No-Scalpel Vasectomy
In the United States, vasectomy is the most common urologic procedure with an estimated 500,000 performed each year. Typically done in an office or procedure room setting, it is a quick, inexpensive, and highly effective method of permanent contraception.
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No-Scalpel Vasectomy Kelly A. Chiles and Marc Goldstein
Introduction Vasectomy is the procedure most commonly performed by urologists in the United States and is quick, inexpensive, and highly effective.1,2 While multiple methods for performing a vasectomy exist, the no-scalpel vasectomy (NSV) has emerged as the gold standard for vasectomy approach.3 A recent review of NSV versus standard incisional vasectomy demonstrated less bleeding, hematoma, infection, intraoperative pain, and a shorter operative time.4
Indications Men who desire permanent surgical sterilization are candidates for the no-scalpel vasectomy. 1 Eisenberg M, Lipshultz L. Re: estimating the number of vasectomies performed annually in the united states: data from the national survey of family growth. J Urol. 2011;185(4):1541–2. 2 Rogers MD, Kolettis PN. Vasectomy. Urol Clin North Am. 2013;40:559–68. 3 Li PS, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol. 1991;145:341–4. 4 Cook LA, Pun A, Gallo MF, Lopez LM, Van Vliet HA. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. 2014;3:CD004112.
K.A. Chiles, MD, MSc (*) George Washington University, Washington, DC 20037, USA e-mail: [email protected] M. Goldstein, MD, DSc (Hon.), FACS Cornell Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 J.P. Mulhall, L.C. Jenkins (eds.), Atlas of Office Based Andrology Procedures, DOI 10.1007/978-3-319-42178-0_8
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K.A. Chiles and M. Goldstein
Procedural Considerations The majority of vasectomies are performed in an office or clinic procedure room setting under local anesthesia and is well tolerated. It is important to identify men who have a scarred or tight scrotum with high-riding testes in whom the vasa are difficult to palpate. In these cases, or in men who are very anxious, vasectomy performed in the operating room under sedation (MAC) is recommended. Both vasa should be easily palpable within the spermatic cords. Congenital unilateral absence of the vas occurs in 1/1000 men and should be diagnosed preoperatively. If there is any uncertainty about the presence of a vas, it is recommended that the vasectomy be performed in the operating room under MAC. If vasectomy is being performed at the same time as a microsurgical varicocele repair, the vasal veins and artery should be preserved since the only venous outflow after varicocelectomy are the vasal veins. Therefore, when performing simultaneous vasectomy or vasal reconstruction and microsurgical varicocelectomy, the operating microscope is utilized to assure preservation of the deferential veins and arteries.5,6
Complications The most disturbing complication of vasectomy is primary failure of the procedure or vasal recanalization, resulting in an unplanned pregnancy. Fortunately, with appropriate follow-up semen analyses, primary failure can easily be
