eMedicine Specialties > Clinical Procedures > Genitourinary Procedures

Vasectomy, No Scalpel

Author: M David Stockton, MD, MPH, Professor, Department of Family Medicine, University of Tennessee Graduate School of Medicine
Contributor Information and Disclosures

Updated: May 21, 2009

Introduction

Vasectomy is the most popular form of permanent surgical birth control for men. In 2002, an estimated 526,501 vasectomies were performed in the United States, which is a rate of 10.2/1,000 in men aged 25-49 years. The no-scalpel vasectomy (NSV), originally developed in China in 1974 and first introduced in the United States in 1984, is an innovative approach to exposing the vas deferens using 2 specialized surgical instruments.1 A recent Cochrane Review concluded that the NSV, as compared to traditional incisional technique, resulted in less bleeding, hematoma, infection, and pain, and a shorter operative time.2 According to one study, 37.8% of physicians, including urologists, family practitioners, and general surgeons, were using the NSV technique by 2002.3

Indications

  • Vasectomy is indicated for any fully informed man who does not want to father any children (or any additional children) and who desires an inexpensive outpatient method of voluntary permanent surgical sterilization.
  • Although less popular than other forms of sterilization, such as tubal ligation for the man’s sexual partner, the procedure offers the advantages of lower expense, lower level of invasiveness (ie, does not require general anesthesia or hospitalization), and quicker recovery time. Also, future checks of fertility are possible at any time with semen analysis, unlike with women who have undergone tubal ligation.

Contraindications

  • Contraindications to no-scalpel vasectomy (NSV) include the following:
    • Anatomic abnormalities, such as the inability to palpate and mobilize both vas deferens or large hydroceles or varicoceles
    • Past trauma and scarring of the scrotum
    • Acute local scrotal skin infections
  • Extreme care and consideration must be taken with patients who are taking anticoagulants or antiplatelet medications.
  • Provision and review of both written and verbal informed consent is paramount. Men and their spouses must understand that vasectomy should be considered a permanent sterilization procedure. Belief that reanastomosis microsurgery provides a good backup plan for fathering future children should be strongly discouraged.
  • Surgical complications, failure rates, alternative methods of birth control, and possible chronic postoperative pain should also be discussed, and all questions should be answered.
  • Emotional instability or equivocal feelings about permanent sterilization are contraindications to vasectomy.
  • Compliance with postoperative follow-up and postprocedure semen analysis is of utmost importance.

More on Vasectomy, No Scalpel

Overview: Vasectomy, No Scalpel
Treatment & Medication: Vasectomy, No Scalpel
Multimedia: Vasectomy, No Scalpel
References
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References

  1. Dhar NB, Bhatt A, Jones JS. Determining the success of vasectomy. BJU Int. Apr 2006;97(4):773-6. [Medline].

  2. Cook LA, Pun A, van Vliet H, Gallo MF, Lopez LM. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. Apr 18 2007;CD004112. [Medline].

  3. Davis LE, Stockton MD. Office procedures. No-scalpel vasectomy. Prim Care. Jun 1997;24(2):433-61. [Medline].

  4. Weiss RS. Re: White M, Maatman T. Comparative analysis of effectiveness of two local anesthetic techniques in men undergoing no-scalpel vasectomy. (Urology 2007;70:1187-1189). Urology. Aug 2008;72(2):462. [Medline].

  5. Thomas AA, Nguyen CT, Dhar NB, Sabanegh ES, Jones JS. Topical anesthesia with EMLA does not decrease pain during vasectomy. J Urol. Jul 2008;180(1):271-3. [Medline].

  6. Barone MA, Hutchinson PL, Johnson CH, Hsia J, Wheeler J. Vasectomy in the United States, 2002. J Urol. Jul 2006;176(1):232-6; discussion 236.

  7. Labrecque M, Nazerali H, Mondor M, Fortin V, Nasution M. Effectiveness and complications associated with 2 vasectomy occlusion techniques. J Urol. Dec 2002;168(6):2495-8; discussion 2498. [Medline].

  8. Barone MA, Irsula B, Chen-Mok M, Sokal DC,. Effectiveness of vasectomy using cautery. BMC Urol. Jul 19 2004;4:10. [Medline].

  9. Sokal D, Irsula B, Chen-Mok M, Labrecque M, Barone MA. A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition. BMC Urol. Oct 27 2004;4(1):12. [Medline].

  10. Denniston GC, Kuehl L. Open-ended vasectomy: approaching the ideal technique. J Am Board Fam Pract. Jul-Aug 1994;7(4):285-7. [Medline].

  11. 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. Nov 1999;162(5):1621-5. [Medline].

  12. Li SQ, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol. Feb 1991;145(2):341-4. [Medline].

  13. Cook LA, Pun A, van Vliet H, Gallo MF, Lopez LM. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. 2006;(4):CD004112. [Medline].

  14. Peterson HB. Sterilization. Obstet Gynecol. Jan 2008;111(1):189-203. [Medline].

  15. McConaghy P, Paxton LD, Loughlin V. Chronic testicular pain following vasectomy. Br J Urol. Feb 1996;77(2):328. [Medline].

  16. Cox B, Sneyd MJ, Paul C, Delahunt B, Skegg DC. Vasectomy and risk of prostate cancer. JAMA. Jun 19 2002;287(23):3110-5. [Medline].

  17. Dassow P, Bennett JM. Vasectomy: an update. Am Fam Physician. Dec 15 2006;74(12):2069-74. [Medline].

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Further Reading

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Keywords

vasectomy, vasectomies, no scalpel vasectomy, after vasectomy, semen analysis, open-ended, azoospermia, sterilization, birth control, male sterilization, vas deferens, deferentectomy, permanent sterilization, noninvasive vasectomy, NSV, non-incisional vasectomy, sharp dissecting forceps, vas fixation, ring forceps

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Contributor Information and Disclosures

Author

M David Stockton, MD, MPH, Professor, Department of Family Medicine, University of Tennessee Graduate School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Luis M Lovato, MD, Associate Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

 
 
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