Guideline sources The following summarized guidelines for the management of vasectomy are prepared by our editorial team based on guidelines from the American Urological Association (AUA/ASRM 2021), the Canadian Urological Association (CUA 2016), the American Urological Association (AUA 2012), and the European Association of Urology (EAU 2012). 1 2 3 4 Guidelines 1. Perioperative care Antimicrobial prophylaxis: avoid administering antimicrobial prophylaxis for routine vasectomy unless the patient presents a high risk of infection. D 2. Surgical interventions Contraindications: Recognize the possible relative contraindications to vasectomy: age of < 30 years not having children no current relationship scrotal pain severe illness. B Anesthesia: Perform vasectomy with local anesthesia with or without oral sedation. E https://web.pathway.md/diseases/recvRTzzy0xBuMYaz 1/3 6/29/23, 3:24 AM Vasectomy Pathway Consider performing vasectomy with IV sedation or under general anesthesia if the patient declines local anesthesia or if the surgeon believes that local anesthesia with or without oral sedation will not be adequate for a particular patient. E Surgical technique: As per CUA 2016 guidelines, recognize that no-scalpel vasectomy is associated with a significantly lower risk of postoperative complications (hematoma, pain, infection) than conventional vasectomy. A Show 2 more As per AUA 2012 guidelines, isolate the vas by a minimally-invasive vasectomy technique, such as the no-scalpel vasectomy technique or other minimally-invasive techniques. B Show 3 more As per EAU 2012 guidelines: Consider decreasing the rates of early recanalization by cautery of the vas deferens, with either thermal or electrocautery devices, and by fascial interposition. B Recognize that no vasectomy technique has been shown to be superior in terms of prevention of late recanalization and spontaneous pregnancy after vasectomy. B 3. Patient education Preoperative counseling: As per AUA 2012 guidelines, conduct a preoperative interactive consultation, preferably in- person. Conduct a preoperative consultation by telephone or electronic communication if in- person arrangement is not possible. E Show 2 more As per EAU 2012 guidelines: Counsel patients before vasectomy about alternative methods of contraception, complication and failure rates, and the need for postoperative SA. B Obtain a written informed consent before vasectomy. B Postoperative counseling: Advise patients and their partners using other methods of contraception until vasectomy success is confirmed by post-vasectomy SA. B Advise stopping other methods of contraception when examination of one well-mixed, uncentrifuged, fresh post-vasectomy semen specimen shows azoospermia or only rare non- motile sperm ( 100,000 non-motile sperm/mL). B 4. Follow-up and surveillance Post-vasectomy semen analysis: As per CUA 2016 guidelines, obtain post-vasectomy SA 3 months after vasectomy. B Show 3 more As per AUA 2012 guidelines, obtain the first post-vasectomy SA 8-16 weeks after vasectomy. B https://web.pathway.md/diseases/recvRTzzy0xBuMYaz 2/3 6/29/23, 3:24 AM Vasectomy Pathway Show 2 more As per EAU 2012 guidelines, obtain post-vasectomy SA to confirm clearance by observing azoospermia B or < 100,000 non-motile sperm/mL in the ejaculate. B Patients with vasectomy failure: Consider performing repeated vasectomy in patients with observed motile sperm on post- vasectomy SA at 6 months after vasectomy. E Obtain serial post-vasectomy SA in patients with > 100,000 non-motile sperm/mL persisting > 6 months after vasectomy and use clinical judgment to decide whether the vasectomy is a failure and whether to consider performing repeated vasectomy. E Conception after vasectomy: offer surgical reconstruction with or without simultaneous surgical sperm retrieval for cryopreservation in couples desiring conception after vasectomy. B References 1. Sharlip ID, Belker AM, Honig S et al. Vasectomy: AUA guideline. J Urol. 2012 Dec;188 6 Suppl):2482 91. Open 2. Gert R Dohle, Thorsten Diemer, Zsolt Kopa et al. European Association of Urology guidelines on vasectomy. Eur Urol. 2012 Jan;61 1 159 63. Open 3. Armand Zini, John Grantmyre, Peter Chan. CUA guideline: Vasectomy. Can Urol Assoc J. 2016 Aug;10 7 8 E274 E278. Open 4. Peter N Schlegel, Mark Sigman, Barbara Collura et al. Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline PART II. J Urol. 2021 Jan;205 1 44 51. Open https://web.pathway.md/diseases/recvRTzzy0xBuMYaz 3/3