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Safety and effectiveness of vasectomy
Abstract
Objective:
To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy.
Design:
A systematic MEDLINE review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998.
Main outcome measure(s):
Early failure rates are <1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%-6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.
Conclusion(s):
Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.
... However, there is evidence indicating that there may be a role for laparoscopic vasectomy, particularly for patients undergoing simultaneous laparoscopy for alternate pathology [7]. Furthermore, by approaching the vasectomy in this way, there is the potential to avoid local complications, such as scrotal haematoma, infection, epididymo-orchitis, and sperm granulomas [8]. Despite this potential, the evidence surrounding appropriate clinical pathways to undertake laparoscopic over traditional vasectomy, as well as outcomes related to laparoscopic vasectomy, remain poorly characterised. ...
... In this way, the barriers of laparoscopic instrument cost, surgical expertise, and anaesthetic duration are mitigated by the necessity of laparoscopic management of the alternate pathology. Furthermore, for patients already undergoing intra-abdominal laparoscopy, the additional scrotal incisions confer further risk of local complications including haematoma, infection, swelling, and postoperative scrotal discomfort [8]. These have been estimated to occur on the order of 1-6% [8]. ...
... Furthermore, for patients already undergoing intra-abdominal laparoscopy, the additional scrotal incisions confer further risk of local complications including haematoma, infection, swelling, and postoperative scrotal discomfort [8]. These have been estimated to occur on the order of 1-6% [8]. It is apparent from the patient perspective that this risk may be unjustified, with patients consenting specifically for laparoscopic vasectomy in these instances as a means of risk prevention [6,12]. ...
Vasectomy is a common procedure performed for family planning. Traditionally, this has been via a scrotal approach. In contrast, laparoscopic vasectomy is a documented but rarely described procedure that may minimise anaesthetic risk, surgical risk, and healthcare expenditure in patients undergoing elective laparoscopic procedures for concurrent pathology such as hernia repair. This scoping review evaluates the clinical utility of laparoscopic vasectomy. It was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Articles were identified with keywords related to laparoscopy and vasectomy. Six peer-reviewed, full-text articles published in English were included in this review. These studies encompass eight individual patient cases of laparoscopic vasectomy performed in the 1990s and early 2000s. All the cases included laparoscopy for concurrent pathology, the most common of which was inguinal hernia. There were no complications associated with laparoscopic vasectomy. For patients requiring laparoscopic surgery for alternate pathologies, synchronous laparoscopic vasectomy improves surgical efficiency by minimising anaesthetic time, operative time, and risk, in addition to lower associated healthcare costs. However, consideration is given to the limitations of this approach, and a note is made of the lack of evidence regarding safety and efficacy given the paucity of cases described in the literature.
... Despite vas deferens recanaliza-tion, the low pregnancy rate is due to the presence of ASAs [14], which are found in 50% of males who have undergone vasectomy [6]. In addition, complications such as bleeding, hematoma, infection, and acute epididymitis can occur during or early after the procedure [15]. ...
... However, because researchers are still seeking volunteers for clinical trials of the technique, its actual contraceptive effect has not been demonstrated in humans. In addition, because the operating mechanism is the same as that of vasectomy, long periods of obstructing the vas deferens might increase the risk of serious side effects [15]. ...
... Complete obstruction of the vas deferens can lead to various side effects, including congestion of the epididymis, painful nodules and sperm granulomas, and ASA production inside the body [15]. Thus, early research into an intra-vas device (IVD) that completely occluded the vas deferens using medical silicone and polyurethane was discontinued due to difficulties in restoring fertility [100,101]. ...
Many contraceptive methods have been developed over the years due to high demand. However, female contraceptive pills and devices do not work for all females due to health conditions and side effects. Also, the number of males who want to actively participate in family planning is gradually increasing. However, the only contraceptive options currently available to males are condoms and vasectomy. Therefore, many male contraceptive methods, including medication (hormonal and non-hormonal therapy) and mechanical methods, are under development. Reversibility, safety, persistence, degree of invasion, promptness, and the suppression of anti-sperm antibody formation are essential factors in the development of male contraceptive methods. In this paper, male contraceptive methods under development are reviewed according to those essential factors. Furthermore, the timeline for the availability of a new male contraception is discussed.
... Vasectomy is a minor surgical procedure resulting in the most permanent form of male contraception, with success rates greater than 99% [1]. Despite a range of techniques, vasectomy universally involves purposeful occlusion and/ or interruption of the vasa deferentia, disrupting the normal outflow of sperm into ejaculated semen. ...
... Despite a range of techniques, vasectomy universally involves purposeful occlusion and/ or interruption of the vasa deferentia, disrupting the normal outflow of sperm into ejaculated semen. Post-vasectomy semen analysis (PVSA) is typically checked 8 to 16 weeks post-procedure per AUA guidelines recommendations to evaluate for azoospermia, given a demonstrated need for approximately 20-30 ejaculations to clear any viable sperm distal to the vasectomy site [1]. The vasectomy procedure is short in duration and commonly performed under local anesthesia in the outpatient setting. ...
... Vasectomy failure is rarely seen in clinical practice, with rates < 1% [1]. Failure can be due to errors of surgical technique such as cutting a structure other than the vas, repeating the vasectomy twice on the same side at different points on the vas, or the presence of an unidentified congenital vas duplication. ...
Purpose of review
Vasectomy is a commonly performed outpatient procedure for male contraception with high success and low failure rates. Vasectomy reversal permits couples desiring the ability to conceive naturally after vasectomy to avoid assisted reproductive technology in many cases. Our review discusses current and emerging vasectomy and vasectomy reversal practices, techniques, and outcomes.
Recent Findings
Various vasectomy techniques have been utilized for vas isolation and occlusion, most notably the no-scalpel vasectomy with intraluminal cauterization and fascial interposition. There are few comparative studies between vasectomy techniques, making it difficult to determine the optimal operative approach. Overall compliance rates with post-vasectomy semen analyses are low, complicating study of vasectomy success rates. The most common methods for reversal include vasovasostomy and vasoepididymostomy, each with their own range of techniques. With recent technological advancements, many novel approaches and tools have been employed to improve patency and pregnancy success such as robotic techniques and anti-fibrotic agents. In addition, there are many patient and partner factors that can affect vasectomy and vasectomy reversal outcomes. Vasectomy reversals need to be approached algorithmically with outcomes assessed based on technique and time since vasectomy.
Summary
Further research across multiple institutions is needed comparing outcomes of novel vasectomy and vasectomy reversal to traditional approaches. Emerging non-surgical options for male contraception will play an important role in the practice of urologists in future years.
... [6,7] Vasectomy, also with the development of no-scalpel vasectomy (NSV), has become a method of choice but is used only by 6-8% of couples worldwide, and < 3% in Asian countries. [8][9][10] Vasectomy, though considered the most reliable method of male contraception, is not entirely free of impediments. At times, concerns have been expressed that vasectomy may elevate the risk of cancer, cardiovascular, and immune-related diseases. ...
... [11] In more than 50% of men, vasectomy leads to an auto-immune response to sperm triggered by phagocytosis in the epididymis. [8] These antibodies increase the probability of infertility after vasectomy reversal. [9,12] Looking toward alternative vas-occlusive contraceptive methods that blocks sperm transport in the vas deferens, various intravasal devices have been examined. ...
... A few studies comment on the functional competence of the spermatozoa in reference to sperm motility and vitality after vasectomy; however, no detailed study has been reported as yet. [8,33] Sperm functional assays performed in the present study define fertilizing capacity of residual spermatozoa from men rendered oligozoospermic by RISUG ® injections that accentuate early contraception. In all the functional parameters studied, a decrease was observed after RISUG ® injection implying the inability of spermatozoa in binding to ZP and causing capacitation. ...
Objectives
An early contraceptive efficacy with reasonable assurance of reversibility has been a challenge in male contraception. With nearly four decades of research in reversible inhibition of sperm under guidance (RISUG ® ) as an intravasal male contraceptive, including pre-clinical trials in rats, rabbits, langur monkeys, and three phases of clinical trials, the present study aims to evaluate the additional parameters of a center of Phase III clinical trials.
Material and Methods
Subjects were recruited following ICMR guidelines of inclusion and exclusion criteria. Samples were analyzed for sperm functional tests, namely, hypo-osmotic swelling, acrosomal intactness, nuclear chromatin decondensation, and sperm mitochondrial activity index. Furthermore, seminal biochemistry and serum hormones such as follicle-stimulating hormone, luteinizing hormone, testosterone, cortisol, and prolactin were assessed along with levels of anti-sperm antibodies and prostate-specific antigen (PSA).
Results
The present study, on human subjects, emphasizes the efficacy of RISUG ® with early onset of contraception and indication of a greater possibility of reversal. A significant decrease in all sperm functional parameters was observed following RISUG ® injection along with increased sperm abnormalities. Semen biochemistry revealed no marked alterations in the concentration of fructose and acid phosphatase, while significantly decreased levels of glycerophosphorylcholine and neutral α-glucosidase were observed. No significant changes in the circulatory levels of hormones and the levels of PSA were observed. In addition, the development of anti-sperm antibodies, an adverse effect of other vas occlusive methods, was not indicated after RISUG ® administration, implying the potential of reversibility in humans as observed earlier in different animal models.
Conclusion
RISUG ® presenting deleterious effects on spermatozoa and marked alterations in epididymal markers provides early contraception with a greater possibility of reversal. Although the progress of RISUG ® toward development as an ideal male contraceptive is slow, the study implies a strong future possibility.
... 2,7,13 Overall, this method persists as a safe, effective option that helps relieve the contraceptive burden on females. 14 ...
... While approximately 30 different methods of isolation of the vas deferens and occlusion of the vas exist, there are two main vasectomy surgical techniques that are important to discuss, conventional versus no-scalpel methods. 2,7,8,13,14,16 The conventional vasectomy technique requires bilateral scrotal incisions which allows for access to and transection of the vas deferens, a less popular technique in the US. 2,8,14 The no-scalpel method, or minimally invasive vasectomy (MIV) is now more highly recommended due to improved outcomes such as shorter operation times, less bleeding and risk of infection, hematoma, less peri-and post-operative pain, and a quicker resumption to sexual activity. ...
... 2,7,8,13,14,16 The conventional vasectomy technique requires bilateral scrotal incisions which allows for access to and transection of the vas deferens, a less popular technique in the US. 2,8,14 The no-scalpel method, or minimally invasive vasectomy (MIV) is now more highly recommended due to improved outcomes such as shorter operation times, less bleeding and risk of infection, hematoma, less peri-and post-operative pain, and a quicker resumption to sexual activity. 7,16 The MIV consists of a small puncture through the scrotal skin with a sharp forceps-like instrument, externalization of the vas deferens and subsequent transection. ...
Background
Vasectomy is a procedure that results in permanent yet reversible sterility and remains a great contraceptive option for many. Previous research studies have highlighted frequency of vasectomy utilization, defining characteristics of individuals who opt for this method, various surgical techniques, and the risks and benefits associated with the procedure. What remains to be defined is why or why not individuals may experience post-vasectomy regret and whether the previous characteristics correlate.
Objective
The objective of this review is to synthesize information regarding reasons individuals may regret their vasectomy and seek reversal, what options exist for accomplishing the reversal, and patients’ fertility prognosis post-vasovasostomy.
Methods
This review utilized a combination of secondary and tertiary data analysis across a wide scope of academic databases pertaining to the topic of interest.
Results
Typically, most males who have sought a vasectomy are satisfied with their decision, however, approximately 6% of this population seeks reversal. Key factors influencing vasectomy regret include age at the time of vasectomy, parental status, pre- and post-operative relationship status, unresolved physical and psychosexual problems, and development of chronic scrotal pain following the procedure. Few options exist for vasectomy reversal including microsurgical reconstructive vasectomy reversal (VR) and sperm extraction for in vitro fertilization. There is no guarantee that fertility will be restored in any case but a major predictive factor for success is the time interval prior to reversal.
Conclusion
Vasectomy is intended to be a permanent form of contraception; however, a minor chance remains that individuals may experience post-operative regret due to various factors. This warrants proper comprehensive counseling by the patient’s provider regarding benefits and risks, procedural outcomes, opportunities for reversal, and fertility prognosis.
... It is important to counsel men thoroughly about possible complications of a vasectomy; however, up-to-date data are scarce [2][3][4]. Vasectomy complications are a frequent cause of litigation [5]. The rate of troublesome chronic scrotal pain quoted in the BAUS patient information leaflet is 'up to 5%', which may discourage some patients. ...
... The notification and recording of late failures are potentially underestimated due to non-reporting by patients. This is well covered in the literature [2,9,11,17]. We have no data on the exact timing of when late failures were reported. ...
Objectives
To provide up‐to‐date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC).
Patients and Methods
Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re‐admission, haematoma and post‐vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis.
Results
Over the 15‐year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%).
Conclusions
Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre‐vasectomy counselling.
... Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC. Vasectomy is the only FDA approved method of male contraception, and is widely considered to be the safest option for permanent sterilization, with long-term failure rates of less than 1% (Schwingl & Guess, 2000). It is estimated that 5%-6% of men undergoing vasectomy will desire reversal for restoration of fertility due to a change in marital status or reproductive goals (Masterson et al., 2013;Potts et al., 1999). ...
... During a VR, the male reproductive anatomy is restored to continuity, either by vasovasostomy or vasoepididymostomy. Patency and post-surgical reproductive outcomes, vary greatly after VR with published patency rates ranging from 62%-97% and pregnancy rates ranging from 26%-92% (Schwingl & Guess, 2000;Sharlip, 1993;Silber & Grotjan, 2004). The Vasovasostomy Study Group (Belker et al., 1992) identified several factors as correlating with post-reversal patency, one of which was the presence of granuloma. ...
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post‐VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
... Compared to female forms of surgical contraception listed above, the reduced risk of fatal side effects resulting from vasectomy has been well-documented over the past half century (Ringheim, 1993;Yin, 2001). Several studies have concluded that, despite possible side effects, vasectomy is a "safer, simpler, less expensive, and equally effective" surgery (Pile & Barone, 2009, p. 295) compared to tubal ligation and IUD birth control (e.g., Huang, 2014;Schwingl & Guess, 2000). ...
Despite medical evidence suggesting that vasectomy is a “safer, simpler, less expensive, and equally effective” option than female surgical contraception, the number of women who had voluntary surgical contraceptive surgeries in China in 2020 was a thousand times more than that of men. Such a gender discrepancy has not been paid attention to by researchers in family science. Limitations of commonly applied knowledge paradigms (e.g., positivism, post-positivism, social constructionism) could make it difficult for researchers to identify and address research questions relating to social change. Building on a newly integrated epistemological position, the objectivity-subjectivity continuum, we argue for a critical interpretivist lens for family scientists to investigate this gender inequality issue regarding families’ choices over surgical contraception.
... The effectiveness of vasectomies for permanent contraception is excellent, with most studies reporting success rates of close to 99% [3][4][5][6][7]. However, post-vasectomy care guidelines for practitioners have been historically ambiguous, with a wide range of time intervals for post-vasectomy semen analysis (PVSA) [8]. ...
Background/Objectives: The American Urological Association (AUA) vasectomy guidelines’ current recommendation to obtain the first post-vasectomy semen analysis (PVSA) from 8 weeks to 16 weeks post-vasectomy is based predominantly on azoospermia rates. However, non-compliance with semen analysis after vasectomy is a known problem in this patient population. An approach that optimizes clearance and compliance is essential when adopting appropriate post-vasectomy care guidelines, specifically the scheduling of the first PVSA. We aimed to conduct a systematic review and meta-analysis of studies assessing compliance and clearance to determine the optimal time of first PVSA. Methods: Databases (MEDLINE, EMBASE, POPLINE) were searched for studies that contained the following: rate of azoospermia and rare nonmotile sperm (RNMS), compliance, recanalization, persistent RNMS, pregnancies, and incidence of repeat vasectomy. Results: A total of 28 studies were included in this review. The patient compliance was 47–100% and trended downward with increasing time to first PVSA. There was a positive trend in azoospermia rate as post-vasectomy time increased, but this plateaued at 8 weeks. Compliance and post-vasectomy semen analysis clearance (PVSAC) converged at 5.7 weeks, with rates of 74.5% and 74.6%, respectively. A proportion of 1.5% of patients exhibited persistent RNMS. Recanalization events had an incidence rate of 1.5%. Repeat vasectomies were performed in 1.6% of patients. Conclusions: Based on our study optimizing post-vasectomy semen clearance with follow-up compliance, we recommend initial PVSA between 6 to 18 weeks post-vasectomy, as this offers improved compliance over current AUA guidelines which recommend PVSA at 8 to 16 weeks and allows for the identification of instances of “subclinical recanalization” that may be missed at later time points.
... For many years, vasectomy has been a globally available option for couples who have completed their family and no longer wish to conceive children. It is recognized as one of the most effective methods of contraception, with success rates exceeding 98% [2,3]. Due to the ease with which vasectomy can be performed either in a medical office or day surgical unit, its popularity has grown steadily over the years. ...
Vasectomy is a reliable male contraceptive method with a success rate exceeding 98%. Despite its efficacy, vasectomy is not foolproof, with potential early and late failures requiring careful postoperative monitoring via post-vasectomy semen analysis (PVSA). Published guidelines emphasize the necessity of conducting PVSA to ensure clinical sterility. Despite these clear guidelines, discrepancies in adherence and interpretation persist, with significant mismatches between guidelines and actual practice. Recent shifts in societal attitudes toward reproductive autonomy, spurred by significant political events and socioeconomic factors, have increased vasectomy rates, particularly among younger, childless men. This demographic change calls for enhanced PVSA compliance and clear communication about the non-immediate contraceptive effect of vasectomy. Home test kits have emerged as a convenient, though not always reliable, method for conducting PVSAs, which may require reevaluation in clinical practice. Given the variations across clinical guidelines and the challenges in achieving consistent PVSA outcomes, further research is needed to harmonize PVSA protocols across different health systems. PVSA is typically conducted between 8 and 16 weeks post-vasectomy, depending on the surgeon’s preference. Success is confirmed when a fresh, uncentrifuged sample exhibits either azoospermia, rare non-motile sperm (RNMS), or fewer than 100,000 non-motile sperm per milliliter. This effort will ensure that both patients and practitioners can rely on vasectomy as a safe and effective form of contraception. Effective patient counseling and strategic follow-up are crucial when it comes to managing expectations and ensuring compliance with post-vasectomy protocols, thereby minimizing the risk of unintended pregnancies post-procedure.
... Vasectomy is a safe, effective, reversible, relatively inexpensive contraceptive service that can be performed in an outpatient setting and requires minimal recovery time [4,5]. It is associated with significantly fewer complications and shorter recovery times than female tubal ligation [6]. ...
Dobbs v. Jackson Women’s Health Organization (Dobbs decision) has already had profound impact on reproductive health care in the United States. Some studies have reported increased incidence of vasectomy after the Dobbs decision. The Military Health System (MHS) provides a unique opportunity to evaluate this relationship in a universally insured, geographically representative population. We conducted a retrospective cross-sectional study of vasectomies among all male beneficiaries in the MHS, ages 18 to 64, from 2018 to 2022. Beneficiaries receiving a vasectomy were identified via billing data extraction from the MHS Data Repository (MDR). Descriptive statistics of demographic factors of all those receiving a vasectomy in the study period were evaluated. Crude and multivariate logistic regression models were used to evaluate for differences in demographic variables in those receiving a vasectomy pre-Dobb’s decision as compared to after the Dobb’s decision. The total number of men receiving a vasectomy each month over the study period was analyzed, as were the numbers in a state immediately implementing abortion access restrictions (Texas), and one without any restrictions on abortion access (Virginia). Our analysis found that men receiving a vasectomy post-Dobbs decision were more likely to be younger, unmarried, and of junior military rank than prior to the Dobbs decision. In the months following the Dobbs decision in 2022 (June-December), there was a 22.1% increase in vasectomy utilization as compared to the averages of those months in 2018–2021. Further, it was found that the relative increase in vasectomy after the Dobbs decision was greater in Texas (29.3%) compared to Virginia (10.6%). Our findings highlight the impact of the Dobbs decision on reproductive health care utilization outside of abortion.
... The identified complications after vasectomy are summarized in Table 1. Vasectomy is the most common non-diagnostic procedure in urology, and it is the most reliable form of male contraception, performed in about 40-60 million men worldwide [1]. Complications shortly after vasectomy include the formation of haematoma, wound infection, and short-term postoperative pain [2,3]. ...
Introduction: Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy.
Material and methods: A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy.
Results: Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications.
Conclusions: Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.
... Vasectomy is a widely used form of male contraception because of its effectiveness and simplicity. An estimated 40 to 60 million men worldwide have undergone vasectomy annually [1,2]. With an increase in divorce rates, early sterilizations, a renewed desire for children, and changes in personal life, there has been an increase in men seeking to restore their fertility through vasectomy reversal [3]. ...
To investigate which surgical technique, macroscopic, microscopic or robot-assisted microscopic, shows highest postoperative patency- and pregnancy rates for vasectomy reversal (VR) by vasovasostomy (VV). This study is an updated version of the systematic review and meta-analysis entitled: “Outcomes of Macrosurgical Versus Microsurgical Vasovasostomy in Vasectomized Men: a Systematic Review and Meta-analysis” published in 2021. We performed a systematic review of the English-, Dutch-, and German-language literature that described postoperative outcomes of macroscopic, microscopic, or robot-assisted microscopic VV for VR. PubMed National Library of Medicine/MEDLINE, Embase, CENTRAL, The Cochrane Library, Web of Science and Scopus were searched from inception to June 2021. Two reviewers independently examined the studies and associated data for eligibility. Primary outcomes were postoperative patency and pregnancy rates. Data on interval to reversal (≤ 7 years and > 7 years) and postoperative complications were also extracted. Forty-nine studies met the inclusion criteria. We identified 46 retrospective studies and three randomized controlled trials (RCT). A total of 10,088 procedures were included. 6822 patients remained after loss to follow-up. The mean age at reversal of vasectomy was 38.0 years, and the mean interval to reversal was 6.5 years. The pooled mean postoperative patency rate was slightly higher after robot-assisted microsurgical VV (92.7%), compared to macrosurgical (81.9%) and pure microsurgical (90.1%) VV. Postoperative pregnancy rates were 42.7%, 69.7%, and 33.3% after macroscopic, pure microscopic and robot-assisted microscopic VV, respectively. Our results showed that microsurgical and robot-assisted microsurgical VV are associated with higher postoperative patency rates compared to the macrosurgical technique. VV with microsurgical assistance showed the highest post-operative pregnancy rates. However, more research is needed due to lack of RCTs and data on robot-assisted microsurgical VV.
... It is a simpler procedure than bilateral tubal ligation (BTL), requires less recovery time and has less risk of complications, and is more cost-effective. [1] This operation prevents spermatozoa from leaving the testis into semen. It has a failure rate of less than 1%. ...
Background
Vasectomy is an effective and safe surgical method of male contraception. It is simpler than female tubal ligation and has fewer complications.
Objective
The aim of this study was to determine the effect of selected demographic characteristics on female health workers’ attitudes to spouses’ use of vasectomy for birth control
Materials and Methods
This was a cross-sectional study of female health workers in two tertiary health institutions in Enugu, Southeast Nigeria. Data were collected using a pretested structured self-administered questionnaire. Data were collected on sociodemographic characteristics and attitudes toward vasectomy.
Results
Two hundred and ninety female health workers completed the questionnaire. The mean age of participants was 32.26 ± 9.39 years. Approximately 66.6% of the women were less than 35 years and 53.1% were married. Only 21.0% of the respondents would encourage their spouses or partners to undergo vasectomy after they have had their desired number of children. Half of the women (50.0%) would prefer to have their tubes tied (tubal ligation) and 63.1% had never discussed vasectomy with their spouses or partners. Younger women (<35 years) were significantly more likely to encourage their spouses/partners to have a vasectomy (odds ratio [OR] 2.1289; P = 0.0231). However, ever-married women (OR 0.1296; P = 0.0000) and women who have had children (OR 0.1767; P = 0.0000) were significantly less likely to do the same. Nurses were more likely to encourage their spouses to undertake vasectomy compared to doctors (OR 2.4750; P = 0.0041).
Conclusion
Vasectomy is not widely accepted among our female health workers; only a fifth of them would encourage their spouses/partners to have a vasectomy.
... Currently, there are various forms of contraception and sterilization in the United States, including birth control such as barrier protection with condoms, oral contraception pills, subdermal implants, intrauterine device (IUD), vasectomy, and tubal ligation surgery [12][13][14]. A vasectomy is a procedure where the tube that carries sperm from each testicle (vas deferens) is cut and sealed, and a tubal ligation involves cutting, tying, or blocking the fallopian tubes to prevent pregnancy [15,16]. With the Supreme Court's overturn of Roe vs. Wade, contraception may be a more significant concern to people across the country. ...
Introduction
With the leaked Supreme Court draft regarding Roe vs. Wade, substantial public reactions followed as the horizon of abortion laws within the United States of America have been changing. We sought to compare internet searches for vasectomy and tubal ligation seven days following the leaked draft on May 2, 2022.
Methods
We used public data provided by Google Trends to investigate the interest and geographic distribution of searches for the two forms of permanent contraception: Vasectomy and tubal ligation. We calculated the mean Search Volume Index (SVI) of these terms. Data analysis was performed with Microsoft Excel Version 16.60 (Redmond, USA), and comparisons between groups were performed using paired t-tests.
Results
The term 'vasectomy' saw a 121% increase (p=0.0063), and 'tubal ligation' had a 70% (p=0.029) increase compared to the week prior. 49/50 states had increased search inquiries for each term. However, the North and Southwestern regions of the U.S. had increased relative surge for vasectomy and the Midwest region for tubal ligation procedures, respectively. South Dakota and Idaho, with trigger laws that banned abortion immediately following the overturn of Roe vs. Wade, had the greatest surge in SVI for tubal ligation and vasectomy, respectively.
Conclusion
Our study indicates that with the potential overturn of Roe vs. Wade, there was a significantly increased interest in these two forms of permanent contraception. Future studies should investigate specific concerns and questions patients may have when it comes to the different options of contraception.
... Vasectomy is a highly effective and safe contraceptive method available to men [1]. It is performed by cutting vas deferens and thus blocking the natural way the sperm are transported. ...
Introduction:
The demographics of men undergoing vasectomy in Poland has not been thoroughly evaluated. The objective of the study is to characterise patients who underwent vasectomy in 2019-2020 in terms of their motivation, the level of acceptance of the method, their social and health status and the way religion influenced their choice.
Material and methods:
This is a prospective observational study based on a survey taken before vasectomy. The surveys attached were collected in 2019-2020. A total number of 253 surveys were collected.
Results:
A total of 43 men aged between 31 and 40 constituted 56.52% of all patients. Of the patients surveyed, 123 (48.62%) were in their first stable relationship. In total, 230 participants (90.91%) declared no intention of having children. A total of 128 patients surveyed (50.59%) showed no interest in the possibility of adoption, whereas 109 (43.08%) did consider adoption. Most of the patients - 150 (59.29%), had been considering vasectomy for 1-3 years. The most popular contraceptive methods were oral contraception - 68 surveyed (26.88%) and condoms - 66 (26.09%). Vasectomy did not collide with religion in 241 cases (95.26%). Seven patients (2.77%) chose vasectomy due to a genetic defect. A total of 46 out of 243 men (18.18%) chose this contraceptive method due to their partners' health.
Conclusions:
Vasectomy in Poland has been performed for over 18 years, however, accessibility has been limited. Recently, the procedure has been gaining in popularity. Now the age structure and partnership status correspond with the data from other centres in the world. Our study showed positive trends of co-responsibility of both partners for procreation and family planning.
... [1][2][3][4] Men should also be made aware of late complications: chronic scrotal pain (1-14%) and delayed vasectomy failure after azoospermia at four months (0.05-1%). 1,5,6 Complications, such as bleeding and testicular pain, can often be managed medically but infrequently (<0.1%) these conditions may require a surgical intervention. 7,8 Exceptionally, surgical management of these complications may lead to testicular atrophy or an orchiectomy. ...
... In addition to the validated tools, video characteristics partially based on Schwen et al. (2020) were collected and are shown in Supplementary Table 2. Clinical variables based on the American Urological Association vasectomy guidelines, Canadian Urological Association guidelines and a systematic review on the safety and effectiveness of vasectomy, were also collected and include mention of early and/or late failure rate, mention of early complications (hematoma, infection, sperm granuloma, epididymitisorchitis, and congestive epididymitis), mention of late complications (chronic scrotal pain and delayed vasectomy failure), mention of potential complication with prior varicocele, mention of pre-op sperm banking or in vitro fertilization following vasectomy, mention of postvasectomy semen analysis or initial ineffective period, mention of reversal possibility, and mention of lack of sexually transmitted infection protection. (Supplementary Table 2) (Schwingl & Guess, 2000; "Vasectomy Guideline -American Urological Association," 2015; Zini et al., 2016). All clinical variables were scored as no (0) or yes (1), and the total percentage meeting criteria for each item was computed. ...
This study aims to critically appraise the quality of vasectomy-related health information currently available on YouTube to better address patient information needs moving forward. A YouTube search was performed using the keyword “vasectomy.” The first 100 videos were assessed, with irrelevant and duplicate videos excluded. Two independent reviewers evaluated the remaining videos using the DISCERN instrument for evaluating the quality of information and the Patient Education Materials Assessment Tool for Audiovisual materials (PEMAT-A/V) for assessing the understandability and actionability of materials. Source characteristics and markers of bias and misinformation were also collected. Seventy-eight videos were included in the study, with a mean duration of 6.6 minutes and mean of 216,672 views. The median DISCERN score was poor at 28 (IQR 22–33) out of a possible 80 with mean PEMAT-AV Understandability and Actionability scores of 67.6% (±16.7%) and 33.8% (±36.2%), respectively. A medical doctor was present in 61 (78.2%) of the videos, of which 53 (86.9%) were urologists and 38 (62.2%) promoted their personal practice or institution. False statements regarding vasectomy were made in 14 (17.9%) videos. Notably, no significant difference was noted in quality, understandability, or actionability of videos created by those with personal promotion to those without. The quality of information regarding vasectomy on YouTube is poor and reaches a wide audience. Continued appraisal and creation of YouTube videos that contain quality, understandable and actionable information by urologists is necessary to ensure patients are well-informed.
... Similar phenomena were also observed in the bubble structure and porous structure between the microneedle and the backing [66,67]. Li et al. reported that the bubble substrate formed by water-soluble polyvinyl alcohol and sucrose has strong compression resistance but weak shear resistance without changing the size and shape of the microneedle, which can achieve rapid separation after being inserted into the skin [68]. In addition, Lee et al. proposed that the porous structure of the platform pad was designed to provide sufficient pressure support for complete insertion into the skin and rapid separation under shear force during detachment in less than 1 s [69]. ...
Unintended pregnancy is a global issue with serious ramifications for women, their families, and society, including abortion, infertility, and maternal death. Although existing contraceptive strategies have been widely used in people's lives, there have not been satisfactory feedbacks due to low contraceptive efficacy and related side effects (e.g., decreased sexuality, menstrual cycle disorder, and even lifelong infertility). In recent years, biomaterials-based long-acting reversible contraception has received increasing attention from the viewpoint of fundamental research and practical applications mainly owing to improved delivery routes and controlled drug delivery. This review summarizes recent progress in advanced biomaterials for long-acting reversible contraception via various delivery routes, including subcutaneous implant, transdermal patch, oral administration, vaginal ring, intrauterine device, fallopian tube occlusion, vas deferens contraception, and Intravenous administration. In addition, biomaterials, especially nanomaterials, still need to be improved and prospects for the future in contraception are mentioned.
Graphical Abstract
Background
Vasectomy is a safe and effective form of contraception. However, fear of altered sexual function is still associated with vasectomy in many men.
Objectives
To assess the prevalence of vasectomy among middle‐aged men in Germany and to investigate possible associations between a previous vasectomy and sexual dysfunctions.
Methods
Data on lifestyle, sexual activity, satisfaction, and dysfunction from 5425 middle‐aged, heterosexual men were collected. Differences between vasectomized (VM) and non‐vasectomized men (NVM) were assessed. Multiple logistic regression analyses were calculated to determine variables associated with erectile dysfunction (ED), premature ejaculation (PE), and low libido.
Results
5425 men with a mean age of 50.6 ± 0.8 years were included in this analysis. Vasectomy was performed in 12.5% (679/5425) on average 8.6 ± 5.8 years ago. 84.4% were sexually active in the last 3 months (93.0% in vasectomized men vs. 83.2% in non‐vasectomized men; p < 0.001), and 45.4% were satisfied with their sexual life (55.2% in vasectomized men vs. 44.0% in non‐vasectomized men; p < 0.001). The prevalence of erectile dysfunction was significantly lower in vasectomized men (12.1% vs. 20.1%; p < 0.001), and a previous vasectomy was associated with a decreased risk for erectile dysfunction in multivariable regression analysis (OR: 0.65 [0.40–0.83]). The prevalence of low libido (4.7% in vasectomized men vs. 7.1% in non‐vasectomized men; p = 0.02) was marginally higher among non‐vasectomized men. The prevalence of premature ejaculation (7.1% in vasectomized men vs. 6.1% in non‐vasectomized men, p = 0.5) did not differ significantly between vasectomized and non‐vasectomized men.
Discussion
A previous vasectomy is not associated with an increased risk for sexual dysfunction, and vasectomized middle‐aged men are more sexually active and satisfied compared to their non‐vasectomized counterparts. The main limitations are the retrospective design and missing pre‐vasectomy data.
Conclusions
Men can be reassured that the fear of sexual dysfunctions and diminished sex life after a vasectomy is unwarranted.
INTRODUCTION
No-scalpel vasectomy is an emerging family planning method that enables the male partner to get more involved. The procedure was first introduced in our institution in 2008 with an average of 7 clients per year (i.e., 86 patients from 2008 to 2019). There were no data when the pandemic started, but starting in March 2022, acceptance for the procedure started to increase. This coincides with the timeline of the study. At present, there are limited studies regarding no-scalpel vasectomy, especially local studies. A better understanding of the characteristics and outcomes of those who underwent no-scalpel vasectomy would aid our institution in formulating and implementing policies and family planning programs.
OBJECTIVES
The study determined the characteristics and outcomes of no-scalpel vasectomy acceptors at Dr. Jose Fabella Memorial Hospital from March 2022 to February 2023. Characteristics included the sociodemographic, medical, reproductive, and duration from inquiry until semen analysis. The outcomes included the absence or presence of complications after the procedure and result of semen analysis.
METHODS
The study utilized a retrospective, descriptive, single, cohort design. Total enumeration was done to get the 36 charts of clients who underwent no-scalpel vasectomy at the Comprehensive Family Planning Center of Dr. Jose Fabella Memorial Hospital from March 2022 to February 2023. Patient charts were retrieved, and data abstraction was done. Tables and figures were used to display the frequency distribution of data collected.
RESULTS
The study had a cohort of 36 individuals who underwent no-scalpel vasectomy, which accounted for 116% of the intended sample size. The characteristics of our clients were mostly urban residents, 30–39 years old, with partner, educated, middle class, employed, Roman Catholic, and having 1–2 children with the age of youngest below 3 years old. Different forms of family planning were used prior to the procedure. Teleconsultation effectively increases our clients for vasectomy. Clients were able to follow up after the procedure, but there was only a decrease in the number of clients who had their semen analysis done and were lost to follow-up.
DISCUSSION
There is an increasing awareness in no-scalpel vasectomy procedure as seen in the increase in acceptors. It is an effective, safe, cost-effective, and permanent male contraceptive procedure, with very minimal manageable complications. However, there is a need for better protocol regarding follow-up with semen analysis result.
CONCLUSION
By determining the characteristics and outcomes of no-scalpel vasectomy acceptors at Dr. Jose Fabella Memorial Hospital from March 2022 to February 2023, the findings of the study hope to aid the health-care providers gain a better insight about the characteristics and outcomes of our male clients who decided to undergo no-scalpel vasectomy as their family planning method of choice. There is a need study in further improving of the formulation and implementation of policies and family planning programs to further reach the male population.
Background
Vasectomy is a widely used method of contraception. However, some men may have the desire to become biological fathers again after a period.
Objective
To explore the effect of time since vasectomy and different male comorbidities on live birth rates from intracytoplasmic sperm injection cycles using donated oocytes by using testicular spermatozoa obtained by testicular sperm extraction.
Materials and methods
This was a retrospective study of 123 couples who underwent a testicular sperm extraction‒intracytoplasmic sperm injection cycle after vasectomy using donated oocytes. Subjects were divided into groups according to time since vasectomy and the male risk factor evaluated. The main outcomes measured were live birth rate per embryo transfer, per oocyte donation cycle, and per couple. We assessed the cumulative live birth rate according to the time since vasectomy and considered male comorbidities: body mass index, hypertension, diabetes mellitus, dyslipidemia, and smoking.
Results
The overall live birth rate per couple was 59.3% (50.6–68.0). Considering the number of embryo transfer and oocyte donation cycle, the live birth rates were 34.1% (27.8–40.4) and 44.5% (36.9–52.1), respectively. The live birth rate according to time since vasectomy was not statistically different between groups. Consequently, the cumulative live birth rate was similar between the different interval times when considering one to eight embryo transfers ( p = 0.74). No statistical differences in live birth rate and cumulative live birth rate were found between groups clustered according to male body mass index, smoking, hypertension, and dyslipidemia. However, diabetic male patients had a significantly lower rate of live birth rate per couple (22.2% [4.94–49.4]) than non‐diabetic patients did (62.7% [53.7–71.8]) ( p = 0.03), but not in their cumulative live birth rate.
Conclusions
The time since vasectomy seems to have no detrimental effects on the live birth rate and cumulative live birth rate in testicular sperm extraction‒intracytoplasmic sperm injection cycles with donated oocytes. Male diabetes negatively affects the overall live birth rate per couple, but not the cumulative live birth rate. These results could be useful for multidisciplinary patient‐tailored counseling, regarding the chance of having a pregnancy and facilitating the decision‐making process of the fertility specialists.
Vasectomy is a safe, standardized, and easy-to-perform method of male contraception. It bears only minimal risk of acute complications and no severe long-term complications. Moreover, vasectomy can be reversed through microsurgical refertilization procedures with a high rate of success and comparatively marginal expenses.
ERKEĞE ÖZGÜ KONTRASEPTİF YÖNTEMLERDE YENİLİKLER;
GELECEK VADEDEN YÖNTEMLER
Introduction: Sterilization is a permanent birth control method, with more couples opting for female sterilization. However, vasectomy is a safe, cost-effective, and simple alternative to tubal ligation. Despite its safety and effectiveness, vasectomy faces limited approval in developing countries like India due to gender biases, lack of access to facilities, and insufficient support. Efforts are needed to raise awareness and promote male sterilization, as its usage in India remains below 1 percent according to NFHS-5 data. Aims: The main aim of study is to assess knowledge and attitude regarding vasectomy among married men. Objectives: 1. Assess the knowledge and attitude regarding vasectomy among married men in selected rural area. 2. To correlate the knowledge and attitude regarding vasectomy among married men in rural area. 3. To associate the knowledge and attitude score with selected demographic variables men's. Methodology: A descriptive design was adopted for the study. The 100 married men were selected as a sample from Salun in Kheda District by the "Non-probability convenient sampling technique" was adopted in this study. The written setting permission was taken from the medical officer of PHC for data collection. The prior consent from was also signed by the married men for the study. The tool for this study was created in three sections: Section A gathered socio-demographic data, Section B contained structural knowledge questionnaires, and Section C included a Likert attitude scale. Data analysis was performed using SPSS software. Frequency and percentage distribution were used to assess knowledge and demographic variables, while mean and standard deviation were employed to describe knowledge, attitude, and utilization related to vasectomy. The study used the Karl Pearson correlation method to examine relationships, and the Chi-square test was employed to determine associations between mean differences. Result: The demographic characteristics revealed that majority of participants 61% of the married men belongs to the age group of 31-40 years, 92% of them were from the Hindu religion, 62% of them were belonged to the nuclear types of families. The Table also reveals that 48% of the participants have completed primary education. 30% of them had a monthly income between 5,000 to 10,000 rupees. 67% of participants had two living children. 66% of them reported having exposure to contraception. 47% of the participants any other group of occupation. 39% of majority of participants had been married for more than 11 years. It was also noted that the level of knowledge, the maximum attainable score was 20 and the participant's knowledge scores range from 2 to 15. The Mean knowledge score is calculated to be 9.32, the standard deviation of 2.18. Conclusion: The Knowledge and Attitude Regarding Vasectomy among Married Men in Rural Area of Kheda District Gujarat, an Descriptive Study"-892-Available online at: https://jazindia.com CC License CC-BY-NC-SA 4.0 study concluded that after the intervention, there was an improvement in knowledge and attitude regarding vasectomy among married men in rural areas of Kheda district. Data were collected from 100 married men using knowledge questionnaires, a Likert scale, and a utilization checklist. The findings indicated that the majority of married men had inadequate knowledge (51%), while 48% had moderate knowledge, and only 1% had adequate knowledge. In terms of attitude, 1% had an unfavorable attitude, 42% had a moderate favorable attitude, and 57% had a favorable attitude.
While hormonal contraceptives are efficacious and available in several forms for women, perception of safety and concern over side effects are a deterrent for many. Existing non-hormonal contraceptives include permanent sterilization, copper intrauterine devices (IUDs), chemical/physical barriers such as spermicides and condoms, as well as traditional family planning methods including withdrawal and the rhythm method. Individuals who wish to retain their fertility in the future can achieve highest adherence and efficacy with long-acting, reversible contraceptives (LARCs), though there is only one, the copper IUD, that is non-hormonal. As rates of unintended pregnancies remain high with existing contraceptive options, it is becoming increasingly attractive to develop novel pregnancy prevention methods for both women and men. Non-hormonal contraceptives can target a variety of critical reproductive processes discussed here. This review focuses on identified non-hormonal contraceptive targets and subsequent drug candidates in development.
Objective:
To evaluate if telehealth consultations would impact the likelihood of patients following through with vasectomies.
Methods:
We utilized electronic medical records from the past 5 years to retrospectively evaluate male patients undergoing a sterilization consult. Telehealth consultations have been offered since March 2020 due to the COVID19 pandemic. Patients were stratified to in-office or telehealth consultation. We then utilized billing codes to determine if patients underwent vasectomy. Percentages of patients who subsequently underwent vasectomy were compared using Chi-square analysis. Logistic regression was performed to identify factors associated with completing vasectomy.
Results:
There were a total of 369 patients who underwent a telehealth male sterilization consultation and 1664 patients who were seen in office. We found that 66.9% of telehealth patients ultimately underwent a vasectomy (n=247) compared to 64.3% of patients who were seen via office assessment (n=1070) (X2= 0.646, p= 0.724). Younger age was the only variable on univariate logistic regression that was associated with completing vasectomy (p = 0.002) via either an in person or televisit, while BMI, race and ethnicity were not significant.
Conclusions:
Only 2/3 of the men completing a vasectomy consult receive a subsequent vasectomy. Both in-office and telehealth consultation resulted in comparable rates of vasectomy. This is the first study to report on the likelihood of following through with a surgical procedure comparing in-office vs. telehealth assessment in male sexual and reproductive medicine. As vasectomy consultations continue to rise, clinicians can be reassured by the effectiveness of telehealth consultations prior to vasectomy.
Objectives:
To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request.
Method:
The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021 identified 508 references, of which 79 were selected and analyzed with the GRADE grid.
Recommendations:
Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
The new edition of this canonical text on male reproductive medicine will cement the book's market-leading position. Practitioners across many specialties - including urologists, gynecologists, reproductive endocrinologists, medical endocrinologists and many in internal medicine and family practice – will see men with suboptimal fertility and reproductive problems. The book provides an excellent source of timely, well-considered information for those training in this young and rapidly evolving field. While several recent books provide targeted 'cookbooks' for those in a male reproductive laboratory, or quick reference for practising generalists, the modern, comprehensive reference providing both a background for male reproductive medicine as well as clinical practice information based on that foundation has been lacking until now. The book has been extensively revised with a particular focus on modern molecular medicine. Appropriate therapeutic interventions are highlighted throughout.
In the current years, conjugated bio-nanomaterials involving magnetic core are interested as promising platform in modern generation biological composites for the treatment of several types of inflammations such as epididymo-orchitis. In this regard, we described a novel Au NPs supported apple pectin (AP) modified magnetic Fe3O4 nanoparticles as a novel nano-biocomposite (Fe3O4@AP-Au NPs). The post-synthetically modified biogenic material was analyzed in details over a number of physicochemical methods like, Fourier transformed infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FESEM), transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS), elemental mapping, X-ray diffraction (XRD) and inductively coupled plasma-optical emission spectroscopy (ICP-OES). In the in vivo part, we divided 80 Wistar rats into five following groups (n = 16 per group): a. Control-intact group, b. Vehicle group, c. Fe3O4@AP-Au NPs group, d. epididymo-orchitis group, and e. epididymo-orchitis/ Fe3O4@AP-Au NPs group. We assessed relative sex organs weight, body weight, germ cell apoptosis, Johnson’s criteria, sperm parameters, and germ cell layers number. Acute epididymo-orchitis raised the prostate relative weight and seminal vesicles and apoptotic indexes of spermatogenic cells, also decreased the quality of sperm such as sperm concentration, normal sperm percentage, and total motility and Johnsen’s and Miller’s scores. Fe3O4@AP-Au NPs group reduced spermatogenic cells apoptotic indexes and prostate weight gain and improved the sperm percentage with total motility, normal morphology, and progressive motility and Johnsen’s and Miller’s criteria.
Background:
Vasectomy causes spermatozoa accumulation in the epididymis, which may cause epididymitis. Inflammation is triggered by alert molecules released following tissue stress or injury. These include UDP-glucose, which activates the pro-inflammatory P2Y14 receptor (P2Y14), and induces immune cell recruitment. However, little is known about P2Y14 in the epididymis and its potential activation following vasectomy.
Objectives:
(i) to localize P2Y14 in the human excurrent duct; and (ii) to examine the effect of vasectomy on P2Y14 protein and P2RY14 mRNA content, the production of selected cytokines and chemokines, and immune cell recruitment in the epididymis.
Material and methods:
in situ hybridization, qRT-PCR, western blotting, immunohistochemistry and immunofluorescence were performed in banked human epididymis samples.
Results:
P2RY14 mRNA and P2Y14 protein were detected in epithelial cells in the efferent duct, epididymis and vas deferens in non-vasectomized men. Keratin 5 (KRT5)-positive basal cells were strongly labeled for P2Y14 in all epididymal segments. A progressive apical localization was detected in principal cells (negative for the proton pump V-ATPase) from the corpus to the cauda. A subset of V-ATPase-positive clear cells also showed strong P2Y14 labeling. Vasectomy induced an increase in P2RY14 mRNA in the corpus and cauda, and stronger apical labeling in principal cells in the corpus. CXCL10 mRNA increased in the cauda and CCL2 mRNA decreased in the corpus of vasectomized versus non-vasectomized men. No change in IL-8 and IL-1β mRNA was detected. Numerous CD45+ leukocytes were detected in the interstitium of the corpus and cauda following vasectomy, while only a few were seen in non-vasectomized men. Several CD45+ leukocytes, some of which containing spermatozoa, were detected in the corpus lumen following vasectomy.
Discussion and conclusion:
Our study indicates that vasectomy-induced spermatozoa congestion may lead to an inflamed-prone local environment characterized by potential activation of P2Y14 and recruitment of immune cells in the epididymis. This article is protected by copyright. All rights reserved.
Objective:
To investigate whether vasectomy, which causes immunological and histological changes to the testes and changes to the hypothalamo-pituitary axis, could influence bone mineral density (BMD) and predispose to osteoporosis.
Patients and methods:
From patients referred to the Bone Densitometry Clinic, the BMD of L1–L4 and of the hip was analysed in 25 vasectomized men and compared with that in age-matched controls, ensuring that both groups had no secondary causes which might predispose to osteoporosis.
Results:
In the spine, the mean (standard deviation) BMD was 1.00 (0.19) g/cm2 for the vasectomized men and 0.96 (0.14) g/cm² for the controls. In the hip (femoral neck and total, respectively) the means were 0.79 g/cm² and 0.90 g/cm² for the vasectomized men and 0.72 g/cm² and 0.96 g/cm² for the controls. None of the differences were statistically significant.
Conclusion:
This study does not support the hypothesis that vasectomy may be a risk factor for osteoporosis.
The results of the present study show that bilaterally vasectomized rabbits with high levels of antibodies to sperm antigens frequently develop an orchitis associated with granular deposits of rabbit IgG and C3 in the basement membranes of seminiferous tubules. The immune deposits correspond in location to electron-opaque deposits seen by electron microscopy. The "membranous orchitis" is characterized by thickening of tubular basement membranes, acc-mulation of macrophages and a few polymorphonuclear leukocytes, and destruction of the basal lamina, of the Sertoli and spermatogenetic cells. The pathogenetic role of the immune deposits and the possibility that they contain antigen-antibody complexes is indicated by: (a) selective accumulation of IgG and C3 granular deposits along the basement membranes of seminiferous tubules in rabbits producing high and persistent levels of antibodies to sperm antigens; (b) the elution of immunoglobulins from tissues with chaotropic ion-containing buffers, acid buffers, or heat; (c) the observation that the immuno-globulins accumulated in the testis contain antibody to sperm antigens; and (d) the demonstration of sperm antigens in a location similar to that of IgG and C3. It is postulated that sperm antigen-antibody complexes are formed in the basement membranes of seminiferous tubules when antigens leaking out of the tubules react with specific antibody coming from the circulation. In two rabbits with higher levels of circulating antisperm antibodies and severe orchitis, granular deposits of IgG and C3 were also present in renal glomeruli. Immunoglobulins eluted from the kidneys contained antibody with antisperm activity. These findings are consistent with the hypothesis that in some vasectomized rabbits extratesticular lesions may develop by a mechanism comparable to that of chronic serum sickness.
To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation.
Retrospective cohort study using linked medical record abstracts.
Six health districts in Oxford region.
13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for one of three specified elective operations, appendicitis, or injuries.
Hospital admission and death after vasectomy or comparison event.
The mean durations of follow up were 6.6 years for men with a vasectomy and 7.5 years for men with a comparison condition. The relative risk of cancer of the testis in the vasectomy cohort (4 cases) compared with that in the other cohorts (17 cases) was 0.46 (95% confidence interval 0.1 to 1.4), that of cancer of the prostate (1 v 5 cases) 0.44 (0.1 to 4.0), and that of myocardial infarction (97 v 226 cases) 1.00 (0.8 to 1.3). There was no evidence of an increase associated with vasectomy in the incidence of a range of other diseases.
Vasectomy was not associated with an increased risk of testicular cancer or the other diseases studied. With respect to prostatic cancer, while we found no cause for concern, longer periods of observation on large numbers of men are required.
Husbands and wives from 141 tubal sterilization couples and 162 vasectomy couples were interviewed just prior to sterilization and then again 1 and 2 years later. We conducted linear regression analyses to determine the pre- and poststerilization predictors of poststerilization regret in each of the four gender x method groups (tubal husbands, tubal wives, vasectomy husbands, vasectomy wives). We confirmed a number of hypotheses based on the research literature and our own earlier work. Both individual and couple factors contributed to the development of regret, as did both pre- and poststerilization factors. An important finding was the degree to which regret among the nonsterilized respondents (tubal husbands, vasectomy wives) was affected by pre- and poststerilization interaction with their spouses.
PIP
Researchers followed 303 couples who sought and then experienced sexual sterilization through the prepaid health care plan of Kaiser Foundation Hospital in Santa Clara, California for 2 years to determine pre- and poststerilization predictors of poststerilization regret. They examined regret in 4 gender x method groups (tubal husbands, tubal wives, vasectomy husbands, and vasectomy wives) by using a latent variable model of regret (LISREL) and a multiple regression analysis. The study results revealed that, prior to sterilization, predictors of poststerilization regret included respondent motivation for additional children and against sterilization, poor husband-wife communication, and much conflict during decision making, and dominance of the decision by 1 spouse. Indeed these negative effects supported a previous study with similar results which concluded that negative effects contribute considerably to the process of developing regret. These effects fit into 5 behavior fields: reproduction, marital harmony, self image, sexuality, and health. The study also found that the feelings of the spouse who was not sterilized, less motivated and less dominant were particularly sensitive to the feelings of the spouse who had a sterilization, especially when the sterilized spouse regretted having undergone sterilization. Therefore physicians should equally consider the attitude of the spouse who did not seek sterilization and realize that his/her poststerilization regret may be influenced by interactions with the often more motivated, more dominant spouse. Since at least 10% of sterilized couples regret their decision, this study should improve the understanding of this mental health issue.
Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.
The results of an operations research project that tested two models of vasectomy service delivery in Colombia show that although clinics serving only males performed a higher monthly average of vasectomies than did clinics serving men in a mixed male-female context (12 vs. nine), that difference was not statistically significant. In both types of experimental clinics, specially trained personnel offered vasectomies and other male services that were advertised and promoted; as a result, those clinics performed an average of almost twice as many vasectomies per month as did control clinics that had a traditional female orientation (10 vs. five). The number of vasectomies performed during the project increased by nearly 120 percent in the experimental clinics and by 59 percent in the control clinics. Contrary to expectations, clients of the exclusively male clinics were no more satisfied with the services they received or with their vasectomy than were clients of the mixed clinics or the control clinics.
The results of the present study show that bilaterally vasectomized rabbits with high levels of antibodies to sperm antigens frequently develop an orchitis associated with granular deposits of rabbit IgG and C3 in the basement membranes of seminiferous tubules. The immune deposits correspond in location to electron-opaque deposits seen by electron microscopy. The "membranous orchitis" is characterized by thickening of tubular basement membranes, acc-mulation of macrophages and a few polymorphonuclear leukocytes, and destruction of the basal lamina, of the Sertoli and spermatogenetic cells. The pathogenetic role of the immune deposits and the possibility that they contain antigen-antibody complexes is indicated by: (a) selective accumulation of IgG and C3 granular deposits along the basement membranes of seminiferous tubules in rabbits producing high and persistent levels of antibodies to sperm antigens; (b) the elution of immunoglobulins from tissues with chaotropic ion-containing buffers, acid buffers, or heat; (c) the observation that the immuno-globulins accumulated in the testis contain antibody to sperm antigens; and (d) the demonstration of sperm antigens in a location similar to that of IgG and C3. It is postulated that sperm antigen-antibody complexes are formed in the basement membranes of seminiferous tubules when antigens leaking out of the tubules react with specific antibody coming from the circulation. In two rabbits with higher levels of circulating antisperm antibodies and severe orchitis, granular deposits of IgG and C3 were also present in renal glomeruli. Immunoglobulins eluted from the kidneys contained antibody with antisperm activity. These findings are consistent with the hypothesis that in some vasectomized rabbits extratesticular lesions may develop by a mechanism comparable to that of chronic serum sickness.
Vasectomy techniques and failure rates vary among surgeons, and the criteria for failure are not often clearly defined. To help establish a yardstick for comparative purposes, a series of 8879 consecutive vasectomies performed with uniform technique over 24 years was reviewed. A subgroup of 5331 men who had returned for at least two postoperative semen tests—the study group—was used for follow-up analysis. Failures were defined as early or late and also were categorized as overt or technical according to the numbers, motility, or persistence of the remaining spermatozoa. There were 97 failures of all types, including 32 (0.60%) early and overt failures and 61 (1.14%) technical failures that involved the persistence of small numbers of spermatozoa, possibly of no significance. Four (0.08%) late overt failures were also seen; each of these was discovered as a result of a pregnancy, and each occurred at least four years after two azoospermic test results. Of the 97 failures, four were recognized as due to missed vasa deferentia, and the remainder were attributed to recanalization. Whether improved and reproducible failure rates can be consistently obtained by other techniques is not yet clear.
(JAMA 1988;259:3142-3144)
Six thousand ninety-two men who had undergone vasectomy were observed for 20,491 person-years of observation in a prepaid group practice. The incidences of first-time hospitalizations for a variety of diagnoses were examined as a proxy for disease incidence rates and compared with similarly derived rates in the remaining male membership of the practice. Vasectomized men had comparatively high rates of hospitalization for a variety of diseases of the genitourinary system during the early postvasectomy perlod. Apart from these, there were no important, statistically convincing elevations in the new hospitalization rates among vasectomized men, as compared with those of the nonvasectomized comparison group.(JAMA 1981;245:2315-2317)
Objective.
—To examine prospectively the relationship between vasectomy and prostate cancer.Design.
—Cohort study.Setting.
—Health professionals (dentists, veterinarians, osteopaths, optometrists, pharmacists, and podiatrists) in the United States.Participants.
—There were 10 055 male members of the Health Professionals Follow-up Study, aged 40 to 75 years, who had had a vasectomy, and 37 800 members who had not had a vasectomy at the time of study entry in 1986. These participants had provided detailed information on various life-style variables including diet.Main Outcome Measure.
—Diagnosis of prostate cancer.Results.
—Between 1986 and 1990,300 new cases of prostate cancer were diagnosed in participants who were initially free of diagnosed cancer. Vasectomy was associated with an elevated risk of prostate cancer (age-adjusted relative risk, 1.66; 95% confidence interval, 1.25 to 2.21; P=.0004). This elevated risk persisted after excluding 21 stage A1 cases (age-adjusted relative risk, 1.56; 95% confidence interval, 1.15 to 2.11; P=.004). Among men who had their vasectomy at least 22 years in the past (before 1965), the risk of prostate cancer was even higher (relative risk, 1.85; 95% confidence interval, 1.26 to 2.72; P=.002). This elevated risk among men with vasectomy did not appear to be caused by detection bias and persisted when we controlled for diet, level of physical activity, smoking, alcohol consumption, educational level, body mass index, and geographical area of residence.Conclusions.
—These results support evidence from other epidemiologic studies that vasectomy increases risk of prostate cancer. The consistency of results among various epidemiologic studies, the increase of risk over time following vasectomy, the apparent lack of confounding or bias, and the existence of physiological changes in the prostate following vasectomy suggest that the association may be causal.(JAMA. 1993;269:873-877)
Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.
PIP:
No-scalpel vasectomy was developed by Dr. Li Shunkiang in China in 1974. In 1989 Profamilia carried out 18 tubal ligations for every vasectomy procedure, and this year in Bogota the first group of Profamilia surgeons underwent training in no-scalpel vasectomy. By 1995 the ratio of tubal ligations to vasectomy dropped to 10 to 1 at the national level and to 4 to 1 in Bogota. The evaluation of no-scalpel vasectomy procedures was conducted at the Men's Clinic in Bogota covering the period of 1989-94. 7513 procedures were done by 5 trained surgeons during this period. The expected incidence of complications was 3%. A sample of 2257 was obtained for evaluation. Variations in the management of the vas deferens included: 1) 1898 cases of ligation with silk and the interposition of the fascia; 2) 227 cases of monopolar electrocoagulation and interposition of the fascia; 3) 21 cases of monopolar electrocoagulation without interposition of the fascia; 4) 9 cases of ligation with silk without interposition of the fascia; and 5) 15 other cases with some kind of technical difficulty. There were no significant differences with respect to the distinct variants. The major complications were: 1) 0.3% had hematoma, 2 cases required surgical drainage; 2) 0.26% had infection, 2 cases required surgical drainage and intravenous antibiotics for scrotal abscess; 3) 1.14% had epididymitis, a congestive type that responded well to anti-inflammatory drugs, while in some cases tetracycline was needed; 4) 0.22% had vasocutaneous fistula, which were resected without problems; and 5) 0.30% had other complications including granulomas of the cord or the scrotal wall. Only 1.27% patients had to see a doctor for postoperative pain.
Husbands and wives from 141 tubal sterilization couples and 162 vasectomy couples were interviewed just prior to sterilization and then again 1 and 2 years later. We conducted linear regression analyses to determine the pre- and poststerilization predictors of poststerilization regret in each of the four gender x method groups (tubal husbands, tubal wives, vasectomy husbands, vasectomy wives). We confirmed a number of hypotheses based on the research literature and our own earlier work. Both individual and couple factors contributed to the development of regret, as did both pre-and poststerilization factors. An important finding was the degree to which regret among the nonsterilized respondents (tubal husbands, vasectomy wives) was affected by pre- and poststerilization interaction with their spouses.
This paper contains data from a qualitative study from 218 in-depth interviews with men and women and their partners who decided to have a vasectomy in six countries: Bangladesh, Kenya, Mexico, Rwanda, Sri Lanka and the USA. It examined the key factors that led men to choose vasectomy and what role their partners played in this decision. The reasons for choosing vasectomy were similar in all of the countries despite many cultural, economic and racial differences; importantly, both men and women cited concern for the woman's health as a principal reason. However, the way in which problems were framed and, to some extent, the degree to which some reasons outweighed others differed. Women's role in the decision tended to be limited in Bangladesh and Sri Lanka, but more active in the other countries. Encouraging men to have vasectomy for their partners' sake and stressing that it is the man's 'turn' to take responsibility for family planning may be effective promotional strategies. Women's ability to support men's decision to a greater degree could be strengthened and vasectomy introduced in a light-hearted or joking way. Issues raised about multiple partners and the need for protection against sexually transmitted infection for those who are not in mutually monogamous relationships are also explored.
Serum chemistry parameters as well as levels of follicle-stimulating hormone (FSH), luteiniz- lng hormone (LH), testosterone, and sperm- immobilizing and sperm-agglutinating an- tibodies were measured prior to vasectomy and at 1.5, 3, 6, 9, and 12 months afterwards in 99 men. We did not, however, acquire a sample from every man for every point in time. Since the development of antibodies to sperm is a well-documented change that occurs in about half of vasectomized individuals, we investi- gated whether men who develop circulating antibodies exhibit any changes in serum chemistry and/or hormone levels when com- pared to those who do not. Although no men had antisperm antibodies at the time of vasec- tomy, 40.5% of the study population sub- sequently developed them. The number of men with circulating antisperm antibodies increased significantly for the first 3 to 6 months and then remained stable for the remainder of the study period. Some individuals had only agglutinating or immobilizing antibodies, but more commonly both types were found. The group of men who exhibited early antibody formation may have had slightly higher mean counts of spermato-
Data from six operations research projects in Brazil, Colombia and Mexico suggest that po- tential vasectomy clients come from a well-defined population of relatively young, well-edu- cated men who have small families and are already practicing contraception. Clients' wives and other vasectomized men are especially influential in the decision to adopt vasectomy. Pro- moting vasectomy through mass media campaigns can be particularly effective in urban cen- ters that have high-quality, accessible services. Promotion campaigns might stress the rea- sons men in these countries give for choosing vasectomy, especially its advantages over female sterilization and temporary methods, men's concern for their wife and her health, their desire to share responsibility for family planning, and the freedom from unintended pregnancy that
In this historical cohort study we identified, located, and, if living, interviewed 10,590 vasectomized men from four cities, along with a paired neighborhood control for each. The times between procedure data and interview or death ranged from under one to 41 years, with median equal to 7.9 years and with 2,318 pairs having ten or more years of follow-up. Participant reports of diseases or conditions that might possibly be related to vasectomy through an immunopathological mechanism were validated by direct contact with physicians and review of medical records. Results of this study do not support the suggestions of immunopathological consequences of vasectomy within the period of follow-up. Except for epididymitis-orchitis, the incidence of diseases for vasectomized men was similar or lower than for their paired controls.(JAMA 1984;252:1023-1029)
Objective.
—To examine the relationship between vasectomy and prostate cancer.
Fifteen epididymectomies were performed on 10 patients with post-vasectomy pain and 12 specimens were available for histopathological review. The findings were compared with those in 2 groups in which epididymectomy was performed for chronic epididymo-orchitis and epididymal cysts. The results showed that 50% of the post-vasectomy group were cured by simple epididymectomy. Pathological findings revealed features of long-standing obstruction and interstitial and perineural fibrosis which may have accounted for the pain. It is important to recognise this late complication of vasectomy and, if surgery is to be performed, to include all of the distal vas and previous vasectomy site in the excision.
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Epididymectomy was performed on 10 men with intractable post-vasectomy pain, on 7 with chronic epididymo-orchitis and 7 with epididymal cysts. The vasectomy patients had pain of mean 6 years duration, 6 months-20 years after surgery. In 9 the pain was a constant, dull ache. 5 had unilateral, and 5 bilateral epididymectomy. Only 5 were relieved of pain: 1 subsequently had orchidectomy with symptomatic improvement. The other 4 were offered orchidectomy. There was no obvious association of clinical findings with results. All 7 patients with epididymo-orchitis were relieved, although 1 required orchidectomy. 4 of the 7 with cysts had complained of pain, and all were asymptomatic after surgery. The most common pathological findings in the vasectomy patients were obstruction and dilatation of the efferent and epididymal ducts with interstitial fibrosis, and perineural inflammation and fibrosis around nerves, particularly in the tail of epididymis. So-called "late vasectomy syndrome" or unremitting pain is rare, and probable related to sperm granuloma.
Summary— Ninety-four patients undergoing vasectomy as day cases were studied prospectively. An overall infection rate of 32.9% was recorded and, apart from haematoma formation and the nasal carriage of organisms, no factors were found that increased the risk of infection. A pre-operative hibiscrub shower did not affect the infection rate, even though it was responsible for a significant reduction in skin flora. This raises the possibility of infection following vasectomy being secondary, not occurring at the time of surgery.
Much has been done to improve quality of care for women seeking family planning services,1 but less is known about quality of care for men in those services. With this in mind, researchers in Kenya designed a mystery clientstudy, in which men posed as potential vasectomy clients at clinics in different parts of the country. There was wide variation in how men were treated. Positive experiences included a courteous reception, full information on vasectomy, and private, sympathetic counselling that included discussion of other contraceptive methods. Negative experiences included ridicule, inadequate information, discomfort in describing the male body and bias against vasectomy. Real-life stories by men were found to have a positive effect on service providers and male clients; many improvements in the quality of service delivery for men are recommended.
While vasectomy is considered a safe form of male contraception judging by worldwide experience in relation to autoimmune disease benign prostatic hyperplasia cardiovascular disease and testicular cancer 2 recent retrospective case-control epidemiologic studies associate vasectomy with prostate cancer. In the U.S. prostate cancer is the 3rd highest case of male cancer mortality with 106000 cases and 30000 deaths annually. Prostate cancer has been studied very little either in terms of risk factors or as regards immunology genetics molecular biology or clinical medicine. As with surgical procedures vasectomy has rarely been subjected to risk analysis. One aspect of case-control studies known to statisticians is a form of "regression toward the mean" where high risk ratio values are selected out because of their extreme severity and believed to be strong associations. Often as more studies are completed the risk levels out toward lower ratios to to unity. The notorious example is the case of reserpine and breast cancer found to have a 3.5 risk ratio in the 1st published study but not replicated in 14 succeeding studies. In the case of vasectomy there is a potential bias for men vasectomized 20 or more years ago as part of a treatment for prostate cancer. More studies are needed to pinpoint this potential risk.
Out of 11 136 Japanese men identified on the island of Oahu, Hawaii in 1965 by the Honolulu Heart Program, 8006 responded to a mailed questionnaire and were examined. Some 1871 responded only to the mailed questionnaire, and 1259 did not respond at all. After 15 years of follow-up, the examined men had significantly lower risk of death from all causes and death from cancer. Minor differences were also noted between the two groups in the risk of cancer of the lung, stomach, colon, and rectum. However, the examined men had a significantly higher risk of prostate cancer. In general, the strength of these non-response effects was mainly due to risk differences in the first five years of the 15-year follow-up period. The relative risk (RR) of each of the seven endpoint events tended towards 1.0 as each of the three successive five-year follow-up intervals were considered. An exception to this was the prostate cancer incidence RR which favoured the unexamined men throughout the entire 15 years, but significantly so only in the last five-year follow-up interval. When the 8006 examined and 1871 unexamined men who responded to the mailed questionnaire were evaluated with respect to the association of cigarette smoking with lung cancer incidence, the RR for smokers was 9.77 for the examined men, and 6.73 for the unexamined men. Since these RRs are not significantly different, there should be little bias in RR estimates of cigarette smoking for lung cancer if the observation was limited to only the examined men. With regard to the association of body mass index (BMI) with colon cancer in older men, the RRs for men in the highest BMI quintile were quite comparable, at 1.37 for the examined group and 1.60 for the unexamined men. We conclude that although some non-response effects on cancer incidence exist in this cohort, they do not appear to be serious enough to have changed conclusions drawn about risk relationships.
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Data from studies examining the effects of vasectomy in a large number of nonhuman primates vasectomized for periods ranging up to 14 years are summarized, and these findings and speculations are used as a framework with which to review the subject of autoimmunity and vasectomy. Attention is directed to autoimmunity to sperm antigens following vasectomy (factors affecting antisperm antibody levels, characteristics of circulating antisperm antibodies, antisperm antibodies in seminal plasma, and cellular immunity following vasectomy), and immunopathology of antisperm autoimmunity (local effects on the male reproductive tract and systemic effects on the male reproductive tract). The 6 hypotheses that have been advanced to explain individual variations in dynamics and types of antisperm antibodies produced following vasectomy are reviewed. 3 tests are commonly used to detect free antisperm antibodies after vasectomy: 1) the spermagglutination test; 2) the sperm immobilization test; and 3) the immunofluorescence test. Spermagglutinating (SA) antibodies, the most common type of antibody produced after vasectomy, occur in approximately 2/3 of vasectomized men and in a majority of vasectomized rhesus monkeys. Sperm-immobilizing (SI) antibodies are also produced in a large percentage (40%) of vasectomized men and rhesus monkeys. About 30% of vasectomized men also have antiprotamine antibodies.
Contradictory experimental results (both animal and human studies) of vasectomy effects on testis the epididymis and sperm transport and vasectomy reversal are reviewed. Recovery of fertility correlated with return of normal sperm counts and seminal fluid quality in the vas deferens on the testicular side of the obstruction at the time of vasovasostomy. 3 important factors influencing return of fertility after surgical reanastomosis are: 1) meticulous microscopic technique for reconnection (1 is presented with accompanying figures and photographs of the surgical technique); 2) duration of time the vas deferens has been obstructed (less than 10 years 19% develop normal sperm counts; more than 10 years 59%); and 3) the presence or absence of a sperm granuloma at the vasectomy site (sperm granulomas at the vasectomy site virtually ensure the presence of good quality sperm in the vas fluid at the time of vasovasostomy). If all 3 factors are favorable vasectomy may be reversible.
The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.
PIP
In an Ottawa study, 410 patients consented to open-ended vasectomy, and in a St. Louis study, 23 patients underwent open-ended vasectomy, in which the abdominal end is cauterized but the lumen on the testicular side is not ligated, clipped, or cauterized. In the Ottawa series, 3% of the patients developed no sperm granuloma and 97% did develop sperm granuloma. The Concept unit was used on 148 patients with a 4% failure rate; however, the Hemoclip application was used on 262 patients with only a 0.4% failure rate. In the St. Louis series, all 23 patients developed sperm granulomas with l case of recanalization. In 9 patients referred to St. Louis for chronic and persistent postvasectomy orchialgia with pain localized in the epididymis, the pain was relieved by vasovasostomy. Evidence indicated that heat cautery was not as efficient a method of sealing the vas as the Hemoclips due to the high failure rate.
The development of sperm agglutinins in serum and seminal plasma in relation to vasectomy was studied in forty-seven men by testing samples taken before vasectomy and on five occasions during the first year after vasectomy. Thirty additional patients were tested only 1 year after vasectomy. One year after vasectomy, sperm agglutinins in the serum in titres from 4 to about 4000 had developed in 62% of the entire group, while antibodies in the seminal fluid detectable by the gelatin agglutination test were present in only 4% of the group, and apart from on unusual case the titres were low here (either 4 or 8). Analysis of the modes of agglutination revealed changing patterns in several patients during the observation period, with a predominance of tail agglutinins after 1 year. In some cases, mixed agglutination was seen with serum but pure tail-to-tail agglutination with seminal plasma. The total number of spermatozoa in a pre-vasectomy ejaculate was found to be correlated with an early immune response and with the titre values after 1 year. The group of patients in whom agglutinins had developed 1 year after vasectomy were found to have significantly larger nodules at the sites of operation than those without sperm agglutinins.
Semen parameters were analyzed in a series of 76 men pre- and postvasectomy. The mean volume decrease was 0.66 ml but it was 0.5 ml or more for only 53% of subjects. A decrease in the number of spermatozoa was correlated primarily with the number of ejaculations. In nearly all cases the total number of spermatozoa contained in all semen samples examined after vasectomy was clearly lower than the average number contained in only one ejaculation prior to vasectomy. Motile spermatozoa were never observed after the 15th day following vasectomy. The reappearance of motile spermatozoa after that time was an almost certain sign of a defect in the vas block or of recanalization of the vas deferens.
A battery-powered, bipolar electrocoagulator has been specifically developed for sealing the cut ends of the divided vas at vasectomy. With a minimum of electric power, the electrocoagulator destroys only the mucosa and one or two muscle cell layers of the vas, which leads to optimal fibrosis of the cut ends. This instrument has been used in more than 1000 vasectomies without a known failure and with a minimum of complications. An analysis of these cases is reported with emphasis upon the method's success in sealing the vas.
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Experience with the bipolar needle in the 1st 1000 cases is reported. All vasa were electrocoagulated with the battery-powered, bipolar electrocoagulator under local anesthesia in the office. This instrument requires a minimum of electric power and destroys only the mucosa and 1 or 2 muscle cell layers. The patients ranged in ages between 20 and 68 (82.5% were between the ages of 20 and 40). The number of living children whom these men had fathered ranged from 0 to 9 (53.2% had 2 children and 9.4% had 4 or more). The analysis confirms the statement that the electrocoagulation, fascial interposition technique has never failed in the author's hands. When the results are compared with ligation and monopolar techniques, the figures cited for wound infection, hematomas, and congestive epididymitis are so similar that they prove the only difference is in the type of cautery used. The low incidence of granulomas (.4%) indicated that the bipolar needle is an effective instrument for sealing the cut vas without ligatures, clips, or other devices.
The authors report the findings from an on-going of 1764 vasectomized men followed up by means of the Scottish medical record linkage system for a total of 4500 man-years after operation. The authors view the results so far as reassuring regarding the safety of vasectomy, although the mean length of follow-up (2.6 years) is still short. The study will continue. Some features of this method of follow-up are described and discussed.
Cell-mediated immunity (CMI) to homologous spermatozoal antigens was studied in sixty-two males following vasectomy of a duration of 1-10 years. A group of twenty-two normal, fertile non-vasectomized males was also included in the study. The inhibition in the leucocyte migration test (LMT), in the presence of spermatozoal antigen, was taken as an index of CMI. Twenty of the sixty-two vasectomized males (32.2 percent) showed a positive LMT reaction. When the results were analysed with reference to the duration of vasectomy, it was noted that four cases each (22.2 percent), showed a positive LMT reaction in the groups 0-2 years, and 3.5 years. On the other hand twelve cases gave a positive reaction in the group 6-10 years (46.1 percent). It appears that the incidence of CMI to spermatozoa increases with the duration in vasectomy.
This study was done to determine if there was a difference in results when both vas ends were closed or when the prostatic end was closed and the testicular end left open. The author performed 6220 vasectomies between June 1, 1972 and June 1, 1992. The first series consisted of 3081 vasectomies in which both ends of the vas deferens were closed. The second series consisted of 3139 vasectomies in which the testicular end of the vas deferens was left open while the prostatic end only was closed. No portion of the vas was excised. Congestive epididymitis was diagnosed in 6% of cases utilizing closed-end vasectomy and 2% of cases where the open-end vasectomy was performed. Open-end vasectomy is recommended because the incidence of congestive epididymitis is reduced.
Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health.
We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not.
Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level.
Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study.
A case is presented of a healthy young man who had Fournier's gangrene after standard bilateral vasectomy. Despite maximal treatment, including extensive necrectomy and broad-spectrum antibiotics, this complication was lethal. To our knowledge a lethal complication of vasectomy has not been reported in the literature.
PIP
A health practitioner performed a standard bilateral vasectomy on a 33-year old male who did not suffer from an immunodepressed state. No complications arose and bleeding was minimal during the vasectomy. 2 days later, he visited a physician with a fever of 39 degrees Celsius and wound reaction. The physician prescribed oral floxacillin, but the following day he suffered acute septic shock and was admitted to a hospital. The incision site was red due to congestion of capillaries, purple, swollen, and painful. Physicians ruled out prostatitis, abscess formation, and a pulmonary source as causes of the fever. The white blood cell count, potassium, creatinine, and glucose levels were very high. Physicians administered parenteral broad spectrum antibiotic treatment (imipenem/cilastatine and metronidazole) even though the blood, urine, and sputum cultures grew no pathogens. They found and evacuated hematoma and necrotic tissue from the vasectomy sites. They placed silicone drains in the sites. Within the next 24 hours, necrosis developed in the scrotum while his clinical condition declined rapidly. He suffered a cardiac arrest. They transported him to the University Hospital in Leiden, the Netherlands where physicians did a necrotomy of the scrotal, penile, and perineal skin and removed both testes. 100 colonies of Streptococcus hemolytic group A, 10-100 colonies of Escherichia coli, and 10 colonies of Staphylococcus epidermidis grew in the cultures of tissue removed at the other hospital. Yet cultures from tissue removed at the University Hospital were negative. No anaerobic bacteria colonies grew. The physicians administered penicillin, ceftazidime, and floxacillin based on antibiotic sensitivity testing results. They also began hemodialysis. 24 hours after necrotomy and bilateral orchiectomy, the necrotizing process had not spread. Yet 13 hours later and 5 days after the vasectomy, the patient succumbed. This case was the 1st known fatal complication of vasectomy. The diagnosis was scrotal gangrene of Fournier.
The relationship of vasectomy to prostate cancer was studied in 5,119 men men with a self-reported history of vasectomy, identified at multiphasic health checkups undergone during 1977-82 while members of the Northern California Kaiser Permanente Medical Care Program. Three unvasectomized comparison subjects were identified for each vasectomized man, matched for age, race, marital status, and date and location of the examination. Follow-up for incident prostate cancer was conducted for a mean length of 6.8 years. The relative risk of prostate cancer associated with vasectomy was 1.0 (95% confidence interval = 0.7 - 1.6); the relative risk was approximately one, regardless of length of interval (less than 10 years, 10-20 years, more than 20 years) between vasectomy and multiphasic health checkup or the age at vasectomy (less than 40 years vs more than 40 years). These data support earlier findings reported in this study group of the lack of an association of vasectomy with subsequent risk of prostate cancer.
No-scalpel vasectomy was developed to increase acceptability of vasectomy by elimination of the fear of the incision. Although this method has been used for over 8,000,000 men, the technique is largely unknown in developed countries. During the King's birthday vasectomy festival no-scalpel vasectomy was compared with standard incisional vasectomy in 1203 patients. An average of 57 procedures per day could be done by each physician with the no-scalpel method, compared to 33 procedures with the standard method (p less than 0.001). The complication rate was 0.4/100 procedures for no-scalpel vasectomy compared with 3.1/100 for standard vasectomy (p less than 0.001). No-scalpel vasectomy is a rapid and economic alternative to standard vasectomy, with fewer complications and increased patient acceptability.
PIP
No-scalpel vasectomy was developed to increase acceptability of vasectomy by elimination of the fear of the incision. Although this method has been used for over 8,000,000 men, the technique is largely unknown in developed countries. During the King's birthday vasectomy festival no-scalpel vasectomy was compared with standard incisional vasectomy in 1203 patients. An average of 57 procedures per day could be done by each physician with the no-scalpel method, compared to 33 procedures with the standard method (p 0.001) The complication rate was 0.4/100 procedures for no-scalpel vasectomy compared with 3.1/100 for standard vasectomy (p 0.001). No scalpel vasectomy is a rapid and economic alternative to standard vasectomy, with fewer complications and increased patient acceptability. (Author's).