Note: This article was originally published in the early 1959. While some information may still be relevant today, it does not necessarily represent a modern understanding of vasectomy and should be viewed primarily as a historical reference.
By Dr. P S Jhaver M.S., F.I.C.S.
Originally published in the Journal of Indian Medical Association, March 1959. Vol. 32 No. 5
Experimental vasectomy dates back to eighteen hundred and thirty. As a clinical procedure it came into use in the later part of the nineteenth century. It was first used for the treatment of senile enlargement of the prostrate. Oschner (1890) suggested the possibility of the operation for eugenic application. Sharp (1937) practised it for eugenic purposes. It is used for the prevention of ascending or descending infection in genito-urinary tuberculosis and also to prevent the infection from the prostatic bed, after prostatectomy. Steinach (1921) advocated the operation for rejuvunation. These days it is widely practised for conception control. This operation is being done by us for the last seven years and cases have been followed up for variable period (Ohri and Jhaver 1958).
Table of Contents
The following are the difficulties during the operation:
A short scrotum or brisk cremasteric reflex makes it difficult to get at the spermatic cord and the vas deferens when the operation is being performed through the scrotal incision. Gentle manipulations may ease the problem.
Pendulous scrotum may not offer any difficulty during the operation but the risk of haematoma is more in them due to large loose space, and care is necessary to prevent the same.
The thickness of the vas deferens varies much. In many, it is thick eoungh to be palpable but in others it is so very thick that indentification is difficult by palpation alone and in such cases the structures other than the vas may be cut by mistake leaving the vas deferens intact behind.
Cases of the anterverted, undescended testes, inguinoscrotal hernia and hydrocele of the tunica vaginalis may make the operation difficult.
Due to Technical Surgical Errors
Injury to the blood vessels eg. testicular artery, may lead to gangrene of the testis. Injury and bleeding from the pampiniform plexus of veins may lead to scrotal haematoma, bleeding may be so profuse as to require orchidectomy. Artery to vas deferens may or may not be cut without any consequences. Plumonary embolism from the pampiniform plexus of veins after a vasectomy has been reported (morson 1933). Injury to the nerves of the spermatic cord may lead to persistent pain in the genitalia which may be worse during coitus and may be very incapacitating.
Improper care of asepsis may lead to scrotal abscess, particularly so in case of scrotal haematoma.
These include sexual debility and various sex disorders. Fear for, and prejudice against the operation seem to be the cause. It is advisable to avoid operation on psychologically unstable cases.
(Conception after the operation)
The causes may be missed vas deferens, spermatozoa persisting in the seminal vesicles, reunion of the cut ends of the vas deferens, duplication of the vas deferens or unknown causes. The remote possibility of such accidents should be explained to the patient before the operation as the consequences may be grave for everyone concerned including the doctor who may have to face legal liabilities.
Vasectomy is a minor surgical procedure, but no less important than a cataract operation. A successful operation brings all the happiness to the person but if there is any complication the consequences can be very grave. This operation is being performed under local anaesthesia, in the hospitals, dispensaries and even in out of the way places. Many serious accidents have occurred due to sensitivity to the local anaesthetic agents and a mishap of the kind during vasectomy will be too big disaster and great care must therefore be taken.
Even the most minor complications after vasectomy are viewed critically as the person undergoing the operation has no disease but has submitted for an operation under pressure of an ever increasing family and has come in perfect health.
The authors came across fourteen cases (in a series of 682) who were sensitive to local anaesthetic agents. Sexual debility after the operation was complained of by three who were cured by suggestion and psychotherapy. In the case done by junior doctors the following complication occurred.
Haemorrhage and gangrene of testis in 2 cases; big haematoma in the scrotum in 2 cases; small haematoma in the scrotum in 5 cases and scrotal abscess in 3 cases.
This shows that the operation though a minor one requires care. Perfect haemostasis is essential to prevent complications.
Difficulties which are met with during vasectomy are described.
Morson, C Brit M.J. 1: 54, 1933
Ohri B.B. and Jhaver P.S Indian J Surg. 20: 484, 1958
Oschner A.J. J.A.M.A 32: 86, 1899
Sharp H.C J. Hered 28: 374, 1937
Steinach E Arch. F. Entw. Sklngamech. d. Orgn. 44:557, 1921