Risks and Complications of Vasectomy
Section snippets
Hematoma formation
The most common immediate complication of vasectomy is hematoma formation. Scrotal hematoma is aesthetically displeasing and painful during the postoperative course. The incidence of scrotal hematoma after vasectomy is low. The accepted overall incidence for hematoma formation is 2% (range, 0.09%–29%).6 According to a national survey of vasectomy providers, the incidence of scrotal hematoma is directly related to the number of vasectomies completed by a physician annually and was reported to be
Vasectomy failure
The failure to achieve or maintain sterilization is one of the most devastating risks of vasectomy. In general, vasectomy failure is defined by the presence of sperm in the ejaculate after the procedure, but the actual definitions vary in terms of sperm numbersand time after vasectomy. For example, although some investigators define vasectomy failure as more than 10 million sperm/L at 12 weeks or later, others define it as more than 5 million motile sperm/mL at 14 weeks or later or more than
Postvasectomy pain
Short-term pain is to be expected after vasectomy. Approximately 30% of patients report some type of pain even 2 to 3 weeks after surgery.21 Long-term pain requiring more aggressive medical or surgical intervention, however, is expected in 1 out 1000 men who undergo a vasectomy.2 Congestive epididymitis and chronic orchalgia are uncommon postvasectomy complications. They comprise a chronic pain syndrome often recognized as postvasectomy pain syndrome (PVPS).22 Congestive epididymitis is a rare
Sperm granuloma
Sperm granulomas are inflammatory reactions that occur in response to extravasated sperm. They have been identified in 15% to 40% of specimens obtained during vasectomy reversals.35 A majority of the sperm granulomas remain asymptomatic. A small subset (2%–3%) of vasectomy patients has pain that can be attributed to sperm granuloma, usually occurring 2 to 3 weeks postoperatively.3 Vasitis nodosa is another complication of vasectomy that is closely related to sperm granulomas. This condition is
Infection
Infection after vasectomy is a recognized complication affecting approximately 3.5% of patients. Much variation exists, especially between no-scalpel versus traditional incisional technique. One randomized controlled study reported a 0.2% infection rate with no-scalpel technique versus 1.5% for standard incisional vasectomy.7 Another study showed infection rates of no-scalpel versus incisional vasectomy techniques as 7.1% and 11.4%, respectively.8 Most infections are limited and treated with a
Immunologic effects of vasectomy
Another common consequence of vasectomy is the development of antisperm antibodies. Vasectomy may cause sperm antigens to be exposed to the immune system, resulting in an antisperm autoantibody response.38, 39 In a recent study, 240 of 272 (88%) men who had a history of prior vasectomy were found to possess serum antisperm antibodies.40 Many studies have addressed the relationship between immune-complex diseases and antisperm autoantibodies. Massey and colleagues1 followed 10,590 men with
Summary
Urologists will remain an important provider of sterilization for undesired fertility. Vasectomy is a safe and effective procedure for permanent contraception and is an important component of urologic practice. Compared with its gynecologic counterpart, vasectomy is 30 times less likely to fail and 20 times less likely to have postoperative complications. Complications from vasectomy, fortunately, are rare, and mostly minor in nature. Immediate risks include infection, hematoma, and pain.
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