My In-Office Vasectomy Experience After Being Told I Needed OR Sedation
Sharing my experience for those who may be in a similar situation.
TLDR: The first doctor wanted to do IV sedation in an OR because he had a hard time isolating the vas deferens. I got a second opinion and went with an in-office procedure instead. Overall, all is well, but I did experience some pain.
Backstory:
I'm 5'11", and when I first went to a urologist consultation, I weighed 290 lbs.
I've always been overweight, with various levels of yo-yoing throughout my life. Also, I'm a grower, not a shower, and I'm uncircumcised. I'll also add that I've never had big ol' hanging balls. Mine have always been more secured/tucked in. I've never had a negative comment from any sexual encounters about them being out of the norm or anything, but from watching porn, there are definitely dudes with saddlebags and others with more tucked-in sacks. That's where I fall on the spectrum.
I went to my first consultation for a vasectomy. That doctor had me lie down on the bed and began to feel for my vas deferens on both sides. I want to add that he just had me drop my pants down to my knees while I laid on the bed. I have thick thighs, and it just made everything more compact.
His observations were as follows:
General: Well-developed, well-nourished male in no apparent distress
Penis: Normal glans, normal meatus, normal shaft
Scrotum: Contracted scrotum with large suprapubic adipose pad. Testicles descended bilaterally with no masses. No hernias. Difficult to palpate vasa.
Basically, he had a hard time isolating my vas deferens and stated that I have a FUPA that made it difficult for him to do the procedure in-office, so he recommended doing it in the operating room under IV sedation.
Well, I was hesitant to do it in an OR because logistically, it would require my wife, my 1-year-old, and my 2-year-old to drive me 1.5 hours each way to this doctor's office. The whole vasectomy process would take around 4 hours or so, basically wasting the whole day. Not to mention, the cost would now be my full deductible of $1,500 because it would be done in the OR with anesthesia.
I decided to get a second opinion, though it took a few weeks to be seen by another urologist.
The second consultation came, and I had actually lost some weight by then. I was down 15 lbs, to 275 lbs.
This consultation was with an RN and not the operating doctor. She did her exam while I was standing, and I dropped my pants all the way down to the floor. In this exam, I was able to stand superhero-style and spread my legs a bit.
She was able to isolate my left vas deferens fairly easily. On the right side, she had to move things around a bit. She also mentioned I had a retracted scrotum. In the end, she found what she was looking for.
She scheduled me for an in-office procedure and mentioned that since she wasn't the operating doctor, we had a fallback plan. The operating doctor would reexamine me on the day of the procedure, and if for whatever reason he felt uncomfortable moving forward, he would cancel the procedure before starting and we would consider an OR approach instead. I was good with that, and we moved on.
In the post-consultation document, she noted the following:
PHYSICAL EXAMINATION: GU: uncircumcised, orthotopic meatus, no lesions, retractile testicles 20 mL, scrotal skin thin, vas deferens short and difficult to separate.
The day of the procedure came a month later, which was yesterday as of this post. I'm down another 15 lbs and now weigh 266 lbs.
My experience:
Because of my retracted scrotum, I took some steps to help make sure all went well. I shaved my sack two nights before and touched it up the morning of. I took a hot shower and drove myself to the office, which was about an hour away. I brewed a hot tea to sip on the drive there. I also put some hot water into an empty plastic water bottle and drove with that bottle between my legs to keep the area warm and loose. I also turned on the heated seats in my car for extra heat and comfort.
I was given an antibiotic pill before we got started. I was then led into the procedure room and asked to take my bottoms off and sit on the bed. All my prep work had me super loose, and my sack was dangling. The nurse prepped me by patting the area with a sterile solution and also stuck a grounding plate to my left thigh. She said it was so I didn't get shocked with static electricity, etc. The doctor came in a few moments later.
He began on my right testicle. He grabbed and maneuvered things around a bit. It didn't feel too bad, just minor discomfort similar to the actual consultation exam. Then came the shot. I felt a bit of a pinch, but nothing crazy, just a normal shot feeling. He then did the deed. Again, I felt maneuvering and juggling around, but nothing intolerable. Soon enough, he was done. He did mention that I had very thick tubes and that he had a hard time clamping them with his instrument because they were thicker than the instrument allowed.
On to the left side.
Same thing: maneuvering and juggling around, then came the shot. I felt a pinch again, like the other side. Then he began to work.
This is where I felt major pain. It was an unbearable sharp poking pain. I told him what I felt, and I visibly got flushed, sweaty, and felt like throwing up. He stopped immediately, gave me another shot, and we waited a minute for the anesthesia to kick in fully.
As I was catching my breath, contemplating my life decisions, and even considering quitting and asking him to end it there because I did not want to feel that sharp pain again, I felt him begin to move around and continue the procedure. Thankfully, there was no more pain. He said that sometimes one side is more sensitive than the other and requires a bit more anesthesia, and that it was nothing alarming.
He was done in no time and patched me up. The team left me in the room to gather myself for a few minutes, and then I put my clothes back on and walked back to my car.
When they pulled off that sticky grounding plate from my thigh, that actually hurt a lot lol.
Aside from that short but very sharp pain on my left side, I would say the procedure went well. I was able to walk to the car just fine and even stopped at the grocery store on my way home to pick up a few light items for the toddlers.
Here are the post-procedure notes:
Procedure: A combination of Marcaine and lidocaine without epinephrine were used to anesthetize the skin and perform bilateral spermatic cord blocks. Care was then taken to minimize intravascular injection. Then, using the modified no-scalpel technique, the skin was opened, and the right vas deferens and its sheath were delivered out into the surgical field. The sheath was opened. The vas deferens was isolated with blunt dissection. The vas was cut with iris scissors. 1 cm of the lumen of the abdominal and testicular ends were cauterized. Hemostasis was obtained with delicate electrocautery. The vas deferens was returned into the scrotum. The skin edges were cauterized carefully to obtain hemostasis.
My appointment was at 11:30 a.m., and I was back in my car by 12:20 p.m. For the remainder of the day, I just sat on the couch icing myself. I bought some vasectomy underwear from Amazon that came with two ice packs. I also bought a protective athletic cup because I have two very active toddler boys, and I didn't want to risk an accidental hit.
I showered later that night and lightly rinsed the area. I slept through the night just fine. I am taking ibuprofen to mitigate inflammation and pain as a precaution because I really do not want any discomfort again. I woke up today with no swelling and no pain. Every now and then, I feel a very minor pull if I walk too much, but only if I'm really looking for it.
Needless to say, aside from that pain on the left side before the anesthesia kicked in, I had a good experience with the in-office procedure, and it only cost me a $65 co-pay. I do not regret skipping the OR approach because it would have cost me more money, and going under anesthesia plus the logistics of the day would have been much more of a hassle. I'm glad I got a second opinion and that this doctor was comfortable doing it in-office.
Now I await the final sterility semen analysis in about 3 months.