Procedural standards as modified from the American Urological Association Vasectomy Guidelines.
- A preoperative interactive consultation should be conducted or
- A preoperative consultation by telephone or
- Provision of information electronically.
The minimum and necessary concepts that should be covered 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 anaesthesia (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.
- 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.
Vasectomists do not need to routinely discuss prostate cancer,
coronary heart disease, stroke, hypertension, dementia or testicular cancer in pre-vasectomy counselling of patients because vasectomy is not a risk factor for these conditions.
Prophylactic antimicrobials are not indicated for routine vasectomy unless the patient presents a high risk of infection.
Vasectomy should be performed with local anaesthesia. If the patient declines local anaesthesia or if the surgeon believes that local anaesthesia with or without oral sedation will not be adequate for a particular patient, then vasectomy may be performed with intravenous sedation or general anaesthesia in exceptional cases only.
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.
The ends of the vas should be occluded by one of three divisional methods:
- Mucosal cautery (MC) with fascial interposition (FI) and without ligatures or clips applied on the vas;
- MC without FI and without ligatures or clips applied on the vas;
- Open ended vasectomy leaving the testicular end of the vas unoccluded, using MC on the abdominal end and FI.
In exceptional cases only 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.
Routine histologic examination of the excised vas segments is not required.
Men or their partners should use other contraceptive methods until vasectomy success is confirmed by PVSA.
To evaluate sperm motility, a fresh, uncentrifuged semen sample should be examined within two hours after ejaculation.
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) or otherwise follow the ASERNIP Guidelines
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.
Vasectomy should be considered a failure if any motile sperm are seen on any PVSA at six months after vasectomy, in which case repeat vasectomy should be considered.
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 or otherwise follow the ASERNIP Guidelines.