Retrospective evaluation of vasectomy outcomes – effectiveness, complications, and adherence to post-vasectomy semen analysis in Czech urological practice

Overview

Introduction: Vasectomy is a highly reliable method of permanent male contraception with a very low risk of failure after confirmed sterility. In Czech clinical practice, sterility is traditionally defined by repeated complete azoospermia, whereas current AUA/EAU guidelines accept a single post-vasectomy semen analysis (PVSA) showing azoospermia or rare non-motile sperm (RNMS ≤ 100,000/mL). Patients and methods: We retrospectively evaluated men after vasectomy between January 2022 and May 2025 who were operated on at our centre or at least two other urological departments and subsequently referred to our clinic for PVSA and/or late follow-up. The primary endpoint was achievement of sterility according to two definitions –⁠ 1. strict –⁠ complete azoospermia; 2. liberal (AUA/EAU) –⁠ azoospermia or RNMS ≤ 100,000/mL without motility in a single fresh uncentrifuged ejaculate. Secondary endpoints were early complications (≤ 30 days), post-vasectomy pain syndrome (PVPS), late failure, and adherence to PVSA. Results: Seventy-one men (median age 38 years, interquartile range 35–42) were included. The probability of sterility was 93% by 24 weeks and 98.6% by 52 weeks; the median time to sterility was 15 weeks (interquartile range 12–18). Early complications occurred in 3 (4.2%) out of 71 (two scrotal haematomas, one orchiepididymitis). Clinically significant PVPS persisting ≥ 12 months was documented in 2 (3.1%) out of 64 patients with sufficient follow-up. Late failure with reappearance of motile sperm after previous clearance was observed in one patient (1.4%), without reported pregnancy. Only ~62% of men submitted a PVSA sample by 12 weeks and ~52% by 24 weeks. Conclusions: In routine Czech urological practice, vasectomy shows high effectiveness (~99% sterility within 1 year) and low morbidity. The main weakness is poor adherence to PVSA, with about half of men lacking laboratory confirmation of sterility. Adoption of the AUA/EAU sterility definition (azoospermia or RNMS ≤ 100,000/mL in a single fresh uncentrifuged sample 12–16 weeks after surgery) could enable earlier, well-documented discontinuation of additional contraception and improve patient motivation to attend PVSA.

Keywords:

ureteral stricture – laser lithotripsy of ureterolithiasis – complications of ureteroscopy – buccal mucosa graft – vasectomy – male sterilization – post-vasectomy semen analysis – azoospermia – rare non-motile sperm – post-vasectomy pain syndrome – patient adherence – compliance