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The Impact of “Open” vs. “Closed” Vasectomy Technique on Rates of Azoospermia at First Post-Vasectomy Semen Analysis
Scott D. Matson, MD1, Sonam Saxena, BS
2, Daniel Nolte, MS
3, Stacey A. Kenfield, ScD
4, Julie Gonzales, HS
3, David Shin, MD
2, James F. Smith, MD
4.
1St. Francis Hospital and Medical Center, Hartford, CT, USA,
2Hackensack University Medical Center, Hackensack, NJ, USA,
3Fellow Health, San Leandro, CA, USA,
4Dept of Urology, UCSF, San Francisco, CA, USA.
Background: The impact of “open” vs. “closed” vasectomy technique is unclear in terms of the rates of sperm granuloma formation, epididymal congestion, and post-vasectomy semen analysis clearance (PVSA). This study examines the rates of azoospermia at first PVSA for no-needle, no-scalpel vasectomy using thermal abdominal end thermal cautery with fascial interposition and with either thermal cautery (closed) or without thermal cautery (open) technique used on the testicular end.
Methods: The surgeon in this study changed surgical technique in February 2023. This IRB-approved, prospective cohort study examines PVSA data collected on all patients using the Fellow PVSA kit before and after the change in technique. Age, ejaculatory frequency, vasectomy technique, and waiting time from vasectomy were key covariates. Vasectomy clearance was defined as azoospermia on the first PVSA sample.
Results: All patients obtaining a vasectomy from May 2022 through December 2024 (n=1,335) were included. In this cohort, 542 consecutive patients using the closed-ended technique and 793 consecutive patients using the “open” ended technique. Overall, 92.7% of men were cleared at their first PVSA. Men undergoing the closed technique were significantly more likely to be cleared at the first PVSA compared to the open approach (95.8% vs. 90.5%, p < 0.001). Older age, higher ejaculation frequency, and longer waiting time were also significantly associated with clearance (p <0.01).The odds of PVSA clearance is 59.5% [95% CI: 24.2-65.3%] lower for those undergoing the open procedure compared to the closed procedure, after controlling for waiting time and age.
Conclusion: It appears that closed-ended vasectomy results in significantly higher chance of clearance in the first PVSA as compared to the same technique using thermal cautery open-ended vasectomy. It would be useful to compare rates of vasectomy failure in these two cohorts of patients in a future study.
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