Effectiveness of vasectomy

Around 42 million couples worldwide rely on vasectomy as a method of family-planning.

Every year 800,000 vasectomies are performed in the US.

Recanalisation: 0.5% of all vasectomies (is defined as the presence of any spermatozoa after one or more previously azoospermic samples were properly collected and documented).

Why are doctors sued following vasectomy?

  1. Failure to be sterile (unwanted pregnancy)
  2. Failure to inform regarding positive semen sample post-operatively
  3. Hematoma/infection
  4. Chronic testicular pain
  5. Atrophy or loss of testicular volume

Vasectomy Failure

Can be due to technical errors, recanalization, or unprotected intercourse before azoospermia is documented

  1. Intraluminal needle cautery (vas not transected, no segment removed): Less than 1%
  2. Cautery both ends and fascial interruption: 1.2 % or less
  3. Cautery (prostatic end) only and fascial interruption (clip): 0.02 to 2.4%
  4. Cautery of both ends and excision of a segment: 4.8% or less
  5. Ligation and fascial interruption: 16.7% or less
  6. Ligation and excision of segment: 1.5 to 29%

To confirm sterility: Obtain a semen analysis 3 months on the postop period; the patient should have had at least 20 ejaculates since the time of vasectomy. Azoospermia in a semen sample is definitive evidence of infertility.

Sokal DC, Labrecque M. Effectiveness of Vasectomy Techniques. Urol Clin N Am 36 (2009) 317–329.