Vasectomy is one of the most reliable and cost-effective permanent methods of contraception. Despite its popularity, certain issues pertaining to the procedure remain unresolved. Appropriate selection of candidates for vasectomy requires thorough counseling and screening, though a foolproof method of eliminating dissatisfaction and regret remains a mystery. Debate continues over the relative merits of the various techniques of isolating and sealing the vasal ends. Postoperative complication rates remain minimal regardless of the technique used, and no single strategy attempting to maximize patient compliance with postoperative semen analysis has enjoyed unmitigated success. Long-term consequences, other than regret, are rare. Finally, issues regarding residency training in the procedure and its impact on procedure morbidity are scarcely addressed in the literature. This study reviews the evolution of vasectomy as a contraceptive procedure and attempts to summarize current literature addressing these unresolved issues.
Vasectomy is among the most reliable and cost-effective methods of contraception. Approximately 15% of the estimated 500,000 vasectomies are performed each year by family physicians in the United States. 1 A survey in 1998 by the American Association of Family Physicians suggested that 29.2% of family physicians offered vasectomy in their offices. Since the no-scalpel vasectomy (NSV) technique authored by Li was introduced to the United States in 1988, it has gained in popularity, and has been found superior to other conventional techniques, both in the ease of performance and in outcomes. 2,3 Other studies have shown no improvement, 4,5 however, suggesting that any technique performed by an experienced surgeon yields similar good results. NSV accounted for 29% of vasectomies in 1995, and 37% of physicians performing NSV taught themselves the procedure. 6
However, certain questions remain unresolved: selection of patients, techniques of managing the vasal ends, the need for postvasectomy semen analysis, matters relating to compliance of patients with semen analysis, relationship of vasectomy to the development of subsequent comorbidities, and whether resident physician training in this procedure has any impact on postoperative morbidity. The fact that the procedure is so widely performed and so permanent lends to unethical practices, with significant and permanent consequences. Hence, there is a need for informed consent from prospective patients. In this article, an effort will be made to describe the evolution of vasectomy as a contraceptive procedure; review some variations in technique; and assess issues associated with preoperative counseling, resident physician training in this procedure, postvasectomy care, and compliance with postprocedural instructions and follow-up and long-term consequences. A description of the procedure is deliberately avoided, as this is well covered in the general literature.