Borrell Joseph A, Gu Catherine, Ye Nancy, Mills Jesse N, Andino Juan J
David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Int J Impot Res. 2025 Jan 31. doi: 10.1038/s41443-025-01018-5.
Vasectomies are safe and effective, achieving up to 99.7% in sterilization, with complication rates around 1-2%. As vasectomy uptake rises, physicians should stay informed about counseling, isolation and occlusion techniques, post-op recovery, and associated risks and complications. Historically, pre-vasectomy counseling has been performed in-person, but recent literature has shown that telehealth is a viable alternative, and a physical exam may not be necessitated. With regard to vas isolation and occlusion, current international guidelines support a minimally invasive approach such as no-scalpel vasectomy with mucosal cautery and fascial interposition, as they are the most effective in achieving vasectomy success and have the lowest complication rates. After a vasectomy, patients should undergo a post-vasectomy semen analysis 8-16 weeks after the procedure to ensure severe non-motile oligozoospermia (≤100,000 non-motile sperm/mL) or azoospermia. While risks and complications from vas isolation and occlusion are rare, patients should be informed about the potential for hematomas, infections, postoperative pain, and vas recanalization. In the U.S, vasectomies have increased in utilization from previous years, likely in the setting of increased access to telehealth and restricted female reproductive access. This trend raises questions about future fertility options such as vasectomy reversals and highlights the need for informed decision-making.
输精管切除术安全有效，绝育成功率高达99.7%，并发症发生率约为1%-2%。随着输精管切除术的接受率上升，医生应了解咨询、输精管分离和闭塞技术、术后恢复以及相关风险和并发症。从历史上看，输精管切除术前咨询是面对面进行的，但最近的文献表明，远程医疗是一种可行的替代方式，可能不需要进行体格检查。关于输精管分离和闭塞，目前的国际指南支持采用微创方法，如无手术刀输精管切除术加黏膜烧灼和筋膜插入，因为它们在输精管切除术中成功率最高，并发症发生率最低。输精管切除术后，患者应在术后8-16周进行精液分析，以确保出现严重的无活动力少精子症（≤100,000个无活动力精子/毫升）或无精子症。虽然输精管分离和闭塞的风险和并发症很少见，但应告知患者有发生血肿、感染、术后疼痛和输精管再通的可能性。在美国，输精管切除术的使用率比前几年有所增加，这可能是由于远程医疗的可及性增加以及女性生殖途径受限。这一趋势引发了关于未来生育选择（如输精管复通术）的问题，并凸显了知情决策的必要性。
