Is open-ended testicular vasectomy better?

The regular closed end vasectomy severs the tube and then obstructs both ends with either suture, clips or electrocautery. In an open end vasectomy the tube end closest to the testicle is left open. The thinking is that this will cause less pain post vasectomy because it doesn't have the immediate change in the pressure gradient that many feel causes pain. It has been shown that the small amount of leakage of sperm in the open procedure can be beneficial as it serves a "pop off" valve of sorts. A sperm granuloma (the immune response) forms at the open site and this is protective.
So the proponents of this tout the benefit of less pain, and a higher likelihood of reversing the vasectomy if desired in the future.
Is it better? Studies show it is similar in results and is certainly an option.
In my practice post vasectomy pain is not something I see commonly although I do see it. And in regards to an easier reversal...most urologists tell patients to only consider a vasectomy if they are certain they want no more children and to consider the procedure permanent. Having said that, one in six men who have had a vasectomy will consider reversing it.
The open is no harder to perform, instead of closing the testicular end of the vas tissue is interposed between the testis end and vas end on the body side. It then becomes a choice issue for he patient. The costs would be the same.

Published on Jul 11, 2012

This is debatable. There is slightly less chance of post vasectomy pain syndrome, but slightly greater risk of failed vasectomy. It is a discussion I often have in my office with my patients.

Published on Jul 11, 2012

The AUA recognizes different ways to perform a vasectomy, and an open-ended vasectomy has been presented to potentially decrease the incidence of post-vasectomy pain syndrome. It is the standard of care to occlude both ends. When an open ended vasectomy is performed typically a spermatocele will form and the vasal fluid will form this walled off cyst at the end of the vas deferens. I am not aware of any cost benefit analysis between the two techniques.

Published on Jul 11, 2012