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Vasectomy

Author
Anthony J Viera, MD, MPH
Section Editor
Michael P O'Leary, MD, MPH
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

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

Worldwide, almost 43 million men underwent vasectomy in 2004 [1]. Slightly more than one-half million vasectomies were performed in the United States (US) in 2002 [2]. Data collected in the US in 2002 also showed that vasectomy was used by 5.7 percent of men ages 15 to 44, making it the fourth most commonly used contraceptive method, after condoms, oral contraceptives, and tubal ligation [3].

Approximately 79 percent of vasectomies in the US were performed by urologists, 13 percent by family physicians, and 8 percent by general surgeons. The cost of the procedure ranges from $350 to $1000, which is below costs associated with long-term pharmacologic contraception or female sterilization procedures [4].

Reported rates of successful infertility after vasectomy exceed 98 percent [5,6], 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 discusses patient counseling, preoperative preparation, surgical techniques, postoperative care and complications, and reversal of vasectomy. The effect of vasectomy on the patient's overall health (eg, cardiovascular or prostate cancer) is also discussed.

                                 
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Literature review current through: Sep 2017. | This topic last updated: Aug 16, 2017.
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References
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  1. Peterson HB, Curtis KM. Clinical practice. Long-acting methods of contraception. N Engl J Med 2005; 353:2169.
  2. Barone MA, Hutchinson PL, Johnson CH, et al. Vasectomy in the United States, 2002. J Urol 2006; 176:232.
  3. Martinez GM, Chandra A, Abma JC, et al. Fertility, contraception, and fatherhood: data on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth. Vital Health Stat 23 2006; :1.
  4. Trussell J, Lalla AM, Doan QV, et al. Cost effectiveness of contraceptives in the United States. Contraception 2009; 79:5.
  5. Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril 2000; 73:923.
  6. Jamieson DJ, Costello C, Trussell J, et al. The risk of pregnancy after vasectomy. Obstet Gynecol 2004; 103:848.
  7. https://www.auanet.org/guidelines/vasectomy-(2012-amended-2015) (Accessed on June 13, 2017).
  8. Lohiya NK, Manivannan B, Mishra PK, Pathak N. Vas deferens, a site of male contraception: an overview. Asian J Androl 2001; 3:87.
  9. Seenu V, Hafiz A. Routine antibiotic prophylaxis is not necessary for no scalpel vasectomy. Int Urol Nephrol 2005; 37:763.
  10. Cooper TP. Use of EMLA cream with vasectomy. Urology 2002; 60:135.
  11. Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004; 26:85.
  12. www.engenderhealth.org/pubs/family-planning/vasectomy.php (Accessed on May 27, 2008).
  13. Aradhya KW, Best K, Sokal DC. Recent developments in vasectomy. BMJ 2005; 330:296.
  14. Li SQ, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol 1991; 145:341.
  15. Cook LA, Pun A, Gallo MF, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev 2014; :CD004112.
  16. Li PS, Li SQ, Schlegel PN, Goldstein M. External spermatic sheath injection for vasal nerve block. Urology 1992; 39:173.
  17. Weiss RS, Li PS. No-needle jet anesthetic technique for no-scalpel vasectomy. J Urol 2005; 173:1677.
  18. White MA, Maatman TJ. Comparative analysis of effectiveness of two local anesthetic techniques in men undergoing no-scalpel vasectomy. Urology 2007; 70:1187.
  19. Kaplan KA, Huether CA. A clinical study of vasectomy failure and recanalization. J Urol 1975; 113:71.
  20. Labrecque M, Hoang DQ, Turcot L. Association between the length of the vas deferens excised during vasectomy and the risk of postvasectomy recanalization. Fertil Steril 2003; 79:1003.
  21. Mason RG, Dodds L, Swami SK. Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? A prospective randomized trial. Urology 2002; 59:424.
  22. Eisner B, Schuster T, Rodgers P, et al. A randomized clinical trial of the effect of intraoperative saline perfusion on postvasectomy azoospermia. Ann Fam Med 2004; 2:221.
  23. Pearce I, Adeyoju A, Bhatt RI, et al. The effect of perioperative distal vasal lavage on subsequent semen analysis after vasectomy: a prospective randomized controlled trial. BJU Int 2002; 90:282.
  24. Chen-Mok M, Bangdiwala SI, Dominik R, et al. Termination of a randomized controlled trial of two vasectomy techniques. Control Clin Trials 2003; 24:78.
  25. Cook LA, Van Vliet H, Lopez LM, et al. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev 2007; :CD003991.
  26. Esho JO, Cass AS. Recanalization rate following methods of vasectomy using interposition of fascial sheath of vas deferens. J Urol 1978; 120:178.
  27. Sokal D, Irsula B, Chen-Mok M, et al. A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition. BMC Urol 2004; 4:12.
  28. Li SQ, Xu B, Hou YH, et al. Relationship between vas occlusion techniques and recanalization. Adv Contracept Deliv Syst 1994; 10:153.
  29. http://www.auanet.org/content/media/vasectomy.pdf (Accessed on April 09, 2013).
  30. Sharlip ID, Belker AM, Honig S, et al. Vasectomy: AUA guideline. J Urol 2012; 188:2482.
  31. Schmidt SS, Minckler TM. The vas after vasectomy: comparison of cauterization methods. Urology 1992; 40:468.
  32. Sokal D, McMullen S, Gates D, Dominik R. A comparative study of the no scalpel and standard incision approaches to vasectomy in 5 countries. The Male Sterilization Investigator Team. J Urol 1999; 162:1621.
  33. Reynolds RD. Vas deferens occlusion during no-scalpel vasectomy. J Fam Pract 1994; 39:577.
  34. Cook LA, Van Vliet HA, Lopez LM, et al. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev 2014; :CD003991.
  35. Schmidt SS. Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases. Br J Urol 1995; 76:373.
  36. Denniston GC. Vasectomy by electrocautery: outcomes in a series of 2,500 patients. J Fam Pract 1985; 21:35.
  37. Labrecque M, Nazerali H, Mondor M, et al. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J Urol 2002; 168:2495.
  38. Errey BB, Edwards IS. Open-ended vasectomy: an assessment. Fertil Steril 1986; 45:843.
  39. Denniston GC, Kuehl L. Open-ended vasectomy: approaching the ideal technique. J Am Board Fam Pract 1994; 7:285.
  40. Shapiro EI, Silber SJ. Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia. Fertil Steril 1979; 32:546.
  41. Hancock P, McLaughlin E, British Andrology Society. British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002). J Clin Pathol 2002; 55:812.
  42. Barone MA, Nazerali H, Cortes M, et al. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol 2003; 170:892.
  43. Griffin T, Tooher R, Nowakowski K, et al. How little is enough? The evidence for post-vasectomy testing. J Urol 2005; 174:29.
  44. Marshall S, Lyon RP. Variability of sperm disappearance from the ejaculate after vasectomy. J Urol 1972; 107:815.
  45. Arango Toro O, Andolz Peitivi P, Lladó Carbonell C, et al. [Post-vasectomy semen in 313 males. Statistical analysis, medical aspects, legal implications]. Arch Esp Urol 1993; 46:29.
  46. Marwood RP, Beral V. Disappearance of spermatozoa from ejaculate after vasectomy. Br Med J 1979; 1:87.
  47. Spencer B, Charlesworth D. Factors determining the rate of disappearance of sperm from the ejaculate after vasectomy. Br J Surg 1976; 63:477.
  48. Klotz KL, Coppola MA, Labrecque M, et al. Clinical and consumer trial performance of a sensitive immunodiagnostic home test that qualitatively detects low concentrations of sperm following vasectomy. J Urol 2008; 180:2569.
  49. Sandlow JI, Winfield HN, Goldstein M. Surgery of the scrotum and seminal vesicles. In: Campbell-Walsh Urology, 9th ed, Wein A, Kavoussi L, Novick A, et al (Eds), Saunders, Philadelphia 2000. p.1098.
  50. Kendrick JS, Gonzales B, Huber DH, et al. Complications of vasectomies in the United States. J Fam Pract 1987; 25:245.
  51. Christensen P, al-Aqidi OA, Jensen FS, Dørflinger T. [Vasectomy. A prospective, randomized trial of vasectomy with bilateral incision versus the Li vasectomy]. Ugeskr Laeger 2002; 164:2390.
  52. Cook LA, Pun A, van Vliet H, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev 2007; :CD004112.
  53. Awsare NS, Krishnan J, Boustead GB, et al. Complications of vasectomy. Ann R Coll Surg Engl 2005; 87:406.
  54. Tandon S, Sabanegh E Jr. Chronic pain after vasectomy: a diagnostic and treatment dilemma. BJU Int 2008; 102:166.
  55. Manikandan R, Srirangam SJ, Pearson E, Collins GN. Early and late morbidity after vasectomy: a comparison of chronic scrotal pain at 1 and 10 years. BJU Int 2004; 93:571.
  56. McMahon AJ, Buckley J, Taylor A, et al. Chronic testicular pain following vasectomy. Br J Urol 1992; 69:188.
  57. Leslie TA, Illing RO, Cranston DW, Guillebaud J. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int 2007; 100:1330.
  58. Morris C, Mishra K, Kirkman RJ. A study to assess the prevalence of chronic testicular pain in post-vasectomy men compared to non-vasectomised men. J Fam Plann Reprod Health Care 2002; 28:142.
  59. Schmidt SS. Spermatic grauloma: an often painful lesion. Fertil Steril 1979; 31:178.
  60. Nangia AK, Myles JL, Thomas AJ JR. Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation. J Urol 2000; 164:1939.
  61. Polackwich AS, Tadros NN, Ostrowski KA, et al. Vasectomy Reversal for Postvasectomy Pain Syndrome: A Study and Literature Review. Urology 2015; 86:269.
  62. Padmore DE, Norman RW, Millard OH. Analyses of indications for and outcomes of epididymectomy. J Urol 1996; 156:95.
  63. Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician 2006; 74:2069.
  64. Black T, Francome C. The evolution of the Marie Stopes electrocautery no-scalpel vasectomy procedure. J Fam Plann Reprod Health Care 2002; 28:137.
  65. Alderman PM. The lurking sperm. A review of failures in 8879 vasectomies performed by one physician. JAMA 1988; 259:3142.
  66. Hendry WF. Vasectomy and vasectomy reversal. Br J Urol 1994; 73:337.
  67. Sharlip ID. What is the best pregnancy rate that may be expected from vasectomy reversal? J Urol 1993; 149:1469.
  68. Belker AM, Thomas AJ Jr, Fuchs EF, et al. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol 1991; 145:505.
  69. Potts JM, Pasqualotto FF, Nelson D, et al. Patient characteristics associated with vasectomy reversal. J Urol 1999; 161:1835.
  70. Clarkson TB, Alexander NJ, Morgan TM. Atherosclerosis of cynomolgus monkeys hyper- and hyporesponsive to dietary cholesterol. Lack of effect of vasectomy. Arteriosclerosis 1988; 8:488.
  71. Massey FJ Jr, Bernstein GS, O'Fallon WM, et al. Vasectomy and health. Results from a large cohort study. JAMA 1984; 252:1023.
  72. Giovannucci E, Tosteson TD, Speizer FE, et al. A long-term study of mortality in men who have undergone vasectomy. N Engl J Med 1992; 326:1392.
  73. Coady SA, Sharrett AR, Zheng ZJ, et al. Vasectomy, inflammation, atherosclerosis and long-term followup for cardiovascular diseases: no associations in the atherosclerosis risk in communities study. J Urol 2002; 167:204.
  74. Smith K, Byrne, Castaño JM, et al. Vasectomy and Prostate Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Clin Oncol 2017; 35:1297.
  75. Bernal-Delgado E, Latour-Pérez J, Pradas-Arnal F, Gómez-López LI. The association between vasectomy and prostate cancer: a systematic review of the literature. Fertil Steril 1998; 70:191.
  76. Dennis LK, Dawson DV, Resnick MI. Vasectomy and the risk of prostate cancer: a meta-analysis examining vasectomy status, age at vasectomy, and time since vasectomy. Prostate Cancer Prostatic Dis 2002; 5:193.
  77. Hiatt RA, Armstrong MA, Klatsky AL, Sidney S. Alcohol consumption, smoking, and other risk factors and prostate cancer in a large health plan cohort in California (United States). Cancer Causes Control 1994; 5:66.
  78. Siddiqui MM, Wilson KM, Epstein MM, et al. Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. J Clin Oncol 2014; 32:3033.
  79. Rohrmann S, Paltoo DN, Platz EA, et al. Association of vasectomy and prostate cancer among men in a Maryland cohort. Cancer Causes Control 2005; 16:1189.
  80. Cox B, Sneyd MJ, Paul C, et al. Vasectomy and risk of prostate cancer. JAMA 2002; 287:3110.
  81. Schwingl PJ, Meirik O, Kapp N, et al. Prostate cancer and vasectomy: a hospital-based case-control study in China, Nepal and the Republic of Korea. Contraception 2009; 79:363.
  82. Holt SK, Salinas CA, Stanford JL. Vasectomy and the risk of prostate cancer. J Urol 2008; 180:2565.
  83. Bhindi B, Wallis CJD, Nayan M, et al. The Association Between Vasectomy and Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Intern Med 2017; 177:1273.
  84. Jacobs EJ, Anderson RL, Stevens VL, et al. Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort. J Clin Oncol 2016.
  85. Møller H, Knudsen LB, Lynge E. Risk of testicular cancer after vasectomy: cohort study of over 73,000 men. BMJ 1994; 309:295.
  86. Hewitt G, Logan CJ, Curry RC. Does vasectomy cause testicular cancer? Br J Urol 1993; 71:607.
  87. Strader CH, Weiss NS, Daling JR. Vasectomy and the incidence of testicular cancer. Am J Epidemiol 1988; 128:56.
  88. Aitken RJ, Parslow JM, Hargreave TB, Hendry WF. Influence of antisperm antibodies on human sperm function. Br J Urol 1988; 62:367.
  89. Goldacre MJ, Wotton CJ, Seagroatt V, Yeates D. Immune-related disease before and after vasectomy: an epidemiological database study. Hum Reprod 2007; 22:1273.
  90. Kronmal RA, Krieger JN, Coxon V, et al. Vasectomy is associated with an increased risk for urolithiasis. Am J Kidney Dis 1997; 29:207.
  91. Kronmal RA, Alderman E, Krieger JN, et al. Vasectomy and urolithiasis. Lancet 1988; 1:22.
  92. Soebadi DM, Gardjito W, Mensink HJ. Intravasal injection of formed-in-place medical grade silicone rubber for vas occlusion. Int J Androl 1995; 18 Suppl 1:45.
  93. Mruk DD. New perspectives in non-hormonal male contraception. Trends Endocrinol Metab 2008; 19:57.
  94. Guha SK, Singh G, Ansari S, et al. Phase II clinical trial of a vas deferens injectable contraceptive for the male. Contraception 1997; 56:245.
  95. Chaki SP, Das HC, Misro MM. A short-term evaluation of semen and accessory sex gland function in phase III trial subjects receiving intravasal contraceptive RISUG. Contraception 2003; 67:73.