to the editor: The review article on vasectomy discusses the relative failure rates with various methods of occluding the vas deferens. Figure 1 illustrates how the vasal occlusion methods for vasectomy are performed. Careful examination of the ligation and fascial interposition method in this figure shows that the suture placed to do the fascial interposition forms a pursestring around the vas deferens itself. In practice, this will likely be tied too loosely and allow the vasal end to slip back inside the sheath, or tied too tightly and strangulate the vasal end, with both resulting in lack of fascial interposition. I suspect this accounts for the extraordinarily high rate of failure with this method. No vasectomist should accept a 16.7 percent failure rate. All vasal occlusion methods that place a ligature around the vas deferens will cause necrosis of the end, leading to a failure of occlusion and an unacceptably high rate of failure.

Many years ago, the late Stan Schmidt developed the intraluminal thermal cautery and fascial interposition method of vasal occlusion.¹ This method of vasal occlusion had a 0 percent failure rate when he performed it;² other authors have reported a less than 1 percent failure rate with this method.³ This is the preferred method of vasal occlusion, and I have reported details of how to incorporate this into No-scalpel vasectomy.⁴ I cannot fathom why a vasectomist would use any other method of vasal occlusion.

editor's note: This letter was sent to the authors of “Vasectomy: An Update,” who declined to reply.