Effectiveness of Vasectomy Techniques
Section snippets
Definition and measurement of vasectomy outcomes
Vasectomy effectiveness may be defined by the absence or occurrence of pregnancy (contraceptive effectiveness) or by the results of semen analyses (occlusive effectiveness).
Effectiveness of vasectomy occlusion techniques
Many vasectomy occlusion techniques have been developed over the years, and these techniques continue to evolve (see the articles by Sheynkin and by Art and Nangia elsewhere in this issue). The authors have reviewed the effectiveness of the vas occlusion techniques that are most commonly used in the United States.10
Most physicians use a combination of these techniques (some investigators do not classify the last four techniques as methods of vas occlusion):
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Ligation
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Cautery (intraluminal)
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Clips
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Summary and recommendations
In the United States and other high-resource settings, there seem to be fewer vasectomy failures and fewer postvasectomy pregnancies than in low-resource settings. This is probably due mainly to differences in vas occlusion methods and subsequent recanalizations.
Given the number of vasectomy procedures performed annually around the world, there is surprisingly little high-quality evidence on the relative effectiveness of various techniques for vas occlusion. Nonetheless, taking into account the
Acknowledgments
The authors thank their many colleagues and coauthors at FHI, EngenderHealth, and around the world who contributed to the studies reviewed in this article. Also, thanks to Kerry Aradhya for editorial assistance.
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Cited by (28)
Survey on vasectomy practices in France in 2022
2024, French Journal of UrologyRisk of vasectomy failure by ligation and excision with fascial interposition: A prospective descriptive study
2020, ContraceptionCitation Excerpt :Most recent clinical practice guidelines from United States of America [3], United Kingdom [21], Europe [22], and Canada [23] recommend that cautery of the mucosa of the vas lumen, preferably combined with interposing the fascia between the divided ends of the vas should be used to occlude the vas. Combining mucosal cauterization of the vas deferens with fascial interposition results in the lowest risk of occlusive failure (well below 1 % based on post-vasectomy semen analysis) [4,18,19]. This technique has been successfully integrated into vasectomy programs in Rwanda [24], Haiti, Kenya, and, more recently, in Colombia after we made the results of our study available locally [12].
Who chooses vasectomy in Rwanda? Survey data from couples who chose vasectomy, 2010-2012
2014, ContraceptionCitation Excerpt :In 2010, the Rwanda Ministry of Health, with technical assistance from FHI 360, took initial steps to reverse this trend by training three Rwandan physicians to become master vasectomy trainers in NSV with thermal cautery (TC) and fascial interposition (FI) on the prostatic end [14]. This method is now considered the most effective technique for vasectomy [15,16]. These master trainers, in turn, trained 64 physicians and 103 nurses in every district of Rwanda during the period of November 2010 to January 2012 [14].
Strengthening vasectomy services in Rwanda: Introduction of thermal cautery with fascial interposition
2013, ContraceptionCitation Excerpt :The most common vas occlusion method, ligation and excision (LE), consists of putting two ligatures on the vas and excising a small segment between the ligatures [4]. Recent and robust studies show that this technique is associated with a high risk of occlusive failure based on semen analysis results (8% to 13%), even when combined with fascial interposition (FI) (6%) [3]. The risk of contraceptive failure is also unacceptably high with simple LE, varying between 4% and 9% after three to 10 years, as reported in Asian countries [4].
Vasectomy Surgical Techniques in 2022
2023, Medecine de la Reproduction
This work was partially supported by Family Health International (FHI) with funds from the US Agency for International Development (USAID), Cooperative Agreement GPO-A-00-05-00022-00 (Sokal), and the Fonds de la recherche en santé du Québec (Labrecque). The views expressed in this article are those of the authors and do not necessarily reflect those of FHI, USAID, or Laval University.