Effectiveness and Complications of Vasectomy With Fascial Interposition Without Mucosal Cautery: A Retrospective Cohort Study.

Abstract

Purpose: Combining fascial interposition and mucosal cautery while leaving the testicular end open (open-ended vasectomy) is an effective and recommended vasectomy occlusion technique. We compared the effectiveness and complication risks of this technique to performing fascial interposition alone without any mucosal cautery (double open-ended).

Materials and methods: We conducted a retrospective cohort study with historical and concomitant controls using the electronic records of 5894 vasectomy patients at a private clinic in Vancouver, Canada. Two surgeons performed no-scalpel vasectomies using fascial interposition with a chromic gut suture and needle. The control group received mucosal cautery of the abdominal segment and fascial interposition covering the abdominal end, whereas the intervention group underwent fascial interposition only without any mucosal cautery. Occlusive effectiveness was assessed using the AUA postvasectomy semen analysis criteria. Complications were defined as in-person visits because of vasectomy-related concerns.

Results: Occlusion success in patients with at least 1 postvasectomy semen analysis was similar: 98.6% (2092/2122) with and 98.7% (1754/1777) without cautery (risk difference 0.1%, 95% confidence interval [CI] -0.7% to 0.9%, P = .8). There was no significant difference in overall occlusive failure between the cautery (0.8%) and no cautery (0.4%) groups (adjusted relative risk [RR_adj] 0.52, 95% CI 0.20-1.22, P = .2). Complication risks were comparable: 5.3% (182/3462) with cautery and 5.2% (127/2432) without cautery (RR_adj 0.95, 95% CI 0.76-1.19, P = .7).

Conclusions: Fascial interposition with suture and needle covering the abdominal end without mucosal cautery (double open-ended) is an effective and safe vasectomy occlusion technique.