Overview of vasectomy

INTRODUCTION

Vasectomy is the most effective available mode of male contraception. The procedure involves interruption or occlusion of the vas deferens, and is typically performed in an outpatient setting under local anesthesia.

Worldwide, in 2004 almost 43 million men had undergone vasectomy [1]. Slightly more than one half million vasectomies were performed in the United States (US) in 2002 [2]. Approximately 79 percent of vasectomies in the US were performed by urologists, 13 percent by family practitioners, and 8 percent by general surgeons. Procedure costs range from $350 to $1,000, which is below costs associated with long-term pharmacologic contraception or female sterilization procedures.

The most common sterilization procedure for women, tubal ligation, requires entering the peritoneal cavity to access the fallopian tubes, and is usually performed under general anesthesia. Compared to tubal ligation, vasectomy is safer, less costly, and has a significantly shorter post-procedure recovery time. Nonetheless, worldwide, tubal ligation is performed five times more often than vasectomy [3]. This suggests lower acceptance of vasectomy, which may be attributed to a variety of reasons, including misperceptions of the procedure and its side effects.

Reported rates of successful infertility for vasectomy exceed 98 percent [4,5], though data are limited by lack of long-term follow-up. Most studies report outcomes only within two years of the procedure, and might not account for subsequent failures due to later recanalization.

This topic will present an overview of vasectomy, and will discuss patient selection, and preoperative and postoperative considerations for the primary physician. The technique of vasectomy is reviewed separately. (See "Vasectomy and other vasal occlusion techniques for male contraception".)