A pre-procedure visit for counseling, physical examination, and obtaining informed consent can be done the day of the procedure, but preferably done during a separate visit in advance of the procedure. You should explain risks, possible complications, and screen for contraindications for vasectomy.
Important
You must explain to the patient and his partner or wife that vasectomy is considered a permanent form of contraception. Although reversal can be attempted, it is usually not covered by insurance, and success rates for reversal range from 30-75%. It is essential that the patient and his partner or wife understand these facts prior to making the decision to proceed with vasectomy.
Risks
Failure (commonly reported rates are less than 1%)
Local infection
Excessive bleeding
There is no increased risk of prostate cancer or testicular cancer
Possible complications
Mild swelling and discomfort
Scrotal hematoma requiring surgical evacuation of blood clot and control of bleeding
Sperm granuloma
Forms when sperm leak from the testicular end of the vas. These may become as large as 2cm in diameter and are usually asymptomatic, but occasionally cause significant pain.
Neuroma
Inflammation involving the perivasal nerves, which may cause pain.
Congestive epididymitis
Sperm and fluid produced by the testicle may build up in the epididymis after the vasectomy, causing congestion, pressure, and distention. This is usually asymptomatic, but occasionally can cause significant pain.
Chronic testicular or scrotal pain
May be caused by sperm granuloma, neuroma, or congestive epididymitis, or the cause may be unknown.
The patient should be given a Patient Information Handout (.doc) on no-scalpel vasectomy. It is also wise to give him a copy of the Post-Procedure Discharge Instructions (.doc) at this time, for his review prior to the procedure.