Are Uncertain Vasectomy Pathology Reports Suggestive of Procedural Failure? Long‐Term Data From a Large Cohort

Purpose: During vasectomy, technical errors such as difficulty identifying and transecting the vas deferens may occur. Pathology reports indicating an incompletely transected vas may create uncertainty regarding procedural success. However, there is a paucity of large cohort studies investigating this correlation. To address this gap, we explored the relationship between abnormal pathology reports and vasectomy failure rates to determine whether such reports should impact clinical decision making. Methods: We retrospectively reviewed charts of men aged ≥18 who underwent vasectomy between 2004–2024. Abnormal pathology reports failed to identify complete vas deferens cross sections. Vasectomy failure was defined as presence of motile sperm or ≥100,000 nonmotile sperm on postvasectomy semen analysis (PVSA) ≥3 months. Results: Of 2446 vasectomies with pathology reports, 2399 (98.1%) reports were normal, 1330 returned for PVSA, and 55 were failures (4.1%). Conversely, 47 (1.9%) had an abnormal report. Of these, 31 patients returned for PVSA, 87.1% ( n = 27) were successes with failure rate of 9.7% ( n = 3), and one patient had sperm on PVSA <3 months after vasectomy but was lost to follow‐up. The three failures were secondary to errors in transecting the vas on one side. Pathology reports stated “benign nerve and fibrovascular tissue,” “artery,” and “no vas deferens lumen visualized.” Conclusions: Outcomes from a large cohort over two decades suggests although pathology provides early feedback, abnormal reports do not reliably predict vasectomy failure. Pathology should not independently guide clinical decision making without confirmatory semen analysis, which remains the marker of success. Future research could investigate outcomes of patients with abnormal pathology who did not follow up for semen analysis.