Advantages of the No-Scalpel Vasectomy Technique

(Strength of Recommendation: A, based on systematic reviews, mixed-quality randomized controlled trials [RCTs], cohort studies, and case-control series.) The NSV technique is associated with fewer complications, produces less perioperative and postoperative pain, results in quicker recovery, takes less time to perform, and is as effective as standard incisional vasectomy. Evidence Summary A Cochrane review evaluated NSV compared with the standard incisional technique.1 It included a large multinational, multicenter, partially blinded RCT including 1,429 men2 and a smaller RCT with 99 men from a residency clinic.3 NSV resulted in fewer postoperative hematomas (odds ratio [OR] = 0.23; 95% confidence interval [CI], 0.15 to 0.36), less scrotal pain (OR = 0.66; 95% CI, 0.52 to 0.83), and fewer postoperative infections (OR = 0.34; 95% CI, 0.13 to 0.90). A nonblinded RCT with 1,203 men from Thailand compared NSV (680 patients) with incisional vasectomy (523 patients) and found a decreased combined risk of hematoma and infection in the NSV group (absolute risk reduction = 0.4 versus 3.1 percent; number needed to treat = 38; 95% CI, 22 to 85).5 Recommendations from Others The World Health Organization recommends NSV over the standard incisional technique, noting that NSV produces less pain and bruising, results in fewer infections and hematomas, and takes less time to perform than the standard incisional technique.6 The American College of Obstetricians and Gynecologists does not make a specific recommendation, but notes that NSV has a lower incidence of hematoma formation (0.1 to 2.1 percent versus 0.3 to 10.7 percent) and infection (0.2 to 0.9 percent versus 1.3 to 4 percent) compared with the standard technique.7 Neither the American Urological Association nor the American Academy of Family Physicians has a policy statement on the recommended method for performing vasectomy.