male tie

Male family planning surgery is mainly to prevent the discharge of sperm, that is, vasectomy. In addition, it also includes the treatment of re-cultivation after infertility or sterilization, that is, vas deferens anastomosis and vas deferens epididymal anastomosis. Vas deferens surgery refers to the use of surgical or non-surgical procedures to cause spermatic tract blockade. After the testis can still continue to produce sperm, mature sperm dissolved in the epididymis, there is still a normal ejaculation process during sexual intercourse, but there is no sperm in the semen. The vas deferens sterilization is simpler, safer, and has no complications of abdominal surgery than the fallopian tube birth control. The postoperative recovery is also faster. Therefore, it is currently the main birth control measure. The vas deferens sterilization includes cutting off the vas deferens, occluding the vas deferens by means of chemical or electrocoagulation, blocking the vas deferens in the lumen, or closing the vas deferens outside the tube. Currently, the most commonly used is male stabbing, followed by vas deferens occlusion. Male stabbing is a ligation and removal of a small segment of the vas deferens, so that sperm can not be excreted, to achieve the purpose of infertility. There are many methods for male stabs. At present, the commonly used method is the pliers method. In addition, there are needle-fixed small incision method, needle-picking method and threading method. Take the pliers method as an example to introduce male stabbing. Male stabbing is a simple, safe and reliable sterilization operation and one of the main operations of family planning. Male stab only blocks the sperm delivery channel, allowing sperm to accumulate in the tail of the fall of the testis, and later liquefied and absorbed. After more than 10 years of stasis, the male can still restore fertility, which proves that the operation of the seminiferous tubule epithelium has no effect, and the male hormone secretion of interstitial cells is not hindered, so the postoperative male secondary sexual characteristics are not It will change and will not affect sexual function and physical strength. Treatment of diseases: chronic bacterial prostatitis Indication 1. Married men carry out family planning, and with the consent of both husband and wife, they perform bilateral male stabbing. If there is chronic prostatitis, it can be treated after surgery to stabilize the condition; if there is chronic epididymitis and severe neurasthenia, other contraceptive measures should be taken. If there is testicular hydrocele, inguinal hernia or severe varicocele, surgery can be performed at the same time. Patients with scrotal skin disease should be treated after the cure. 2. Male stabs are performed due to other conditions. If one side of the epididymal tuberculosis is not expected to be born, the contralateral vas deferens can be ligated when the diseased side epididymis is removed to prevent the lesion from spreading to the contralateral epididymis. In the case of prostate resection for prostate hypertrophy, in order to prevent postoperative epididymitis, bilateral male stabbing can also be performed. Contraindications 1. Hemorrhagic disease, mental illness, severe neurosis, sexual dysfunction, acute or severe chronic disease. 2. Acute or chronic inflammation of the genitourinary system should be cured before surgery or other birth control measures. 3. Scrotal skin acute or chronic inflammation, lymphedema or other skin diseases that interfere with surgery should be cured before surgery. 4. Scrotal disease, such as inguinal hernia, hydrocele, varicocele, etc., should be cured after surgery, or surgery in the scrotum while performing male stab surgery. Preoperative preparation 1. Explain to the recipients, explain the importance of family planning, the physiological knowledge of male sexual function, and the safety, reliability and simplicity of male stabbing, and eliminate ideological concerns. 2. If there is rural housing surgery, dust and fly-proof facilities are required. 3. Acute and chronic infection of the urinary tract, scrotal skin disease and scrotal disease, after the cure, then male stab. 4. Pay attention to the history of drug allergy and do a procaine skin test. 5. Bathe before the operation, clean the vulva, and replace the cleansing pants. Shave the pubic hair before surgery. 6. Prepare a blade, 5ml syringe, 1 small needle for skin test, 4 small gauze, 1 separate forceps separation pliers (with a mosquito-type hemostatic forceps to remove the clamp teeth, the end sharpening tip), a vas deferens fixed clamp 1 (Or use a straight hemostatic forceps to grind the jaws, the end thickness is 1.2mm, bend into a circular hole with an inner diameter of 2mm and an outer diameter of 3.5mm. You can also narrow the front end of the tissue clamp and keep two teeth.) Put (sharp the wire, bend it into a hook, and put it on the handle). 7. Cut or shave the pubic hair, wash the penis and scrotum with soapy water for 5 minutes, and disinfect the skin 3 times with a 1:1000 benzalkonium solution before surgery. Surgical procedure 1. Position in the supine position, the two lower limbs are slightly separated. 2. Fix the vas deferens and gently pull the testicles down to the side to tighten the spermatic cord into a straight line. The vaginal canal is fixed by the three-finger method, that is, the surgeon uses the left middle finger and the thumb to pinch the vas deferens, the middle finger is topped, and the finger is pressed down, so that the vas deferens is firmly fixed on the superficial superficial surface of the upper part of the scrotum. 3. Local anesthesia with 0.5% to 1% procaine in the upper part of the scrotum fixed to the scrotum at the anterior wall of the scrotum without obvious blood vessels, do 1cm diameter of the ridge, then the needle close and along the vas deferens into the distance, injection anesthesia 1 to 3 ml of liquid, so that the anesthetic solution is infiltrated along the circumference of the vas deferens, so as to achieve the effect of the closed loop of the spermatic cord. 4. Separate the incision with a sharp knife or a vas deferens separation pliers tip, puncture the scrotum skin from the local anesthesia needle, and then puncture in the direction of the vas deferens, directly to the fixed vas deferens, separate the small holes and enlarge the holes to 0.3 ~ 0.5 Cm to separate the skin, the meat film, the fascia of each layer, and the fascia around the vas deferens. 5. Clamp the vas deferens and insert the vas deferens from the separated scrotal skin hole until the vas deferens. After the fixed forceps touch the vas deferens, open the forceps in the vertical position, use the left middle finger to push the vas deferens into the ring, and fasten the forceps. The handle, the vas deferens and some of the fascia tissue are placed, and the vas deferens is gently lifted out and turned outside the incision. 6. Propose the vas deferens with a sharp knife or a separation forceps to pierce the vas deferens to the wall. Carefully separate the film to reveal a white smooth vas deferens. The vas deferens is then used to hook the vas deferens through the wall of the tube and present it outside the vasectomy of the vas deferens. 7. Separate the vas deferens with a separation forceps close to the vas deferens, and peel off the attached tissue. When a small gap is separated, the tip of the forceps is passed through, and the tip of the forceps is slowly opened in parallel with the vas deferens. The length of the free vas deferens is about 1.5 to 2.0 cm. 8. The seminal vesicle perfusion is inserted into the vas deferens with an injection needle, and the spermicidal drug is slowly injected into the seminal vesicle. The commonly used one is 1:10000 phenylmercuric acetate 2~3ml. 9. Ligation of the vas deferens with a vascular clamp gently squeeze the ligature at one end of the vasectomy, ligation with a medium wire, and cut the vas deferens, clamp the vascular tube at the opposite end, check the ligation end without bleeding, cut the short tail, and then use the blood vessel Pliers clamp the vas deferens fascia next to the ligation end and lift it up to allow the vasectomy ligature to retract downward. Then, at the appropriate part of the unligated end, the vas deferens was gently pressed with a vascular clamp, and the spermatic fascia lifted by the medium wire at the press site and the opposite end was indeed ligated, and the long tail was retained, and the excess vas deferens was cut out by about 1 cm. In this way, the contralateral vas deferens are embedded in the fascia, so that the two ends are isolated to prevent recanalization. Temporarily place the vas deferens in the scrotum. 10. Ligation of the contralateral vas deferens with the same method. 11. Also, the vas deferens will be ligated to the long tail line of the vas deferens first, revealing the vasectomy tube, carefully check that there is no bleeding, cut the short tail, gently pull the testicle down, and return the vas deferens to the scrotum. Its reset. The same method also returns the contralateral vas deferens. 12. Close the incision; suture the needle 1 stitch, or use a forceps to press the gap clamp closed, or use your fingers to squeeze the gap closed. complication 1. The causes of bleeding caused by bleeding include improper selection of surgical indications, scrotal incision not avoiding blood vessels, scrotal incision too small, vas deferens fixed slippage blind clamp, peeling of vas deferens damaged blood vessels, poor treatment of vas deferens and poor postoperative management, etc. . However, most of the surgery is rough and the hemostasis is not completely caused during surgery. Most of the bleeding occurred within 24 hours after surgery. Generally, cold compress, pressure dressing, application of hemostatic drugs and antibiotics can be used. If hematoma has formed, hemorrhage can be extracted after a few days, and hyaluronidase and intramuscular injection of chymotrypsin can be injected to promote hematoma liquefaction. If the hemorrhage has not stopped, the hematoma rapidly increases within 48 hours, then surgery should be performed immediately to remove the hematoma. Stop bleeding and place drainage. Apply hemostatic drugs and antibiotics and prevent other complications. 2. The cause of infection is often caused by the original scrotal infection and genitourinary infection, the scrotum is not cleaned and disinfected as required before surgery, the surgical instruments and dressings are not aseptically required, the operation is rough, the tissue damage is excessive, and the bleeding is not stopped. Complete and postoperative dressing shedding, wound contamination, etc. Postoperative infection can be divided into two categories, namely, shallow infection of the scrotum incision and deep tissue infection such as spermatic cord. The former is limited to the scrotal incision and subcutaneous tissue, the latter deep into the spermatic cord and other tissues, the infection can make the spermatic cord thick and hard, pain and tenderness, and even develop into a spermatic abscess, causing epididymis, testis and seminal vesicle, prostate infection. If infection has occurred, use effective antibiotics, local hot compresses, spermatic cord closure and other treatments. If abscesses are formed, drainage should be cut in time to prevent acute infections from becoming chronic infections. 3. Tissue reaction caused by trauma after painful nodule, local small nodules can be formed, generally nodules gradually shrink within 1 to 2 months, leaving no symptoms. If the pain occurs at the ligation site after 1 month of surgery, the nodules are enlarged, and there is obvious tenderness, it is a painful nodule. The causes are rough operation, heavier tissue damage, postoperative local adhesions leading to scar formation; too much ligature too thick, causing foreign body reaction; spermatic cord or vas deferens stump hematoma mechanization; spermatic or vas deferens ligation stump Residual infection; the vas deferens is not stripped clean, and the nerve fibers are ligated or cut off to cause neurofibromatosis; the vasectomy is too tight to loosen the wall or the ligature is detached, and the semen overflows from the ligation stump to cause sperm granuloma formation. Wait. If painful nodules occur, general treatment is generally used, such as procaine plus hydrocortisone hydrocortisone or chymotrypsin for partial infiltration. Infectious nodules can also be partially blocked with antibacterial drugs. If you have not healed for a long time after various treatments, you can consider surgical resection. 4. In the short-term after epididymal stagnation, the epididymis may be slightly swollen and painful. It usually disappears after a few days. If the epididymis continues to enlarge after 1 month of surgery, the pain will increase, and it can be radiated along the spermatic cord to the lower abdomen or waist, and it will be aggravated after sexual intercourse or fatigue. Examination revealed that the tail of the epididymis, the head or all of it increased, the surface was smooth, the tension was high, and the vas deferens near the epididymis was also thickened, which was the epididymal stagnation. The cause is the continuous stagnation of semen in the epididymis after ligation, and the pressure in the lumen continues to increase, so that the epididymis tube ruptures spontaneously, forming sperm granuloma; epididymal infection or surgical injury reduces the local blood supply and affects the absorption function of the epididymis. Such as epididymal stagnation, generally non-surgical treatment, such as lifting the scrotum with the cremaster, avoiding sexual intercourse, application of female hormones, spermatic epididymis closure, hot compress and physical therapy. If the treatment is not cured after long-term repeated treatment, epididymis resection or vas deferens anastomosis may be considered. 5. The cause of sexual dysfunction is the psychological disorder caused by the lack of understanding of the relationship between male and female sexual function; organic diseases such as postoperative bleeding, infection, painful nodules, epididymis, prostate Inflammation, seminal vesiculitis and other chronic diseases of the body; due to age and health differences. Sexual dysfunction, such as organic lesions should be actively treated, non-organic lesions for psychotherapy and drug treatment, may also consider vas deferens anastomosis. 6. Causes of re-fertility There is no spermicidal perfusion of spermicide in the operation. The residual sperm is not empty after the operation and the contraceptive measures are abandoned prematurely; the other tissues are misplaced and the vas deferens are missed; the congenital vas deferens repeat deformity. Sperm routine examination does have sperm, and the vas deferens should be re-ligated.

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