Tuesday, November 11, 2014

AUA Vasectomy Guidelines: Part 1

  • The minimum and necessary concepts that should be discussed in a preoperative vasectomy consultation 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 analysis (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.
    • Patients should refrain from ejaculation for approximately one week after vasectomy.
    • Options for fertility after vasectomy include vasectomy reversal and sperm retrieval withfertilization.  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.