, with a small sip of water, ALL of your other usual morning doses of regularly prescribed medicines. Use your asthma inhalers and bring them with you to the hospital.

Pre-Operative Diet Instructions

Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:

1. Eight hours before the Scheduled Start of your Surgery:
   DO NOT EAT any solid foods, including juices with pulp (e.g., orange juice, nectars), lozenges, candy, chewing gum, and mints. DO NOT DRINK full liquid, such as milk, cream, and jello. You may continue to drink up to eight ounces of clear liquids until SIX hours before the scheduled start of your surgery. Clear liquids include Water, clear juices (e.g., apple, grape), black tea and black coffee.
2. Six hours before the Scheduled Start of your Surgery:
   DO NOT TAKE anything by mouth except for your usual medicines; follow the Preoperative medication instructions above.
3. Exceptions:
   DO NOT TAKE anything by mouth for eight hours, except for your usual medicines, if you are pregnant, morbidly obese, or are diagnosed with diabetes, renal failure, or stomach acid reflux with heartburn.

Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.

Pre-Operative Cleaning Instructions (bathing and showering instructions)

Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:

1. Generously lather your body, scrub well, and rinse. Give particular attention to the area were the incision will be made for your procedure.
2. Following the morning shower, do not apply creams, body oils, lotions, perfumes, deodorants, makeup, lipstick, nail polish or any other cosmetic product to the skin or nails.
3. Do not use Hibiclens on your face. You may use any other antibacterial soap for the face.
4. Children under 5 years of age are to be given a bath using an over the counter antibacterial soap.

On The Day Of Surgery

• Take your medicines as instructed above.
• You may brush your teeth; rinse your mouth, but do not swallow the water.
• Leave all jewelry (including wedding and all other rings) and valuables (including money and credit cards) at home.
• If you wear contact lenses, glasses or hearing aids, please bring a case or container, and solution for contacts, to protect them while you are in surgery.
• Wear a minimum amount of makeup, and no mascara. Please remove the nail polish from both index fingers.
• Please bring a copy of your current medical problem list from you primary care physician (family medicine/internist).
• Minors (anyone less than 18 years old) must be accompanied by a parent or legal guardian to sign the operative consent fount

The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery.

After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.

Time To Arrive For Your Surgery

During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery.

ARRIVAL TIME:
WHERE TO ARRIVE:

The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below.

Indications:

Patient is a male that wishes to be sterilized; he has been counseled regarding the permanence of this procedure and a chance that even reversal at a later date may not restore fertility. Pt has a stable marital arrangement and is finished having children.

Alternatives:

Alternatives are standard birth control measures for both sex partners.

Risks/Complications:

The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures including the testicular artery which may result in atrophy or loss of the testicle, chronic epididymal and testicular pain which may be relieved by reversal of the vasectomy and recannalization in the future. Patient is aware that he must continue to use contraception until he has ejaculated 20 or more times and has a negative semen analysis confirming "no sperm seen" if the procedure fails a pregnancy can result and additional procedures may be necessary. If the patient decides in the future that a reversal of the vasectomy is desired there may be a 10-20% chance he will not become fertile again. However, a biological child can still be obtained using artificial reproductive techniques at considerable cost to the patient.

You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.

To view the actual printable form for this surgery, click here: Counseling Note for Vasectomy. To print the document, simply select print after you have opened the page. You can use that copy to sign before your surgery.

Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary.

There are two types of Vasectomy: No-Incision Vasectomy and Standard Vasectomy, both of which are described below.

No-Incision Vasectomy

Indications: Patient is a fertile male that wishes a vasectomy.

Sample Procedure Dictation:

The patient was laid in the supine position then prepped and draped in the usual standard sterile manner. Local lidocaine anesthesia was given bilaterally a small stab wound was made and the vas deferens was isolated and cut. It was allowed to fall back into the scotum without significant bleeding noted. The skin punctures were left open to heal primarily. The patient tolerated the procedure well and was observed for approximately one hour. He was able to ambulate and urinate before leaving the office with an escort.

Discharge:

1. For initial pain, Tylenol #3: take 1-2 tablets by mouth every 4-6 hours prn.
2. For mild pain, take 2 tablets of extra strength Tylenol 500mg q 4-6 hours prn.
3. Scrotal support, bed rest for 24 hours and no strenuous activity for two weeks.
4. Return to office for severe swelling, pain, fever > 101.5, or chills.
5. Return to the office in 6 weeks or after 20 ejaculations for semen analysis.
6. Use contraception until cleared by your physician
7. Patient was given above instructions and verbalized understanding.

Standard Vasectomy

Indications: Patient is a fertile male that wishes a vasectomy.

Sample Procedure Dictation:

The patient was laid in the supine position then prepped and draped in the usual standard sterile manner. Local lidocaine anesthesia was given bilaterally and two small incisions were made and the vas deferens was isolated, coagulated and cut. It was allowed to fall back into the scotum without significant bleeding noted. The skin incisions were closed with running 4-0 chromic sutures. The patient tolerated the procedure well and was observed for approximately one hour. He was able to ambulate and urinate before leaving the office with an escort.

Discharge:

1. For initial pain, Tylenol #3: take 1-2 tablets by mouth every 4-6 hours prn.
2. For mild pain, take 2 tablets of extra strength Tylenol 500mg q 4-6 hours prn.
3. Scrotal support, bed rest for 24 hours and no strenuous activity for two weeks.
4. Return to office for severe swelling, pain, fever > 101.5, or chills.
5. Return to the office in 6 weeks or after 20 ejaculations for semen analysis.
6. Use contraception until cleared by your physician
7. Patient was given above instructions and verbalized understanding.

To the family and friends of patients undergoing surgery.

SCHEDULED STARTING TIME OF SURGERY:

ESTIMATED LENGTH OF SURGERY:

You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation.

The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria.

We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us.

Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor.

1. Wear the scrotal support or athletic supporter for at least 24-48 hours. You may wear it as long as you are more comfortable with than without it.
2. Avoid strenuous physical exercise and heavy lifting for about two weeks. You may perform all other usual activities after 24 hours.
3. You may shower or bathe beginning the following day after vasectomy. Apply soap gently, rinse and dry by blotting instead of rubbing.
4. Some physicians do not close the incision with stitches because they feel that the edges tend to heal more quickly without them. If the stitches have been used to close the skin incisions, they will dissolve by themselves and do not require removal. If a stitch dissolves prematurely, the incision may open a little and there may be a slight discharge or bleeding from the wound. This is normal, as is minor swelling and tenderness, which usually subsides in about 48-72 hours. Continue to bathe as usual, and place 2x2 gauze pads inside the suspensory at the site of discharge. 2x2 gauze pads can be obtained at any local pharmacy/drugstore. If severe pain, swelling or bleeding occurs, CALL YOUR DOCTOR or go to the nearest emergency room for evaluation.
5. If you have pain after the operation, take two Tylenol tablets 4-6 hours apart. An ice bag will provide additional comfort after the anesthesia wears off. Lying flat for a few hours will reduce discomfort associated with movement.
6. Maintain the usual contraceptive precautions until a semen analysis has been performed twice with "no sperm" found. Before participating in unprotected intercourse, bring a semen sample (produced by masturbation) to our office (Tuesdays and Thursday) for microscopic examination on two separate occasions. If on microscopic examination, sperm are found, continued protection is required and another semen analysis will be conducted in two weeks.

Frequently Asked Questions after surgery

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