Vasoepididymal Anastomosis (VEA) Consent

Informed Consent For Surgical Operation / Procedure

Procedure: Vasoepididymal Anastomosis (VEA)

1. Patient Details

I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):

Procedure: _______________________________
Diagnosis: ________________________________
Major illness & comorbidities: ________________________________

2. Authorization

I authorize Dr. __________________ to perform the above procedure, along with such assistants and associates as may be selected by him/her.

I understand that members of the surgical team, including residents or trainees under appropriate supervision, may perform parts of the procedure according to their training and competence.

3. Nature of Procedure

VEA is a microsurgical procedure to bypass epididymal obstruction by connecting the vas deferens to an epididymal tubule under an operating microscope.

Bilateral surgery, conversion to vasovasostomy, or abandonment of reconstruction may be necessary depending on operative findings if sperm are not found intraoperatively.

4. Benefits

The intended benefits include:

  • Restoration of sperm transport
  • Improvement of fertility potential
  • Allowing natural conception where possible
  • Reducing the need for ART

5. No Guarantee

No guarantee of return of sperm, fertility or pregnancy is given.

The success rate of the procedure (patency rates) ranges from 50–80%, depending on the findings and case-to-case basis.

IVF/ICSI or sperm retrieval may still be required.

6. Risks

General Risks

  • Bleeding
  • Infection
  • Hematoma
  • Anaesthetic complications
  • Pain
  • Wound problems

Procedure-Specific Risks

  • Failure of reconstruction
  • Persistent azoospermia
  • Anastomotic blockage
  • Sperm granuloma
  • Hydrocele
  • Chronic scrotal pain
  • Injury to epididymis/vas/testis
  • Testicular atrophy (rare)
  • Need for repeat surgery

7. Fertility Outcomes

Patency is approximately 50–80%.

Natural pregnancy is approximately 20–50%, depending on female partner fertility, obstruction duration and other factors.

8. Postoperative Course

  • Scrotal support
  • Avoid intercourse for 3–4 weeks
  • Avoid heavy lifting for 4 weeks
  • Semen analysis after 6–8 weeks
  • Follow-up thereafter

9. Alternatives

  • Observation
  • Sperm retrieval (PESA/MESA/TESE/Micro-TESE)
  • IVF/ICSI
  • Donor sperm
  • Adoption

10. Blood Transfusion

I consent to blood transfusion if necessary and understand associated rare risks.

11. Anaesthesia

Risks and benefits of anaesthesia have been explained.

12. Photography / Data

I consent to anonymized photography/video and academic use.

13. Intraoperative Decision

I authorize modification or extension of the procedure if medically necessary.

14. Team-Based Care

Residents/fellows may participate under supervision.

15. Patient Declaration

I understand the procedure, risks, benefits, alternatives and expected outcomes. My questions have been answered. I voluntarily consent.

Patient to write:

“I have understood the procedure, risks, benefits and alternatives explained to me in a language I understand.”

Signatures

Patient Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Doctor Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Witness Name & Signature: ____________________________________

Contact No.: ______________________________

ATTENDANT CONSENT (If applicable)

Reason patient unable to consent:

Attendant Name: __________________________________________

Relationship: _____________________________________________

Signature: ________________________________________________

Contact No.: ______________________________________________

INTERPRETER STATEMENT (If applicable)

I confirm an accurate explanation in understandable language.

Name: _________________________________________________

Signature: ______________________________________________

Contact: ________________________________________________

HIGH-RISK CONSENT (If applicable)

High-risk factors explained due to:

Patient Signature: ________________________________________

Doctor Signature: _________________________________________

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