Step 1: Visit your regular doctor
Step 2: Going to the urologist
Step 3: The day before the procedure
Step 4: The day of the procedure
The procedure, the doctor will have you disrobe, and your scrotum will be swabbed with betadine solution, the doctor will ask you to lay back on the table, but if you like you can prop yourself up on your elbows and watch. The doctor will inject Novocaine under the skin of your scrotum and after a suitable waiting period come back and make two small incisions into the skin. Reaching in, he will pull the vas deferens outside the scrotal sac. I'm a little hazy at this point ;-) But the deferens were severed and the ends tied. The vas deferens were pushed back inside and the incisions sutured.
Step 5: After the procedure
At the 10 day to two week point you will return to the doctor for the removal of the stitches.
At eight weeks you will return to the doctor with a "specimen"
At twelve weeks you'll return with another "specimen"
The specimens must be fresh, and uncontaminated.
At the twelve week point the doc should know whether the procedure was a success, until the doctor clears you you must continue to use other forms of birth control.
Step 6: The Aftermath
There are the possibility of complications in order of importance
chronic testicular pain
changing your mind.
All in all, it's provided a worry free solution to birth control for my wife and I, and I've never regretted the choice.
Although I've stated that they're irreversible, that's not strictly true, but the expense of reversal is not generally covered by insurance and has a high failure rate.