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Am Fam Physician. 2000;61(5):1464

Vasectomy is a safe and effective method of contraception. The major drawbacks to this procedure are the adverse effects related to the incision and the delay between the procedure and sterility. The no-scalpel vasectomy technique was developed in hopes of reducing some of the postoperative symptoms related to the standard incision. Some studies have suggested that the no-scalpel technique is quicker and has fewer complications than the standard incision technique, but there have been no randomized studies comparing these two different techniques. Sokal and colleagues compared the no-scalpel vasectomy with the standard incision vasectomy in terms of safety, ease of use and effectiveness.

The study was a prospective, partially blinded, parallel-group, randomized multi-center clinical trial. There were 1,429 men enrolled in the study who were randomized to one of the two vasectomy techniques. The persons who evaluated the patient's postoperative symptoms were blinded to the procedure used. Follow-up took place three to 15 days after the vasectomy and again after 10 weeks to evaluate sterility.

The operating time for the no-scalpel technique was shorter than that for the standard incision vasectomy. Both techniques had similar surgical difficulties during the procedure, and the effectiveness for both procedures was comparable, with 1.8 and 1.6 percent failures at 10 weeks, respectively, for no-scalpel and standard incision vasectomies. The standard-incision patients were more likely to develop a hematoma, to have more mild-to-moderate postoperative pain at early follow-up and to develop an incision infection. There were no differences between the two groups with regard to patient satisfaction. The no-scalpel vasectomy patients did report earlier resumption of sexual activity.

The authors conclude that no-scalpel vasectomy is a safe and effective procedure providing significant benefit over the standard incision technique. No-scalpel vasectomy takes less operative time, is safer and causes fewer postoperative problems than the standard incision vasectomy procedure, with similar failure rates.

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