MATERIALS
Vasectomy in Office Urology:
Technique, Outcomes, and Learning Curve
2025 Volume 75 Issue 4 Pages 375-381
Details
2025 Volume 75 Issue 4 Pages 375-381
Objective: To present a standardized office-based vasectomy technique and to evaluate perioperative outcomes and the learning curve of procedures performed by a single surgeon.
Methods: A retrospective analysis was conducted of 234 vasectomies performed at our clinic between January 2010 and July 2025. The surgical technique consisted of a single midline puncture without a scalpel, double ligation of the proximal vas, double ligation with fold-back ligature of the distal vas, intraluminal mucosal cauterization, excision of approximately 1.5 cm of the vas, and a non-sutured skin closure. Cases were divided sequentially into five periods (four of 50 cases and one of 34 cases). Operative time, complications, and achievement of azoospermia were compared across periods.
Results: Mean operative times (95％ CI) were 27.0 min (25.8-28.2) in the 1st period, 25.5 min (23.9-27.1) in the 2nd, 23.0 min (21.7-24.3) in the 3rd, 22.7 min (21.5-23.9) in the 4th, and 21.5 min (19.7-23.3) in the 5th, with significant shortening from the 3rd period onward (p＝0.00166). Complications included minor wound infection in 0.9％, epididymitis in 3.4％， and hematoma or bleeding in 2.6％ (1.7％ resolved conservatively, 0.9％ required evacuation). Postoperative semen analysis confirmed azoospermia in 93.2％ at the first test (≥1 month), and 94.9％ by the second test (≥2 months). One case (0.4％, 2nd period) required reoperation; no failures occurred after the 3rd period. Eleven patients (4.7％) did not undergo semen analysis. After the 175th case, the rate of complete semen testing reached 100％ following reinforcement of postoperative instructions.
Conclusions: An office-based vasectomy technique combining a single midline puncture, non-sutured closure, double proximal ligation, distal folding ligature, intraluminal cauterization, and vas excision demonstrated low complication rates, early and reliable achievement of azoospermia, and reproducibility suitable for outpatient urology practice.
