Chapter 144 - Vasectomy

Summary

Vasectomy is an extremely common, cost-effective, and permanent form of contraception dating back to the late 1800s. Presently, in the USA, approximately 500,000 vasectomies are performed annually. An approximated 11% of the USA population uses vasectomy as their means of contraception, making it the most commonly performed urologic procedure in the USA.

In comparison with other methods, vasectomy has been estimated to produce a 5-year saving of nearly $14,000. Contraception saves the USA $19 billion a year in medical costs. The three most cost-effective forms of contraception when comparing all types are the copper-T IUD, vasectomy, and the LNG-20 IUS.

Couples often come to a personal decision on contraception, and therefore must choose from various options. Urologists can educate patients regarding vasectomy as a safe, costeffective, permanent form of contraception.

The initial office visit of a patient seeking a vasectomy should begin with a complete history/physical and specific questions regarding the patient’s reasons for seeking a vasectomy. Questions to the patient should include: if discussion about vasectomy has occurred with the partner; how many children they have, and if they know anyone else who has had a vasectomy. Other pertinent questions should include family history of bleeding disorders, patient use of antiplatelet or anticoagulant medications, and any past history of surgery/ trauma to the testis or inguinal canal (i.e., hernia). The exam, while complete, should focus on palpation of both vasa deferentia. The feasibility of performing the vasectomy procedure is based on the patient’s anatomy. Complications to be discussed include epididymitis, recanalization, chronic orchialgia, and anti-sperm antibodies.