What techniques do you use for patients with tight scrotums during in-office vasectomies?

If, on the initial counseling visit, I know that the patient has a very tight scrotum and is anxious about the vasectomy, I may just defer performing it in the operating room of the outpatient facility. If, however, it becomes apparent only during the procedure that his vas is difficult to access du...

I have decided, after many years of experience, to only offer vasectomy here in our surgery center, performed under IV sedation or general anesthesia. I do this to avoid these sometimes difficult circumstances with a tight/thick scrotum or anxious patient. I find that the procedure can move along qu...

Keeping the room warm and the patient as relaxed as possible. Have also seen a warm towel or warming pad over a towel used prior to prep while the patient is waiting.

All of my patients get Valium before a vasectomy in my office for light sedation, anxiety reduction, and relaxation of the spermatic cord.

Occasionally, I will do high-riding testes or tight scrotums in the OR. Anesthesia relaxes the cremasteric fibers, making vasectomy a lot easier.