Vasectomy

Publication Date: December 1, 2012
Last Updated: March 14, 2022

Preoperative Practice

A preoperative interactive consultation should be conducted, preferably in person. If an in-person consultation is not possible, then preoperative consultation by telephone or electronic communication is an acceptable alternative. (Clinical Principle / Expert Opinion, )
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The minimum and necessary concepts that should be discussed in a preoperative vasectomy consultation include the following:
• Vasectomy is intended to be a permanent form of contraception.
• Vasectomy does not produce immediate sterility.
• Following vasectomy, another form of contraception is required until vas occlusion is confirmed by post- vasectomy semen analysis (PVSA).
• Even after vas occlusion is confirmed, vasectomy is not 100% reliable in preventing pregnancy.
• The risk of pregnancy after vasectomy is approximately 1 in 2,000 for men who have post-vasectomy azoospermia or PVSA showing rare non-motile sperm (RNMS).
• Repeat vasectomy is necessary in ≤1% of vasectomies, provided that a technique for vas occlusion known to have a low occlusive failure rate has been used.
• Patients should refrain from ejaculation for approximately one week after vasectomy.
• Options for fertility after vasectomy include vasectomy reversal and sperm retrieval with in vitro fertilization. These options are not always successful, and they may be expensive.
• The rates of surgical complications such as symptomatic hematoma and infection are 1–2%. These rates vary with the surgeon's experience and the criteria used to diagnose these conditions.
• Chronic scrotal pain associated with negative impact on quality of life occurs after vasectomy in about 1–2% of men. Few of these men require additional surgery.
• Other permanent and non-permanent alternatives to vasectomy are available.
(Clinical Principle / Expert Opinion, )
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Clinicians do not need to routinely discuss prostate cancer, coronary heart disease, stroke, hypertension, dementia or testicular cancer in pre-vasectomy counseling of patients because vasectomy is not a risk factor for these conditions. (Standard, B)
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Prophylactic antimicrobials are not indicated for routine vasectomy unless the patient presents a high risk of infection. (Recommendation, C)
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Anesthesia for Vasectomy

Vasectomy should be performed with local anesthesia with or without oral sedation. If the patient declines local anesthesia or if the surgeon believes that local anesthesia with or without oral sedation will not be adequate for a particular patient, then vasectomy may be performed with intravenous sedation or general anesthesia. (Clinical Principle / Expert Opinion, )
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Vas Isolation

Isolation of the vas should be performed using a minimally-invasive vasectomy (MIV) technique such as the no-scalpel vasectomy (NSV) technique or other MIV technique. (Standard, B)
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Vas Occlusion

The ends of the vas should be occluded by one of three divisional methods:
  1. Mucosal cautery (MC) with fascial interposition (FI) and without ligatures or clips applied on the vas;
  2. MC without FI and without ligatures or clips applied on the vas;
  3. Open ended vasectomy leaving the testicular end of the vas unoccluded, using MC on the abdominal end and FI
OR by the non-divisional method of extended electrocautery. (Recommendation, C)
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Non-Divisional Vasectomy with Extended Electrocautery (Marie Stopes International Electrocautery Technique)

The divided vas may be occluded by ligatures or clips applied to the ends of the vas, with or without FI, and with or without excision of a short segment of the vas, by surgeons whose personal training and/or experience enable them to consistently obtain satisfactory results with such methods. (Option, C)
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Routine histologic examination of the excised vas segments is not required. (Clinical Principle / Expert Opinion, )
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Postoperative Practice

Men or their partners should use other contraceptive methods until vasectomy success is confirmed by PVSA. (Clinical Principle / Expert Opinion, )
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To evaluate sperm motility, a fresh uncentrifuged semen sample should be examined within two hours after ejaculation. (Clinical Principle / Expert Opinion, )
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Patients may stop using other methods of contraception when examination of one well-mixed, uncentrifuged, fresh post-vasectomy semen specimen shows azoospermia or only rare non-motile sperm (RNMS or ≤100,000 non-motile sperm/mL). (Recommendation, C)
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Eight to sixteen weeks after vasectomy is the appropriate time range for the first PVSA. The choice of time to do the first PVSA should be left to the judgment of the surgeon. (Option, C)
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Vasectomy should be considered a failure if any motile sperm are seen on PVSA at six months after vasectomy, in which case repeat vasectomy should be considered. (Clinical Principle / Expert Opinion, )
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If >100,000 non-motile sperm/mL persist beyond six months after vasectomy, then trends of serial PVSAs and clinical judgment should be used to decide whether the vasectomy is a failure and whether repeat vasectomy should be considered. (Clinical Principle / Expert Opinion, )
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Recommendation Grading

Overview

Title

Vasectomy

Authoring Organization

American Urological Association

Publication Month/Year

December 1, 2012

Last Updated Month/Year

January 8, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide guidance to clinicians who offer vasectomy services.

Inclusion Criteria

Male, Adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Counseling, Management, Treatment

Diseases/Conditions (MeSH)

D003275 - Contraceptive Devices, Male

Keywords

Sterilization, vasectomy, male contraception