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

1. Dr.Jayaram Reddy, MS, MChProfessor, Dept of Urology, Hyderabad Dr. Sasikala Kola, Consultant Obs- Gyn Hyderabad

2. NO SCALPEL VASECTOMY • CONVENIENT • SAFE • MORE EFFECTIVE IN POPULATION STABILISATION. WHY VASECTOMY • RELIABLE • NO MORBIDITY

3. WHY IS IT NOT ACCEPTED READILY • MISCONCEPTIONS – LIKE SEXUAL DISABILITY PHYSICAL DIABILITY • FEAR OF CUTTING / SUTURES • MALE PREDOMINANCE.

4. 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.

5. 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.

6. 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.

8. INSTRUMENTS

9. EXTRACUTANEOUS VAS FIXATION CLAMP

10. VAS DISSECTING FORCEPS

11. SCISSORS

12. ANAESTHESIA • LOCAL ANAESTHESIA • VASAL BLOCK

13. LOCAL ANAESTHESIA

14. VASAL BLOCK

15. 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 LigatureCauteryHaemoclips • Facial interposition • Dressing

16. 3 Finger technique for vas fixation

17. Holding with ringed clamp

18. Piercing the skin with dissecting forceps

19. Delivery of vas

20. Vas occlusionLigatureCautery Haemoclips

21. Dressing

23. POST OPERATIVE INSTRUCTIONS • Antibiotics. • Analgesics. • Scrotal support for 7 days. • Rest.

24. POST OPERATIVE INSTRUCTIONS • Resume light work immediately. • Avoid heavy work for 2 days. • Discontinue cycling for 7 days. • Don’t kick start scooter for 2 days: can ride one.

25. 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.

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

27. RELATIVE CONTRAINDICATIONS • LARGE HYDROCELE. • ELEPHETIASIS. • INGUINAL HERNIA / • SCROTAL MASS. • BLEEDING DISORDERS

28. COMPLICATIONS • INFECTION • HEMATOMA • SPERM GRANULOMA • ANTISPERM ANTIBODIES.

29. 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.