Vasectomy failure using an open-ended technique

Abstract

An open-ended vasectomy technique that involved purposeful creation of a sperm granuloma on the testicular side of the vas was used in 4 patients as a possible contribution to easier reversal, since animal and human studies suggest that such a granuloma prevents pressure-induced epididymal damage and favors maintenance of normal spermatogenesis. The 4 vasectomies were performed at an outpatient clinic using local anesthesia. Through transverse high scrotal incisions, .5 cm segments of vas were removed, and the abdominal side lumina were cauterized to a depth of .5 cm. The testicular side was neither cauterized nor ligated. No complications occurred in any patient, and all wounds healed normally. Examination of semen specimens 15 ejaculations after vasectomy revealed azoospermia in 2 men and active motile sperm in 2 others. Repeat semen analyses on the 2 men up to 5 months after vasectomy revealed persistence of motile spermatozoa. Repeat vasectomies were preformed, at which time sperm granulomas .5 cm in diameter were excised, and both vas lumina were cauterized, resulting in azoospermia on later semen analysis. The failure rate of 50% with the open-ended technique is clearly unacceptable. Cauterizing or removing a longer length of vas and transposition of the open testicular end to a separate fascial plane might reduce failure rates to acceptable levels, but until this is proven in large-scale studies, vasectomy should be presented as a permanent operation.