No-scalpel vasectomy — a new approach to male surgical contraception: a single center experience

Abstract

BACKGROUND: No-scalpel vasectomy is a modern approach to performing vasectomy, in which access to the vas deferens is achieved through a puncture of the scrotum. AIM: To analyze of own experience in the use of no-scalpel vasectomy. MATERIALS AND METHODS: During the period from April 2017 to December 2022, 32 men underwent non-scalpel vasectomy at the Mother and Child Clinic Yaroslavl. Three operations were performed under intravenous anesthesia, 29 under local anesthesia. Occlusion of the vas deferens was achieved by excision of the fragment, coagulation of the lumen, ligation of the ends of the duct and fascial interposition. RESULTS: The average age of the patients was 39 years (range 35 to 62 years). All patients were married. The mean number of children in patients undergoing vasectomy was 2.3 ± 0.4. In all cases, the reason for performing a vasectomy was cited by patients as dissatisfaction with other methods of contraception. The average operation time was 19.0 ± 4.0 minutes. The average size of the scrotal skin puncture was 9.3 ± 1.3 mm (range 7 to 11 mm). The severity of pain during surgery, as assessed on a visual analogue scale (VAS), varied from 1 to 3 points, with an average of 2.3 ± 0.5 points. In the postoperative period, one patient developed acute epididymitis (3.1%), and one patient (3.1%) developed a small hematoma (up to 1 cm) in the area of the surgical wound. A week after surgery, 15 patients (46.8%) reported the presence of pain with a visual analogue scale score of 1 to 3 points, with an average of 2.2 ± 0.7 points. One month after the operation, no pain was noted in any patient. The results of the study of the ejaculate 3 months after the operation showed the presence of azoospermia in 27 (84.4%) patients and the presence of single immobile spermatozoa (less than 100,000/ml) in 5 (15.6%) patients, which allowed us to state 100% occlusive effectiveness of vasectomy. CONCLUSIONS: No-scalpel vasectomy is a less traumatic and safe method of male surgical contraception. The operation under local anesthesia is associated with minimal discomfort for the patient. Maximum success rates can be achieved using the technique of vas deferens occlusion through excision of the fragment, coagulation of the lumen, ligation of the ends of the duct, and fascial interposition.