Vasectomy under local anaesthesia performed free of charge as a family planning service: Complications and results

Abstract

Objective: The aim of this study was to evaluate the safety and efficacy of vasectomy performed under local anaesthesia by junior doctors at a secondary level hospital as part of a free family planning service.
Method: Men requesting vasectomy were extensively counseled and given written instructions to use alternative contraception until 2 semen analyses at 3 and 4 months postvasectomy had confirmed azoospermia. Bilateral vasectomy was performed free of charge as an out-patient procedure under local anaesthesia by junior Urology registrars at a secondary level hospital (Karl Bremer) in the Western Cape. The ends of the vasa were ligated and in most cases fascial interposition was used. Statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, Fisher’s exact or Spearman’s rank correlation tests as appropriate.
Results: Between January 2004 and December 2005, 479 men underwent vasectomy. Their average age was 36.1 (range 21-66) years. They had a median of 2 (range 0 to 10) children, and only 19% had 4 or more children. The average operation time was 15.5 (range 5-53) minutes. Complications occurred in 13%: pain (7.3%); swelling (5.4%); haematoma (1.3%); sepsis (1%); difficulty locating the vas (1%); vaso-vagal episode (0.6%); bleeding (0.6%); wound rupture (0.4%) and dysuria (0.2%) (some men had more than one complication). Only 63.3% of the men returned for one semen analysis and only 17.5% returned for a second analysis. The vasectomy failure rate ranged from 0.4% (sperms persisting >365 days postvasectomy) to 2.3% (sperms seen >180 days postvasectomy and/or in the second semen specimen). No pregnancies were reported. Comparing the 4 Urology registrars who performed 89% of the procedures the complication (5.6%) and failure rates (0) were lowest for the registrar who had performed the smallest number of vasectomies and whose average operation time was longest. Comparing the first 1/3 to the last 1/3 of procedures performed by each of the doctors, there was a significant decrease in average operating times, but not in the complication rates. There were no significant correlations between complication or failure rates and the average operating time or the number of procedures performed by each of the doctors.
Conclusions: Bilateral vasectomy under local anaesthesia performed by junior doctors had very low minor complication (13%) and failure rates (0.4% to 2.3%). Despite intensive counseling and written instructions, 37% of men did not return for any postoperative semen analysis. However, there were no reported pregnancies or litigation resulting from alleged vasectomy failure. There were no clear correlations between complication and failure rates and average operation time or the number of procedures performed by individual doctors. This indicates that vasectomy can be safely and effectively performed by junior doctors as an out-patient procedure under local anesthesia. Vasectomy should be much more actively promoted and supported by all health delivery services in South Africa as a safe and effective form of male contraception.