Purpose of review
Vasectomy is a commonly performed outpatient procedure for male contraception with high success and low failure rates. Vasectomy reversal permits couples desiring the ability to conceive naturally after vasectomy to avoid assisted reproductive technology in many cases. Our review discusses current and emerging vasectomy and vasectomy reversal practices, techniques, and outcomes.
Recent Findings
Various vasectomy techniques have been utilized for vas isolation and occlusion, most notably the no-scalpel vasectomy with intraluminal cauterization and fascial interposition. There are few comparative studies between vasectomy techniques, making it difficult to determine the optimal operative approach. Overall compliance rates with post-vasectomy semen analyses are low, complicating study of vasectomy success rates. The most common methods for reversal include vasovasostomy and vasoepididymostomy, each with their own range of techniques. With recent technological advancements, many novel approaches and tools have been employed to improve patency and pregnancy success such as robotic techniques and anti-fibrotic agents. In addition, there are many patient and partner factors that can affect vasectomy and vasectomy reversal outcomes. Vasectomy reversals need to be approached algorithmically with outcomes assessed based on technique and time since vasectomy.
Summary
Further research across multiple institutions is needed comparing outcomes of novel vasectomy and vasectomy reversal to traditional approaches. Emerging non-surgical options for male contraception will play an important role in the practice of urologists in future years.
