Most Vasectomies Are Performed in Urology Practices by Physicians Using Ligation and Local Anesthesia

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AVSC International and the US Centers for Disease Control and Prevention conducted a survey of physician practices in urology (702) general surgery (660) and family medicine (323) throughout the US to examine vasectomy practices. In 1991 the vasectomy rate was 10.3 vasectomies/1000 men with the midwest having the highest vasectomy rate (14.5/1000). Urologists performed most vasectomies (72%) followed by family physicians (15%) and general surgeons (13%). Among the 702 urology practices 94% performed vasectomies. 29% of general surgery practices and 18% of family practice physicians performed them. In 43% of urology practices more than 50 vasectomies per year were conducted. The mean number of vasectomies in urology and family practices was greatest in the midwest (113 and 26 respectively). The mean number of vasectomies in general surgery practices was greatest in the northeast and the west (26 each). Physicians offices were the most common setting for the procedure (77%) followed by outpatient hospital clinics (19%) and family planning clinics free-standing surgical centers and health maintenance organizations (4%). Regardless of physician type physicians tended to perform vasectomies in their office. They used local anesthesia for 99% of all vasectomies (76% local anesthesia alone or 23% with sedation). General anesthesia was practiced more often in general surgery practices (5% vs. 1% for urology practices and 0 for family practice practices). No practice in the west used general anesthesia. Vas ligation was the most frequent method of performing the vasectomy (39% alone and 22% with cautery). Cautery alone comprised 20% of vasectomies. Clips were used for only 11% of vasectomies. Yet urology textbooks advise cautery or clips over vas ligation. These findings indicate a need for case control studies to examine the effectiveness of ligation in comparison with other vas occlusion methods.