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

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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.

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About the authors

Aleksei I. Ryzhkov

Yaroslavl State Medical University; LLC «Mother and Child Yaroslavl»

Author for correspondence.
Email: 1129682@gmail.com
ORCID iD: 0000-0001-7919-9830
SPIN-code: 8699-2647

MD, Cand. Sci. (Med.), assistant professor of the Department of urology with nephrology, urologist

Russian Federation, Yaroslavl; Yaroslavl

Svetlana Yu. Sokolova

LLC «Mother and Child Yaroslavl»

Email: ntvbyfntnrf@mail.ru
ORCID iD: 0000-0002-3673-0713

urologist

Russian Federation, Yaroslavl

Igor S. Shormanov

Yaroslavl State Medical University

Email: i-s-shormanov@yandex.ru
ORCID iD: 0000-0002-2062-0421
SPIN-code: 7772-8420

Dr. Sci. (Med.), professor, head of the Department of Urology with Nephrology

Russian Federation, Yaroslavl

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2. Figure. Stages of a vasectomy: a — fixation of the vas deferens using the 3-finger technique; b — capture of the vas deferens by the annular duct; c — puncture of the skin over the vas deferens; d, e — isolation of the vas deferens from the surrounding tissues; f — resection of a fragment of the vas deferens, coagulation and ligation of the end vas deferens with performing fascial interposition; g — postoperative wounds

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