Open vs Closed Vasectomy, my research summary
Hi friends,
I just finished doing a bunch of research on this and wanted to share my results for others making this decision.
tldr: I am going to pay out of pocket to get a no-scalpel open ended vasectomy vs a no-scalpel closed ended vasectomy which would be free covered by my insurance.
Context: I just got off the phone with a Kaiser urologist who did no-scalpel closed (one of the few who do no scalpel, I had to fight through the bureaucracy just to get to him), and his message was: Unless you're a surgeon don't bother researching different techniques. We do things how we've been trained and that's that. :)
Scalpel v No Scalpel
Firstly, regarding no scalpel vs scalpel, the key paper is Auyeung 2020 (https://pmc.ncbi.nlm.nih.gov/articles/PMC7084350/) a major meta study which shows a frightening 24% of scalpel vasectomies had some non-surgical pain (e.g., happened >2 weeks after surgery so not related to healing) vs 7% for no-scalpel. Of note, there was no difference in rate of PVPS between methods. Urologists frequently cite a much lower number of 5% PVPS, but PVPS requires the pain to persist beyond 3 months in duration. For me, 2 months of pain that goes away by itself is significant even if my urologist claims that it’s “successful and not a complication”, so going no-scalpel was a no brainer. Also if you care about American Urology Association recommendations, they recommend no-scalpel.
Open v Closed
Regarding open, vs closed, the evidence here is less strong. there are only really 2 good papers and unfortunately they are old. Neither are RCTs. Despite the limitations, to me these studies provide enough evidence along with a believable theory of why open ended should be better to convince me to go open ended.
Note the AUA considers open ended one of several accepted best practices, not the exclusively recommended method (so their rec for open is less strong than their rec for no-scalpel). They do mention the 2% vs 6% rate of congestive epidydimitis from the Moss paper below.
1986 Errey paper (https://www.fertstert.org/article/S0015-0282(16)49404-5/pdf)) - compared 4330 scalpel, open ended vs 3867 scalpel, standard. Open ended had almost 1/2 of the return visits for epididymal congestion. Opened also had about 1/2 the rate of return visit for granulomas. Author theorizes granulomas formed by fresh sperm less likely to create symptomatic granulomas than those formed by dead / rotten sperm when the epid. explodes. Key limitation here is it's comparing older, scalpel open to scalpel closed techniques, whereas I am choosing between no scalpel open and no scalpel closed.
1992 Moss paper (https://www.nsvi.org/wp-content/uploads/2022/02/Moss.1992.pdf) - doc did 3k closed ended then switched to open ended and did 3k open ended. 3x decrease in congestive epididymis. Key flaw here is majority of closed ended vasectomies were scalpel, at the tail end he switched to no scalpel. He does briefly mention stats for the last 300 closed ended, which were likely the no scalpel ones, to the first 300 open ended ones with were all no scalpel and quotes a drop from 6% epid. cong. to 2%.
Lastly regarding efficacy of open ended, 2025 Diabate (https://vasectomie.net/wp-content/uploads/2025/08/Diabate-open-ended-effectiveness.2025.pdf) shows open ended vasectomies are as successful at sterilization as std.