ArticleLiterature Review

Risks and Complications of Vasectomy

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Abstract

Vasectomy is a safe and effective procedure for permanent contraception. Vasectomy is 30 times less likely to fail and 20 times less likely to have postoperative complications than its gynecologic counterpart. Complications from vasectomy are rare and minor in nature. Immediate risks include infection, hematoma, and pain. Complications seldom lead to hospitalization or aggressive medical management. Technique is surgeon dependent; however, certain techniques, such as fascial interposition, seem to decrease rates of vasectomy failure. Despite myriad vasectomy techniques, failure rates are less than those seen with tubal ligation. Available data suggest that vasectomized men do not seem at increased risk for immune-complex diseases.

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... OCP services understanding and use remains suboptimal in LMICs [2, 12,14] and, while available, SR HR services are difficult to provide [15,16,17,18], including lack of confidentiality, information lapse, lack of finances, cultural and societal stigma, Women-oriented services offered by OCP providers and dissatisfaction [15,16,17,18]. While the development of a young environment for OCP resources and access to tools has been improved, more efforts are needed [19]. ...
... OCP services understanding and use remains suboptimal in LMICs [2, 12,14] and, while available, SR HR services are difficult to provide [15,16,17,18], including lack of confidentiality, information lapse, lack of finances, cultural and societal stigma, Women-oriented services offered by OCP providers and dissatisfaction [15,16,17,18]. While the development of a young environment for OCP resources and access to tools has been improved, more efforts are needed [19]. ...
... The high cell phone coverage rates seem definitely clever and feasible to increase the penetration of OCP services. It shows that text messaging procedures can alter behavior in both the shortest and the longest possible times and enhance the outcomes of substance smoking [25,26], physical activity and obesity [13,14,15,16,17,18,19], diabetes, self-control of asthma, adherence to hypertensive medication and to the Hours [27,28,29,30,31,32,33,34]. This is because, despite various types of telephones, many people can access text messages. ...
Article
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There are several applications in use worldwide which improve sexual and reproductive health (OCP) among young people using mobile technology but none of these applications are in Arabic language. Mobile apps reflect a feasible and productive way to improve access in low and middle income countries to OCP services and resources. This paper describes the development of mobile application to help women to choose the best contraception, a responsive and distribution application for mobile sexual and reproductive health services aimed at raising the demand for HRS services for women in Jordan. Methods: The research uses robust measurement techniques to determine the effect of the mobile app. In order to detect the causal influence of the mobile app to raise awareness and increase usage of sexual and reproductive health services, we recommend a randomized control sample. The principal consequence of the impact assessment is the improvement in the percentage of OCP and instruments, OCP and sexual behavior. The app model is also tested and results were recorded. Aim: The study aims to illustrate the idea that a mobile application can be used to guide women to choose the best contraception and to raise awareness among Women in Jordan and increase the use of OCP resources and services. The results of the study will lead to the creation of a demand-based, cultural and user-friendly mobile app that enhances OCP services for Women in Jordan and worldwide.
... It should be stressed that reproductive coercion such as forced non-use of condoms and sabotage of the withdrawal method of contraception are comparable to violent crime [53]. Vasectomy is a safe, simple J Add Pre Med and effective method of permanent contraception; it was reported to be 30 times less likely to fail and 20 times less likely to have postoperative complications than tubal ligation in women [62] and may be a viable solution for some males (incapable to control their behavior and consistently use condoms), although it does not eliminate the necessity of condoms to prevent STI. Complications of vasectomy are rare and minor in nature. ...
... Complications seldom lead to hospitalization or aggressive medical management. In particular, vasectomized men do not seem to have elevated risk of immune-complex diseases [62]. A populationbased case-control study showed no association between prostate cancer and vasectomy and neither a meta-analysis provided evidence of such association. ...
... It should be stressed that reproductive coercion such as forced non-use of condoms and sabotage of the withdrawal method of contraception are comparable to violent crime [53]. Vasectomy is a safe, simple and effective method of permanent contraception; it was reported to be 30 times less likely to fail and 20 times less likely to have postoperative complications than tubal ligation in women [62] and may be a viable solution for some males (incapable to control their behavior and consistently use condoms), although it does not eliminate the necessity of condoms to prevent STI. Complications of vasectomy are rare and minor in nature. ...
Article
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The full text is available at: https://elynspublishing.com/index.php/journal/article/high-abortion-rate-in-russia-on-the-role-of-condom-use-and-alcohol-misuse The full text file available here is merged with a plagiarizied article published 2019. Claimed DOI: 10.31579/2688-7517/003
... Failure is only one of a number of potential complications associated with vasectomy. Bleeding, hematoma formation, infection, sperm granuloma, chronic pain or orchitis, fistula and psychological distress have all been reported following vasectomy (18)(19)(20)(21)(22). There has been a concern that vasectomy is associated with a higher risk of prostate cancer, testicular cancer, mortality or cardiovascular risk, but expert review of these publications and follow-up studies have concluded these risks are not substantially increased following vasectomy (4,22). ...
... Hematoma formation is the most common complication immediately following vasectomy. Hematoma and bleeding are documented to occur in 0-29% of patients with an acceptable rate of 2% (4,5,18). Physicians performing fewer than ten vasectomies annually have a reported 3 times greater rate of hematoma compared to physicians performing more than 50 vasectomies annually (23). ...
... The quoted risk for an infection following vasectomy is 3.4% (18,19). Antibiotics are not indicated for the standard vasectomy (4). ...
Article
Vasectomy provides a long-term effective sterilization for men and is performed on nearly 500,000 men annually in the United States. Improvements in technique have led to a decreased failure rate and fewer complications, although significant variations in technique exist. Use of cautery occlusion with or without fascial interposition appears to have the least failures. A no-scalpel approach lowers risk of hematoma formation, infection and bleeding post-operatively. A patient can be considered sterile when azoospermia is achieved or the semen analysis shows less than 100,000 non-motile sperm per milliliter. Incorporating these principles may allow the physician to optimize outcomes in vasectomy.
... Induction of autoantibodies against spermatozoa is a frequent complication of vasectomy in man and animals (Bigazzi, 1981;Adams and Wald, 2009;Lustig et al., 2014). Vasectomy in men produces autoantibodies to sperm antigens at a prevalence of 60-70% at 5-6 months after vasectomy (Adams and Wald, 2009). ...
... Induction of autoantibodies against spermatozoa is a frequent complication of vasectomy in man and animals (Bigazzi, 1981;Adams and Wald, 2009;Lustig et al., 2014). Vasectomy in men produces autoantibodies to sperm antigens at a prevalence of 60-70% at 5-6 months after vasectomy (Adams and Wald, 2009). Whether the autoimmunity to sperm antigens can also trigger epididymal pathology remains unknown as epididymal biopsy is not indicated, but this issue may gain relevance in cases of re-fertilization by vasovasostomy (Francavilla and Barbonetti, 2017). ...
Article
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Background: Infection and inflammation of the reproductive tract are significant causes of male factor infertility. Ascending infections caused by sexually transmitted bacteria or urinary tract pathogens represent the most frequent aetiology of epididymo-orchitis, but viral, haematogenous dissemination is also a contributory factor. Limitations in adequate diagnosis and therapy reflect an obvious need for further understanding of human epididymal and testicular immunopathologies and their contribution to infertility. A major obstacle for advancing our knowledge is the limited access to suitable tissue samples. Similarly, the key events in the inflammatory or autoimmune pathologies affecting human male fertility are poorly amenable to close examination. Moreover, the disease processes generally have occurred long before the patient attends the clinic for fertility assessment. In this regard, data obtained from experimental animal models and respective comparative analyses have shown promise to overcome these restrictions in humans. Objective and rationale: This narrative review will focus on male fertility disturbances caused by infection and inflammation, and the usefulness of the most frequently applied animal models to study these conditions. Search methods: An extensive search in Medline database was performed without restrictions until January 2018 using the following search terms: 'infection' and/or 'inflammation' and 'testis' and/or 'epididymis', 'infection' and/or 'inflammation' and 'male genital tract', 'male infertility', 'orchitis', 'epididymitis', 'experimental autoimmune' and 'orchitis' or 'epididymitis' or 'epididymo-orchitis', antisperm antibodies', 'vasectomy'. In addition to that, reference lists of primary and review articles were reviewed for additional publications independently by each author. Selected articles were verified by each two separate authors and discrepancies discussed within the team. Outcomes: There is clear evidence that models mimicking testicular and/or epididymal inflammation and infection have been instructive in a better understanding of the mechanisms of disease initiation and progression. In this regard, rodent models of acute bacterial epididymitis best reflect the clinical situation in terms of mimicking the infection pathway, pathogens selected and the damage, such as fibrotic transformation, observed. Similarly, animal models of acute testicular and epididymal inflammation using lipopolysaccharides show impairment of reproduction, endocrine function and histological tissue architecture, also seen in men. Autoimmune responses can be studied in models of experimental autoimmune orchitis (EAO) and vasectomy. In particular, the early stages of EAO development showing inflammatory responses in the form of peritubular lymphocytic infiltrates, thickening of the lamina propria of affected tubules, production of autoantibodies against testicular antigens or secretion of pro-inflammatory mediators, replicate observations in testicular sperm extraction samples of patients with 'mixed atrophy' of spermatogenesis. Vasectomy, in the form of sperm antibodies and chronic inflammation, can also be studied in animal models, providing valuable insights into the human response. Wider implications: This is the first comprehensive review of rodent models of both infectious and autoimmune disease of testis/epididymis, and their clinical implications, i.e. their importance in understanding male infertility related to infectious and non-infectious/autoimmune disease of the reproductive organs.
... It is known that autoimmunity to sperm can result from inflammation of testicles (orchitis), both of infectious and non-infectious origin [13][14][15]20,21,23,32,44,[46][47][48][49][50][51][52]. Commonly, non-infectious orchitis occurs in traumas (including biopsy, invasive procedures, and surgical intervention, such as vasectomy in 20-30% cases). ...
... Varicocele is traditionally considered a potentially curable cause of male infertility, and varicocelectomy still serves as the gold standard of treatment; however, surgical intervention often fails to restore fertility and improve semen analysis, so the outcome of the operation remains poorly predictable [24,51,76]. Earlier, ASAs were not considered as a factor that negatively affects the result of surgical treatment, but nowadays, many re-searchers have reported an increase of ASA levels after surgical intervention [42,43,50,78,80,86,116,[119][120][121]. ...
Preprint
Full-text available
According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility often is associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction, thus preventing ovum fertilization. Infertility diagnosis requires mandatory check for the ASAs. The concept of blood-testis barrier currently is re-formulated with emphasis of informational paracrine and juxtacrine effects, rather than simple anatomical separation. Aetiology of male infertility includes both autoimmune and non-autoimmune diseases, but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter blood-testis barrier facilitating ASAs production as well. There are contradictory data on the role of ASAs in pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to “danger concept” mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypoandrogenism and hypothyroidism also facilitate ASAs production. Diagnostic value of various ASAs was not yet clearly attributed, and their cut-levels not agreed neither in sera nor in ejaculate. The assessment of the autoimmunity role in pathogenesis of male infertility is ambiguous.
... It is known that autoimmunity to sperm can result from inflammation of testicles (orchitis), both of infectious and non-infectious origin [13][14][15]20,21,23,32,44,[46][47][48][49][50][51][52]. Commonly, non-infectious orchitis occurs in traumas (including biopsy, invasive procedures, and surgical intervention, such as vasectomy in 20-30% cases). ...
... Varicocele is traditionally considered a potentially curable cause of male infertility, and varicocelectomy still serves as the gold standard of treatment; however, surgical intervention often fails to restore fertility and improve semen analysis, so the outcome of the operation remains poorly predictable [24,51,76]. Earlier, ASAs were not considered as a factor that negatively affects the result of surgical treatment, but nowadays, many re-searchers have reported an increase of ASA levels after surgical intervention [42,43,50,78,80,86,116,[119][120][121]. ...
Article
Full-text available
According to global data, there is a male reproductive potential decrease. Pathogenesis of male infertility is often associated with autoimmunity towards sperm antigens essential for fertilization. Antisperm autoantibodies (ASAs) have immobilizing and cytotoxic properties, impairing spermatogenesis, causing sperm agglutination, altering spermatozoa motility and acrosomal reaction , and thus preventing ovum fertilization. Infertility diagnosis requires a mandatory check for the ASAs. The concept of the blood-testis barrier is currently re-formulated, with an emphasis on informational paracrine and juxtacrine effects, rather than simple anatomical separation. The eti-ology of male infertility includes both autoimmune and non-autoimmune diseases but equally develops through autoimmune links of pathogenesis. Varicocele commonly leads to infertility due to testicular ischemic damage, venous stasis, local hyperthermia, and hypoandrogenism. However, varicocelectomy can alter the blood-testis barrier, facilitating ASAs production as well. There are contradictory data on the role of ASAs in the pathogenesis of varicocele-related infertility. Infection and inflammation both promote ASAs production due to "danger concept" mechanisms and because of antigen mimicry. Systemic pro-autoimmune influences like hyperprolactinemia, hypo-androgenism, and hypothyroidism also facilitate ASAs production. The diagnostic value of various ASAs has not yet been clearly attributed, and their cut-levels have not been determined in sera nor in ejaculate. The assessment of the autoimmunity role in the pathogenesis of male infertility is ambiguous, so the purpose of this review is to show the effects of ASAs on the pathogenesis of male infertility.
... Risks of surgical contraceptive methods include pain or infection at surgical site. Postoperative complications for sterilization procedures, such as vasectomy, are rare and minor in nature (Adams and Wald, 2009). It is estimated that overall, 15% of vasectomies resulted in post-surgery pain, with higher rates (24%) reported among those with a scalpel vasectomy compared to those having a vasectomy using non-scalpel techniques (7%) (Auyeung et al., 2020). ...
... As discussed in the Benefit Coverage, Utilization, and Cost Impacts section, the projected increase in vasectomy utilization postmandate would result in a decrease in female sterilization procedures (235 enrollees). In the absence of undergoing female sterilization, these enrollees would avoid risks (although rare) associated with surgical contraceptive methods such as pain, infection, or postoperative complications (Adams and Wald, 2009;Cook et al., 2007). ...
Technical Report
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The version of California Senate Bill (SB) 523 analyzed by CHBRP (amended March 16, 2021) would require health plans and policies, including MediCal managed care plans, to expand coverage for contraception to include all U.S. Food and Drug Administration (FDA)-approved contraceptives for men and women, male sterilization procedures, and certain clinical services. The bill also removes the requirement for a prescription to obtain coverage of FDA-approved over-the-counter (OTC) contraceptives. SB 523 requires coverage without cost sharing or out-of-pocket (OOP) expenses for these additional benefits and explicitly prohibits health plans and policies from imposing medical management techniques to access coverage.
... Complications after vasectomy are rare, but 10-15% of men may suffer from chronic post vasectomy pain in their testicle(s) or groin. Epididymal congestion post vasectomy is one possible mechanism for the chronic pain and therefore vasectomy reversal has become a viable treatment option [23,29]. ...
Article
Full-text available
The management of patients suffering with chronic testicular and groin pain is very challenging. With increased awareness of men’s health, more patients and clinicians are open to talk about this complex problem that affects over 100,000 men/year. The pathogenesis of chronic orchialgia is still not clear, but there are several postulated theories. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide permanent durable pain relief. The goal of this article is to review and discuss the management of patients with chronic orchialgia using currently available literature.
... It happens gradually, and we should avoid placing the male with breeding females soon after surgery[19]. There are also sperm granuloma formation at the vasectomy site and orchitis that contribute to infertility, as well as oxidative stress that leads to apoptosis, but no one knows for sure the pathogenesis of post-vasectomy infertility[1,9]. Sperm granuloma formation is directly linked to the effective reduction of spermatogenesis. ...
Article
Full-text available
Background: Cuniculus paca is the second largest neotropical rodent. It is not endangered, but your habitat has been destroyed and the specie has been hunted, because of its prized meat. In this context captive breeding is an alternative to reduce the hunt. Then, adult male vasectomy is an interesting alternative for Cuniculus paca since the animal does not lose libido and maintain cyclicity of females into the enclosure. This technique is a method of sterilization which the vas deferens is surgically clamped, cut, or otherwise sealed and thus prevents the release of sperm when a male ejaculates. The aim of this study was to describe the vasectomy technique on a male spotted paca kept in captive. Case: A captive adult male of Cuniculus paca, lived in Brazilian wild fauna breeding for scientific research. It was maintained on precinct with no other animal, ate fruits, vegetables, tubers and rodent chow and water offered ad libitum. It was submitted to bilateral vasectomy to maintain reproductive behavior on bevy, but not impregnate females. The anaesthesia was performed using ketamine hydrochloride (25 mg/kg IM) and midazolam (0.5 mg/kg IM) as premedication, and iso-flurane in open system by facemask diluted in 100% O 2 for induction and maintenance. Immediately after induction, was performed epidural anesthesia using 4 mg/kg of lidocaine hydrochloride without vasoconstrictor associated in the same syringe with 0.2 mg/kg of methadone hydrochloride to promote analgesia. As the testes in this species are inside the abdomen , the surgical approach was made by paraprepucial skin incision and ventral midline abdominal incision. After access the cavity, the testes were located and the vaginal tunics were incised to access the vas deferens. After exposed, both were doubly ligated, sectioned and removed a segment of approximately 1 cm of each duct. Finally, the occlusion of subcutaneous and muscle layers were made using 2-0 absorbable and skin with 2-0 non-absorbable sutures. Postoperatively, benzathine penicillin (30,000 IU/kg IM once), tramadol (4 mg/kg IM once) and meloxicam (0.3 mg/kg SC SID for 3 days) were administered. Ten days post-surgery, the animal was fully recovered and after twenty days, it was transferred to enclosure of females. None were fertilized after vasectomy, and there was no change in reproductive behavior among individuals. Discussion: Zoos and breeding have a problem when animal population increases too much, thus vasectomy is an important alternative to avoid this, because it does not lose sexual behavior, but cannot impregnate. The spotted paca presented intracavitary testicles without elevation Skin evidence to scrotum formation, however may also present inguinal regions testes beside penis or scrotum, most evident in reproductive season, similarly occurs in rats and agoutis. In the present case was performed bilaterally vasectomy to have satisfactory results for spermatogenesis reduction, confirming was indicated by some studies in rats and rabbits. Some studies in monkeys and rodents showed that after some time the spermatic cells decrease. In the present study sexual behavior and quality of patient ejaculate, were not completely monitor, to not interfere on management, but there was no female fertilized in a period of 1 year. This procedure showed to be feasible and an easy implementation for maintenance of the estrous cycle of females.
... Third, the new morbidity diagnosis, SIM, allows clinicians and researchers to classify many cases of postabortion bleeding and cramping that do not meet the clinical criteria for RPOC (AE) or hematometra (morbidity). Fourth, the framework further standardizes the elements of an abortion incident to allow comparisons with other minimally invasive clinical procedures performed in outpatient settings such as vasectomy [44,45], colonoscopy [46] or endoscopy [47]. Furthermore, the PAIRS taxonomy may have relevance for the in-progress protocol development for standardizing abortion research outcomes with standardized incident reporting and nomenclature [48,49]. ...
Article
Objectives: To develop and validate standardized criteria for assessing abortion-related incidents (adverse events, morbidities, near misses) for first-trimester aspiration abortion procedures and to demonstrate the utility of a standardized framework [the Procedural Abortion Incident Reporting & Surveillance (PAIRS) Framework] for estimating serious abortion-related adverse events. Study design: As part of a California-based study of early aspiration abortion provision conducted between 2007 and 2013, we developed and validated a standardized framework for defining and monitoring first-trimester (≤14weeks) aspiration abortion morbidity and adverse events using multiple methods: a literature review, framework criteria testing with empirical data, repeated expert reviews and data-based revisions to the framework. Results: The final framework distinguishes incidents resulting from procedural abortion care (adverse events) from morbidity related to pregnancy, the abortion process and other nonabortion related conditions. It further classifies incidents by diagnosis (confirmatory data, etiology, risk factors), management (treatment type and location), timing (immediate or delayed), seriousness (minor or major) and outcome. Empirical validation of the framework using data from 19,673 women receiving aspiration abortions revealed almost an equal proportion of total adverse events (n=205, 1.04%) and total abortion- or pregnancy-related morbidity (n=194, 0.99%). The majority of adverse events were due to retained products of conception (0.37%), failed attempted abortion (0.15%) and postabortion infection (0.17%). Serious or major adverse events were rare (n=11, 0.06%). Conclusions: Distinguishing morbidity diagnoses from adverse events using a standardized, empirically tested framework confirms the very low frequency of serious adverse events related to clinic-based abortion care. Implications: The PAIRS Framework provides a useful set of tools to systematically classify and monitor abortion-related incidents for first-trimester aspiration abortion procedures. Standardization will assist healthcare providers, researchers and policymakers to anticipate morbidity and prevent abortion adverse events, improve care metrics and enhance abortion quality.
... In men who have undergone vasectomy and the etiology of their chronic orchialgia is thought to be due to postvasectomy pain syndrome with a physical examination suggestive of congestion associated pain with fullness of the epididymis and pain with intercourse, vasectomy reversal may be considered (14,15). Although the majority of data on RAVR is not specifically for chronic orchialgia, a number of studies have evaluated the use of the operative robot to perform RAVR for fertility restoration, and patency rates can be assessed to extrapolate to the ability to perform this operation for chronic orchialgia, with expected similar responses to microsurgical vasectomy reversal for chronic orchialgia, as it is essentially performing the same operation with a different tool. ...
Article
Chronic orchialgia is one of the most common complaints seen in the urologists office and has traditionally been considered a very difficult diagnostic and therapeutic challenge for the clinician. First line management of chronic orchialgia is conservative treatment; however, in men who fail conservative therapy, surgical intervention may be indicated. Microsurgery has been the mainstay for surgical treatment of chronic orchialgia, but the implementation of robotics to microsurgery lends itself particularly to surgical treatment of chronic orchialgia. PubMed was used to perform a current literature search on chronic orchialgia with robotic microsurgery, robotic spermatic cord denervation, robotic varicocelectomy, and robotic vasectomy reversal. Although conservative therapy is considered the first line treatment for chronic orchialgia, reported outcomes are moderate to poor, with the need to proceed to surgical intervention in select cases. Current surgical therapies in which robot assistance have been applied to microsurgery include microsurgical denervation of the spermatic cord, varicocelectomy, and vasectomy reversal. As further studies have assisted in the understanding of surgical treatment of chronic orchialgia, the application of robot assistance to this level of microsurgery has been shown to be feasible and safe with comparable outcomes to traditional microsurgery and may provide potential advantages.
... 12% aller Männer in den USA sind unterbunden [1]. 5 ...
Article
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Einführung 12% aller Männer in den USA sind unterbunden [1]. 5–7% von ihnen entwickeln erneuten Kinderwunsch. Vasektomien sind die häufigste Ursache männlicher Sterilität. Mikrochirurgische Rekonstruktionen der oberen Samenwege sind die häufigste gewählte und kostengünstigste Methode der Refertilisierung. Neu­ erwachter Kinderwunsch bei Partnerwechsel nach Vasektomie sind die häufigste, kongenitale und post­ infektiöse Verschlussazoospermie seltenere Indikationen für eine mikrochirurgische Rekonstruktion bei oberem Samenwegsverschluss. Obstruktive Azoospermie nach Trauma ist eine Rarität. Viele Kandidaten informieren sich über ihren Refertili­ sierungswunsch im Internet und können gewonnene Informationen nicht gewichten. Die vorliegende Zu­ sammenstellung der Resultate eines Operateurs soll den Hausarzt dazu befähigen, Rat suchenden unter­ bundenen Männern fundiert Auskunft geben und seine Internetinformationen gewichten zu können. Der Eingriff Die mikrochirurgische Vaso­Vasostomie (VV) (Anasto­ mose Samenleiter auf Samenleiter) ist ein tageschir­ urgischer Eingriff in Vollnarkose. Die Vas­deferens­ Stümpfe werden dargestellt und angefrischt. Falls das hodenseitige Stumpfsekret Spermien enthält und auch das prostataseitige Ende durchgängig ist, erfolgt die End­zu­End­Anastomose. Die Anastomosennaht erfolgt immer zweischichtig mittels einer inneren Mukosa­ und einer äusseren Muskularis­Naht (Abb. 1 x). Im Gegensatz zum makroskopischen Eingriff werden mi­ krochirurgisch dreimal höhere Erfolgsraten erzielt. Eine Vaso­Epididymostomie (VE) direkt an den Nebenhoden ist in einigen Fällen nötig, um spermienhaltiges Sekret zu erhalten. Eine solch hohe Anastomose ist ohne Mikroskop nicht möglich. 2–4 Stunden nach dem Ein­ griff können die Patienten die Tagesklinik verlassen. Die Arbeitsunfähigkeit beträgt 5 Tage 100%. Die Ein­ griffskosten liegen bei CHF 5000–7000 und sind nicht kassenpflichtig. Die postoperative Analgesie beschränkt sich auf Paracetamol. Postoperative Komplikationen wie Nachblutungen und Infekte sind selten und liegen durchwegs im Promillebereich. Patienten und Methoden Zwischen 1989 und 2009 wurden vom korrespondie­ renden Autoren (A. S.) als Erstoperateur 203 mikro­ chirurgische Vaso­Vaso­ bzw. Vaso­Epididymostomien durchgeführt. Messbare Erfolgsparameter sind: Durchgängigkeit der Samenwege und Schwangerschaftsrate. Ein Spermio­ gramm zur Erfolgskontrolle wird 2, 4, 6 und 12 Monate postoperativ durchgeführt. Die Samenwege gelten als offen, wenn das Ejakulat Spermien enthält. Sekundäre Verschlüsse nach postoperativ initial offenen Samen­ wegen werden auch nach 12 Monaten erfasst und in der Statistik als Misserfolg aufgeführt. Das mediane Alter der Kandidaten am Operationsdatum liegt bei 42 (27 bis 68) Jahren. Die mediane Dauer von Vas­ ektomie bis Refertilisierung beträgt 11 (1 bis 46) Jahre. Das mediane Alter der Partnerinnen liegt bei 33 Jahren. Von 203 mikrochirurgisch operierten Kandidaten sind die Daten von 180 auswertbar. Ausgeschlossen werden 12 kürzlich Operierte, noch ohne Spermiogramm­Kon­ trolle, sowie 11 Kandidaten wegen «lost to follow­up». Bei den 180 auswertbaren Fällen liegt bei 144 (80%) ein Status nach Vasektomie vor. Bei 36 Fällen sind die Gründe für den oberen Samenwegsverschluss Miss­ bildungen oder infektiös mit Status nach Epididymitis. Post­Vasektomie­Fälle werden getrennt von den miss­ bildungs­ und infektbedingten Fällen ausgewertet.
... ► contraceptivos reversíveis de longa duração ► esterilização ► menopausa ► Diu de cobre ► SIU-LNG postoperative hematoma, pain, infection and granuloma are the most common complications. 10 Due to the safety of LARC methods and DMPA, these contraceptives are excellent options for women who have completed their families and need contraception for many more years until menopause. 1,4,8 There is scarce information on the uninterrupted long-term use of LARC methods or DMPA until menopause and its relationship to the number of female or male sterilizations. ...
Article
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Introduction Women require effective contraception until they reach menopause. The long acting reversible contraceptives (LARC) and the depot-medroxyprogesterone acetate (DMPA, Depo-Provera®, Pfizer, Puurs, Belgium) are great options and can replace possible sterilizations. Purpose To assess the relationship between the use of LARCs and DMPA and terminations ascribed to menopause and sterilizations in a Brazilian clinic. Methods We reviewed the records of women between 12 and 50 years of age attending the clinic that chose to use a LARC method or DMPA. Cumulative termination rates due to sterilization or because the woman had reached menopause were computed using single decrement life-table analysis over 32 years. We also examined all records of surgical sterilization at our hospital between the years 1980-2012. Results Three hundred thirty-two women had continuously used the same contraceptive until menopause, and 555 women had discontinued the method because they or their partners underwent sterilization. From year 20 to year 30 of use, levonorgestrel intrauterine-releasing system (LNG-IUS - Mirena®, Bayer Oy, Turku, Finland; available since 1980), copper intrauterine device (IUD - available since 1980) and DMPA users showed a trend of cumulative higher discontinuation rates due to menopause when compared with the discontinuation rates due to sterilization. Over the study period, a steep decline in the use of sterilization occurred. Conclusion Over the past 15 years of research we have observed a trend: women usually preferred to continue using LARC methods or DMPA until menopause rather than decide for sterilization, be it their own, or their partners'. The annual number of sterilizations dropped in the same period. The use of LARC methods and DMPA until menopause is an important option to avoid sterilization, which requires a surgical procedure with potential complications. Thieme Publicações Ltda Rio de Janeiro, Brazil.
... Complications from vasectomy are rare and minor in nature. 16 Vasectomy acceptance and prevalence has been declining in India from 74.2% (proportion of all sterilizations) in 1970 to 4.2% in 1992 and 1% in 2016. Barriers in the organizational structure and poor access to services may contribute to the decrease in vasectomies. ...
Article
Background: Female sterilization is the most requested permanent contraceptive method worldwide and one of the most frequently performed elective, intra-abdominal surgical procedure in reproductive-age women. Even though considered as simple and safe procedure, complications do occur including death.Methods: The primary objective of the following study is to determine the demographic patterns of women presenting as sterilization complications and secondary is to evaluate possible etiological factors leading to complications and lay standard guidelines to reduce complication rate.Results: Over a decade, 103 cases of female sterilization related complications were documented, out of 14 cases (13.6%) were of laparoscopic tubal ligation and rest 89 were minilaparotomy (86.4%). In 3 cases tubal ligation was not performed as surgeon was not able to either open peritoneal cavity or find fallopian tubes due to adhesions (2.91%). In 70 cases (67.96%) sterilization were performed in primary health centre (PHC). Four patients (3.88%) required hospital stay of more than a month with longest stay being 43 days. Exploratory laparotomy with surgical intervention was done in 34 cases (33%). Two patients (1.94%) died due to tubectomy complications due to septicemia and encephalitis.Conclusions: Female sterilization is very popular and commonly performed permanent method of sterilization but complications can happen and many of them are preventable with proper screening and selection of cases with proper evaluation before surgery. There is a need to have proper training in sterilization and to stick to standards of sterilization procedure to minimize chances of complications.
... Although the condition can be alleviated by anti-inflammatories, surgical drainage, or vasovasostomy (vasectomy reversal), these interventions may not always fully improve the pain. 40 Providers should screen patients for any preoperative scrotal discomfort as this has been noted to be a risk factor for the development of chronic postvasectomy pain. 41 Regardless of the information that men receive from providers about the safety of vasectomy and the measures taken to ensure their comfort during the procedure, patients may continue to report anxiety to the extent that they request sedation. ...
... 3,27,28,49,68 Vasectomy is often associated with the development of an autoimmune response against sperm antigens, as well the appearance of sperm granulomas in the epididymis. 46,49,69,70 Epididymal Mφs and DCs are likely to be directly involved in the complex immune disturbance caused by vasectomy, 49 from the early sensing of danger signals in the distal epididymis to the late development of granulomas (masses of extravasated spermatozoa surrounded by immune cells) and sperm autoantibodies. It is worth noting that epididymal tumors are extremely rare. ...
Article
Full-text available
The onslaught of foreign antigens carried by spermatozoa into the epididymis, an organ that has not demonstrated immune privilege, a decade or more after the establishment of central immune tolerance presents a unique biological challenge. Historically, the physical confinement of spermatozoa to the epididymal tubule enforced by a tightly interwoven wall of epithelial cells was considered sufficient enough to prevent cross talk between gametes and the immune system and, ultimately, autoimmune destruction. The discovery of an intricate arrangement of mononuclear phagocytes (MPs) comprising dendritic cells and macrophages in the murine epididymis suggests that we may have underestimated the existence of a sophisticated mucosal immune system in the posttesticular environment. This review consolidates our current knowledge of the physiology of MPs in the steady state epididymis and speculates on possible interactions between auto-antigenic spermatozoa, pathogens and the immune system by drawing on what is known about the immune system in the intestinal mucosa. Ultimately, further investigation will provide valuable information regarding the origins of pathologies arising as a result of autoimmune or inflammatory responses in the epididymis, including epididymitis and infertility.
... Finally, distinguishing those adverse events and morbidity that occur at the time of the aspiration abortion procedure or recovery from those that occur after the woman leaves the facility will procedures performed in outpatient settings such as vasectomy [44,45], colonoscopy [46], or endoscopy [47]. Furthermore, the PAIRS taxonomy may have relevance for the in-progress protocol development for standardizing abortion research outcomes with standardized incident reporting and nomenclature [48,49]. ...
... La Organización Mundial de la Salud considera la vasectomía como un procedimiento quirúrgico, que incluso puede ser realizado por médicos generales, en un área quirúrgica con muy pocos requerimientos o en un consultorio privado 3,6 . Puede lograr un 30% menos de fracaso cuando se compara con la esterilización femenina y tiene una probabilidad 20 veces menor de generar complicaciones postoperatorias 7,8 . ...
Article
Full-text available
La vasectomía se ha considerado un procedimiento quirúrgico menor, máxime cuando en un alto porcentaje de las veces se puede realizar con anestesia local en un consultorio médico; sin embargo, en aquellos pacientes donde el urólogo decide programar con anestesia general se encuentra frecuentemente un fenotipo particular que ofrece dificultades tanto al cirujano como al anestesiólogo.
... Vasectomy is a safe and reliable form of contraception. 1,7 In addition to being more effective and safer than female sterilization methods, vasectomy is less expensive. 1 In terms of cost savings, it has been predicted that if the number of tubal ligations and vasectomies were equal, potential annual savings in the United States would be US$266 million in procedure cost alone and US$13 million additional savings in postoperative complication management. 1 Despite these obvious benefits, very few Western countries offer funded vasectomies, with the exception of the UK, where vasectomies are fully funded by the National Health Service and where there is stringent access to funded tubal ligation procedures. ...
Article
INTRODUCTION: Although vasectomy rates in New Zealand have been reported as among the highest worldwide, there is limited information about who is receiving these services and how they are being accessed. This information is needed to develop equitable access to vasectomy services. AIM: To describe the ethnicity and socioeconomic status of men accessing District Health Board-funded and self-funded vasectomies in Counties Manukau. METHODS: A retrospective cohort analysis of provider data linked to ethnicity and area deprivation as an indicator of socioeconomic status. RESULTS: Of 332 vasectomies, 66% were for New Zealand European men. Socioeconomic status was not associated with the number of procedures for New Zealand European men, but of the Māori and Pacific men who underwent vasectomies, most lived in the greatest areas of deprivation; 58% (18/31) and 50% (12/24), respectively. When vasectomies were funded, the number of procedures doubled for men from areas of high deprivation. The number of procedures was low for men of other ethnicities. DISCUSSION: Our findings indicate differential access to vasectomies by ethnicity and socioeconomic status. Funding vasectomies may provide community benefits in terms of improving equity in access and alleviating a financial burden for many families living in areas of high deprivation.
... La vasectomie est la cause d'infertilité masculine la plus fréquente. Aux Etats-Unis, 12% des hommes sont vasectomisés [1], et 5à7%d'entre eux développent ànouveau un désir de paternité. Les reconstructions microchirurgicales des voies épididymaires et déférentielles représentent le choix de refertilisation le plus fréquent et le moins coûteux. ...
... [62] The previous intrauterine device model (the Dalkon shield) has been associated with 66 increased risks from pelvic inflammatory conditions, although there are no risks to the current model without STI close to insertion. [67] . ...
Article
A contraindication is included in a medical treatment, it is a prescription that should be avoided for example by performing a different medical procedure or administering one or more medications or medicines or if combined with another medications, which increases the risk of deteriorating the patient's own symptoms or conditions of death. It is also part of the drug prospectus which contains the therapeutic indications. Indication is the opposite of the contraindication. An absolute contraindication is a condition in which the use of a joint treatment is categorically prohibited. This paper discusses the current methods used in contraception and its Related Studies.
... It should be stressed that vasectomy is a safe and efficient method of permanent contraception; it was reported to be 30 times less likely to fail and 20 times less likely to have postoperative complications than tubal ligation in women. Complications of vasectomy are rare and minor in nature [65,66]. Vasectomy is mentioned here because it is obviously preferable to the unintended pregnancy and abortion. ...
Article
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... 19 In human medicine, postoperative complications in the surgical site of vasectomy have been described. 20 21 Reports of complications of vasectomy in Table 1 Signalment, surgical findings and evolution of reproductive behaviour score of the four horses enrolled in the study listed in chronological order of intervention veterinary medicine are limited, but our unpublished experience with conventional vasectomy in rams also presented a relative frequency of perioperative morbidity. Laparoscopic vasectomy has been described in human medicine [22][23][24][25] and also in some animal species showing that it is a simpler, safer and quicker procedure than the conventional technique, avoiding some complications of the open surgery. ...
Article
This report describes a technique for standing laparoscopic vasectomy in stallions through a prospective descriptive study. A preliminary study was carried out with two experimental intact male horses and subsequently the procedure was performed in two clinical cases. These horse owners want to keep their animals in the most possible natural way, preserving its stallion behaviour in a herd without generating offspring. The horses were sedated and restrained in stocks and laparoscopic vasectomy was performed using three portal sites in both paralumbar fossae recording surgical times. A 4-cm segment of each ductus deferens (DD) was occluded with laparoscopic vessel sealing devices and subsequently excised. Semen collection was performed using an artificial vagina before the laparoscopic procedure and at 15 and 60 days postoperatively. Sexual behaviour and spermiogram were analysed. Two months after vasectomy, control laparoscopy was performed in experimental horses to assess the surgical site. Bilateral vasectomy could be performed without intraoperative complications in a mean surgical time of 20 min per DD. Success of the procedure was confirmed in all cases by azoospermic ejaculates 60 days after vasectomy. This is the first time that the technique for laparoscopic vasectomy is described in horses.
... 19 In human medicine, postoperative complications in the surgical site of vasectomy have been described. 20 21 Reports of complications of vasectomy in Table 1 Signalment, surgical findings and evolution of reproductive behaviour score of the four horses enrolled in the study listed in chronological order of intervention veterinary medicine are limited, but our unpublished experience with conventional vasectomy in rams also presented a relative frequency of perioperative morbidity. Laparoscopic vasectomy has been described in human medicine [22][23][24][25] and also in some animal species showing that it is a simpler, safer and quicker procedure than the conventional technique, avoiding some complications of the open surgery. ...
Article
Full-text available
This report describes a technique for standing laparoscopic vasectomy in stallions through a prospective descriptive study. A preliminary study was carried out with two experimental intact male horses and subsequently the procedure was performed in two clinical cases. These horse owners want to keep their animals in the most possible natural way, preserving its stallion behaviour in a herd without generating offspring. The horses were sedated and restrained in stocks and laparoscopic vasectomy was performed using three portal sites in both paralumbar fossae recording surgical times. A 4-cm segment of each ductus deferens (DD) was occluded with laparoscopic vessel sealing devices and subsequently excised. Semen collection was performed using an artificial vagina before the laparoscopic procedure and at 15 and 60 days postoperatively. Sexual behaviour and spermiogram were analysed. Two months after vasectomy, control laparoscopy was performed in experimental horses to assess the surgical site. Bilateral vasectomy could be performed without intraoperative complications in a mean surgical time of 20 min per DD. Success of the procedure was confirmed in all cases by azoospermic ejaculates 60 days after vasectomy. This is the first time that the technique for laparoscopic vasectomy is described in horses.
Article
Venous thromboembolic events have several known major risk factors such as prolonged immobilization or major surgery. Pulmonary embolism has rarely been reported after an outpatient vasectomy was completed. We present the rare case of a healthy 32-year-old Caucasian male with no known risk factors who presented with pleuritic chest pain 26 days after his outpatient vasectomy was performed. Subsequently, he was found to have a pulmonary embolism as per radiological imaging. We explore the association between outpatient vasectomies and venous thromboembolic events. A review of the literature is also included.
Chapter
This chapter examines the lifespan and usage of robotic microsurgical platforms in the treatment of chronic scrotal content pain and male fertility issues. Beginning with the use of the first microscope during a surgical procedure and finishing in more contemporary times, the information provided runs the gamut from addressing the use of a robotic microsurgical platform to treat varicocele, vasectomy reversal, and denervation of the spermatic cord in order to treat chronic scrotal content pain. Seminal studies within the field are introduced and the results explored. Of particular interest is the most commonly used robotic microsurgical platform, the DaVinci Robot that allows for improved prognoses, decreased surgical time once accounting for learning curve, elevated comfort of the fellowship-trained robotic microsurgeon, and decreased recuperative time on the part of patients as well as decreased risk of infection.
Article
Full-text available
The blood-epididymis barrier (BEB) is a critical structure for male fertility. It enables the development of a specific luminal environment that allows spermatozoa to acquire both the ability to swim and fertilize an ovum. The presence of tight junctions and specific cellular transporters can regulate the composition of the epididymal lumen to favor proper sperm maturation. The BEB is also at the interface between the immune system and sperm. Not only does the BEB protect maturing spermatozoa from the immune system, it is also influenced by cytokines released during inflammation, which can result in the loss of barrier function. Such a loss is associated with an immune response, decreased sperm functions, and appears to be a contributing factor to post-testicular male infertility. Alterations in the BEB may be responsible for the formation of inflammatory conditions such as sperm granulomas. The present review summarizes current knowledge on the morphological, physiological and pathological components associated with the BEB, the role of immune function on the regulation of the BEB, and how disturbance of these factors can result in inflammatory lesions of the epididymis.
Chapter
The scrotum is separated into right and left hemiscrotal compartments by a septum called the median raphe. The normal scrotal wall thickness varies between 2 and 8 mm. The scrotal wall contains the following structures: rugated skin, superficial fascia, dartos muscle, external spermatic fascia, cremasteric fascia, and internal spermatic fascia. These layers are indistinguishable on a normal clinical exam. The tunica vaginalis consists of parietal and visceral layers normally separated by 2–3 mL of straw-colored fluid often referred to as a physiologic hydrocele. On ultrasound this fluid is often seen as a thin anechoic rim around the head of the epididymis [1]. The parietal and visceral layers join at the posterolateral aspect of the testis where the tunica attaches to the scrotal wall [2].
Article
We conducted a systematic review to examine the prevalence of minor and major complications following first-trimester aspiration abortion requiring medical or surgical intervention. We searched PubMed, CINHAL, Scopus, and the Cochrane Library for articles published between 1980 and April 2015 that reported on repeat aspiration, hemorrhage, infection, cervical/vaginal trauma, uterine perforation, abdominal surgery, hospitalization, anesthesia-related complications, and death. We limited our review to studies that included ≥100 abortions performed by physicians in North America, Western Europe, Scandinavia, and Australia/New Zealand. We compared the prevalence of complications that required additional interventions for abortions performed in office-based clinics and surgical center or hospital clinic settings. From 11,369 articles retrieved, 57 studies met our inclusion criteria. Evidence from 36 studies suggests ≤3.0% of procedures performed in any setting necessitate repeat aspiration. Hemorrhage not requiring transfusion occurred in 0-4.7% of office-based procedures and 0-4.1% of hospital-based procedures, but was ≤1.0% in 23 studies. Major complications requiring intervention, including hemorrhage requiring transfusion and uterine perforation needing repair, occurred in ≤0.1% of procedures, and hospitalization was necessary in ≤0.5% of cases in most studies. Anesthesia-related complications occurred in ≤0.2% of procedures in six office-based studies and ≤0.5% of procedures performed in surgical centers or hospital-based clinics. No abortion-related deaths were reported. The percentage of first-trimester aspiration abortions that required interventions for minor and major complications was very low. Overall, the prevalence of major complications was similar across clinic contexts, indicating that this procedure can be safely performed in an office setting. Laws requiring abortion providers to have hospital admitting privileges or facilities to meet ambulatory surgical center standards would be unlikely to improve the safety of first-trimester aspiration abortion in office settings. Copyright © 2015. Published by Elsevier Inc.
Article
Portability, safety, low cost and efficiency, together with the ability to accurately define pathology rapidly, have made ultrasound the primary imaging modality for evaluation of the scrotum, testis and paratesticular structures. These factors provide for timely diagnosis and treatment. Scrotal ultrasound is particularly helpful when a physical examination is inconclusive or a disease process prevents adequate examination. The detailed imaging of ultrasonography is often an essential component of the diagnosis of a variety of symptoms including scrotal pain or trauma, infertility and abnormal findings on physical exam. This chapter will explore the techniques and protocols for performing scrotal ultrasounds in order to make the most thorough assessment of patient symptoms leading to diagnosis.
Article
Objective: This study aimed to characterize candidates undergo vasectomy in the public health system, Araçatuba- SP and to study related variables. Methods: We surveyed 300 medical patients and vasectomized contacted by telephone to assess several characteristics. The variables analyzed for the study were age, marital status, education, religion, monthly family income and per capita, number of living children, reason for seeking treatment method, contraceptive use, marital relationship quality, decision time (date of intent to perform the procedure) and not because of the procedure. Data were pooled for the analysis of results. Results: The age of the candidates ranged from 23 to 65 years (mean 36.86 years) and average 2.56 living sons. The average monthly family income was R$ 1.079,15, with average per capita income of R$ 249,07. The couple's contraception before the procedure was on account of the woman who used oral anti-conception (84%). The complication rate with the method was around 6.04%, the biggest complication was dehiscence (77.7% of cases of complications), these being mainly during the first 100 cases. Conclusion: Vasectomy is a very effective contraceptive method, with low complication rate and low cost, should be encouraged by the public health system as a means of family planning policy.
Article
Objective: This study aimed to characterize candidates undergo vasectomy in the public health system, Birigui- -SP and to study related variables. Methods: We surveyed 150 medical patients and vasectomized contacted by telephone to assess several characteristics. The variables analyzed for the study were age, marital status, education, religion, monthly family income and per capita, number of living children, reason for seeking treatment method, contraceptive use, marital relationship quality, decision time (date of intent to perform the procedure) and not because of the procedure. Data were pooled for the analysis of results. Results: The age of the candidates ranged from 25 to 50 years (mean 35.68 years) and average 2.4 living sons. The average monthly family income was R$ 1.267,45, with average per capita income of R$ 302,94. The couple's contraception before the procedure was on account of the woman who used oral anti-conception (79%). The complication rate with the method was around 8%, the biggest complication was deiscence (83,3% of cases of complications), these being manly the first 50 cases. Conclusion: Vasectomy is a very effective contraceptive method, with low complication rate and low cost, should be encouraged by the public health system as a means of family planning policy. © Todos os direitos reservados a SBRA - Sociedade Brasileira de Reprodução Assistida.
Article
No-scalpel vasectomy Introduction: Vasectomy is a safe and effective technique of male fertility control. Despite this, in the world are carried out more than double female sterilization in comparison with vasectomies, that is more pronounced in less developed countries. Aims: To present our experience and results in patients undergoing a no-scalpel vasectomy. Methods and Material: A total of 309 patients undergoing a no-scalpel vasectomy between June 2009 and May 2010 were included. For each case was record age, operative time, sperm count at 3 months post vasectomy and peri-operative morbidity. Results: 309 vasectomies were performed, 281 patients (91%) were controlled with at least one sperm count. Azoospermia was obtained in the first sperm count at 3 months in 189 patients (67%). In 81 patients (29%) were observed ≤ 100,000 sperm 100% immobile. 9 patients (3.2%) needed a second semen analysis and 2 patients a third one for less than 100,000 sperm that were 100% immobile. 6 patients (2%) consulted by minor complications such as postoperative pain, epididymitis or hematoma with spontaneous resolution. Conclusions: Vasectomy is a safe and reproducible method of male contraception, presenting an effectiveness rates higher than others contraceptive methods. There are no absolute contraindications for performing the procedure. A sperm count should be done at 3 months of the procedure. The early failure rate in our study is 0.3%.
Article
This study aimed to describe and compare semen parameters (pre-freeze and post-freezing) and antisperm antibodies of donkeys with epididymal sperm granuloma and healthy controls. Feral donkeys (n = 10) castrated in a concurrent study were enrolled in the present experiment. Three feral donkeys had unilateral granulomas, two feral donkeys had bilateral granulomas, whereas the remaining five were grossly normal. The granulomas were either single or multiple, firm, well-circumscribed, tan to red, and 1 to 5 mm in size. Upon incision, abundant, thick, tan to white-yellow fluid was recovered. Histopathology revealed epithelioid macrophages, multinucleated giant cells, and abundant sperm cell fragments with mineralized cellular debris. Each epididymis was dissected, and semen harvested for cryopreservation. Semen was assessed for sperm motility parameters, plasma membrane integrity, and mitochondrial membrane potential. All donkeys had semen cryopreserved in a standard manner. In addition, post-thaw semen from all donkeys was assessed for antisperm antibodies (IgG and IgA), acrosome integrity and morphology. After freezing, the progressive motility and percentage of sperm with an intact membrane of donkeys with sperm granuloma was lower (P = 0.04). There was no difference in total motility, morphology, damaged acrosome across groups (P > 0.05). Three donkeys with sperm granuloma (60%) displayed increased IgG and IgA antisperm antibodies. In conclusion, sperm granulomas only marginally affected sperm quality and resulted in IgG antisperm antibodies binding to sperm with damaged plasma membrane. It remains to be determined if sperm granuloma and antisperm antibodies affect fertility in donkeys.
Chapter
Portability, safety, economy, and efficiency, together with the ability to accurately and rapidly define pathology, have made ultrasound the primary imaging modality for evaluation of the scrotum, testis, and paratesticular structures. These factors provide for timely diagnosis and treatment. Scrotal ultrasound is essential in the diagnosis of testicular cancer and is particularly helpful when a physical examination is inconclusive or when the disease process prevents adequate examination. The detailed imaging of ultrasonography is often a vital component in the diagnosis of symptoms including scrotal pain, trauma, infertility, and abnormal findings on a physical exam. This chapter details the embryology of testicular development, ultrasound anatomy of testicular development, normal and abnormal scrotal ultrasound findings and clinical pearls to assist the urologist in symptom assessment and diagnosis.
Chapter
Of all sexually active couples, 12–15% are infertile. When broken down by gender, a male component can be identified 50% of the time either in isolation or in combination with a female factor. The majority of the causes of male infertility are treatable or preventable, so a keen understanding of these conditions is paramount. Despite advancements in assisted reproductive technologies, the goal of a male infertility specialist is not simply to retrieve sperm. Instead, the male infertility specialist attempts to optimize a male’s reproductive potential and thereby allow a couple to conceive successfully through utilization of less invasive reproductive techniques. Often, this involves the use of sperm or testicular tissue cryopreservation prior to fertility insult. At the same time, the male fertility specialist is wary of underlying or causal, potentially serious medical or genetic conditions that prompted reproductive evaluation. Previous research in a US male fertility clinic analyzing 1,430 patients identified causes of infertility from most to least common: varicocele, idiopathic, obstruction, female factor, cryptorchidism, immunologic, ejaculatory dysfunction, testicular failure, drug effects/radiation, endocrinology, and all others. The focus of this book on the role of reactive oxygen species (ROS) is easily applied to the majority of the listed conditions (described in detail in later chapters) which comprise this chapter’s overview of pre-testicular, testicular, and post-testicular causes of male infertility.
Article
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Vasectomy has been considered a minor surgical procedure, even more so in view of the fact that, most of the time, it can be performed under local anaesthesia in a doctor's office. However, a particular phenotype is frequently found among those cases in which the urologist decides to use general anaesthesia, that poses a challenge for the surgeon as well as the anaesthetist.
Article
Providing social housing for adult male macaques can be challenging. One successful strategy for long-term social housing of adult male macaques is to pair them with adult females; however, unwanted breeding must be prevented by sterilization of the male or female. Vasectomy is a simple, highly effective, and minimally invasive method of contraception that is used at our institution to facilitate social housing. We performed a retrospective review to analyze the surgical outcomes and rate of postoperative complications after vasectomy of adult rhesus macaques at our research facility. In addition, we evaluated the success rate of pairing vasectomized macaques with female partners. Over 10 y, 16 macaques were vasectomized, of which 5 developed postoperative complications such as orchitis, epididymitis, or surgical site infection. These complications resolved completely and without incident after antibiotic and analgesic therapy; an additional male had postoperative incisional swelling that resolved quickly after NSAID treatment. This complication rate is consistent with that in humans by surgeons who perform open vasectomies relatively infrequently. In addition, 5 of the vasectomized macaques (31%) developed sperm granulomas, which are a common and generally benign complication in humans and have been reported to develop in 40% of macaques after vasectomy. Successful pair housing with a female partner was achieved for 13 of 16 (81%) of the vasectomized macaques. We conclude that surgical vasectomy is a safe and simple procedure that can be used as a highly effective method to facilitate social housing of adult male rhesus macaques in research facilities.
Article
This study was aimed to evaluate canine vasocystotomy as a testosterone-preserving method of sterilization and investigate its potential post-operative complications. Five healthy adult male dogs underwent surgical procedure to transplant vasa deferentia to the urinary bladder. Under general anesthesia, caudal abdomen was opened and both vasa deferentia were ligated and transected. Then, the proximal free ends were sutured to mucosal layer of urinary bladder on its cranio-dorsal aspect. Serum testosterone level was measured on a weekly basis. Six-week postoperative assessments were performed including semen and urine sampling, ultrasound, contrast vasography, and tissue sampling. Statistical analyses revealed no significant differences in serum testosterone levels compared to its baseline value. Along with non-motile and broken spermatozoa, no cast or crystals were observed in urine samples. Semen analyses revealed azoospermia. No vasal obstruction or contrast leakage was observed in vasographs indicating bilateral patency in all dogs. Normal thickness of the bladder was found in ultrasounds. Histopathology showed normal testicular architecture and no inflammatory response was found in bladder or vas deferens following vasal transplantation. No significant change was found in testicular volume at the end of the study. This study suggested that vasocystostomy could be considered as an alternative method for canine sterilization with no significant changes in the testosterone concentrations and no evidence of postoperative complications. The preservation of testosterone could be regarded as an advantage and makes this approach favorable compared to the routine methods of sterilization especially for herding and guard dogs, because it prevents overpopulation while maintains the functionality.
Chapter
Chronic orchialgia can affect over 100,000 men/year. Treatment options include conservative medical therapy with NSAIDs, antidepressants, anticonvulsants, and narcotics. Surgical options such as targeted microsurgical denervation and microcryoablation can provide more permanent pain relief. This chapter presents a structured algorithm for the management of these patients. We also detail robotic microsurgical application and techniques for targeted denervation of the spermatic cord, varicocelectomy, and vasectomy reversal.
Chapter
This chapter aims to provide useful information on penile, scrotal, and testicular surgical complications, risks, and consequences. For other associated procedures, refer to the relevant chapter and volume.
Article
Objective: To evaluate the analytical performance and usability of the Trak Male Fertility Testing System, a semiquantitative (categorical) device recently US Food and Drug Administration (FDA)-cleared for measuring sperm concentration in the home by untrained users. Design: A three-site clinical trial comparing self-reported lay user results versus reference results obtained by computer-aided semen analysis (CASA). Setting: Simulated home use environments at fertility centers and urologist offices. Patient(s): A total of 239 untrained users. Intervention(s): None. Main outcome measure(s): Sperm concentration results reported from self-testing lay users and laboratory reference method by CASA were evaluated semiquantitatively against the device's clinical cutoffs of 15 M/mL (current World Health Organization cutoff) and 55 M/mL (associated with faster time to pregnancy). Additional reported metrics include assay linearity, precision, limit of detection, and ease-of-use ratings from lay users. Result(s): Lay users achieved an accuracy (versus the reference) of 93.3% (95% confidence interval [CI] 84.1%-97.4%) for results categorized as ≤15 M/mL, 82.4% (95% CI 73.3%-88.9%) for results categorized as 15-55 M/mL, and 95.5% (95% CI 88.9%-98.2%) for results categorized as >55 M/mL. When measured quantitatively, Trak results had a strong linear correlation with CASA measurements (r = 0.99). The precision and limit of detection studies show that the device has adequate reproducibility and detection range for home use. Subjects generally rated the device as easy to use. Conclusion(s): The Trak System is an accurate tool for semiquantitatively measuring sperm concentration in the home. The system may enable screening and longitudinal assessment of sperm concentration at home. Clinical trial registration number: ClinicalTrials.gov identifier: NCT02475395.
Chapter
Portability, safety, economy, and efficiency, together with the ability to accurately and rapidly define pathology, have made ultrasound the primary imaging modality for evaluation of the scrotum, testis, and paratesticular structures. These factors provide for timely diagnosis and treatment. Scrotal ultrasound is essential in the diagnosis of testicular cancer and is particularly helpful when a physical examination is inconclusive or when the disease process prevents adequate examination. The detailed imaging of ultrasonography is often a vital component in the diagnosis of symptoms including scrotal pain, trauma, infertility, and abnormal findings on physical exam. This chapter will explore the techniques and protocols for performing scrotal ultrasounds in order to make the most thorough assessment of patient symptoms leading to diagnosis.
Article
Full-text available
Autoimmune responses to meiotic germ cell antigens (MGCA) that are expressed on sperm and testis occur in human infertility and after vasectomy. Many MGCA are also expressed as cancer/testis antigens (CTA) in human cancers, but the tolerance status of MGCA has not been investigated. MGCA are considered to be uniformly immunogenic and nontolerogenic, and the prevailing view posits that MGCA are sequestered behind the Sertoli cell barrier in seminiferous tubules. Here, we have shown that only some murine MGCA are sequestered. Nonsequestered MCGA (NS-MGCA) egressed from normal tubules, as evidenced by their ability to interact with systemically injected antibodies and form localized immune complexes outside the Sertoli cell barrier. NS-MGCA derived from cell fragments that were discarded by spermatids during spermiation. They egressed as cargo in residual bodies and maintained Treg-dependent physiological tolerance. In contrast, sequestered MGCA (S-MGCA) were undetectable in residual bodies and were nontolerogenic. Unlike postvasectomy autoantibodies, which have been shown to mainly target S-MGCA, autoantibodies produced by normal mice with transient Treg depletion that developed autoimmune orchitis exclusively targeted NS-MGCA. We conclude that spermiation, a physiological checkpoint in spermatogenesis, determines the egress and tolerogenicity of MGCA. Our findings will affect target antigen selection in testis and sperm autoimmunity and the immune responses to CTA in male cancer patients.
Chapter
Making the effort to plan and prepare before the reversal can reduce potential risks and complications as well as improve patient care and reversal outcomes. Obtaining proper consent for the reversal is important to address standard as well as reversal-related risks. Preparing the patient with verbal and written pre-reversal instructions, especially regarding medications, supplements, and blood thinners, increases the chances of compliance and reduces likelihood for complications. In addition, taking the time to arrange for appropriate operating room time, preprepared surgery packs, the correct microsutures and instruments as well as a consistent surgical team ensures an easier reversal experience for both the surgeon and patient while providing better results. The most commonly used types of anesthesia by top experts are general or mild conscious sedation with local anesthesia. All together, these presurgical preparations maximize the reversal outcomes which is the ultimate goal of the surgery.
Thesis
Depuis la loi du 4 juillet 2001, la vasectomie est reconnue comme méthode de contraception masculine. Cette loi a autorisé ce geste en l'encadrant avec des règles précises et strictes. L'AFU diffuse depuis plusieurs années une fiche d'information-patient. L'accès à cette intervention reste cependant encore limité. Il n'existe pas de données publiées récentes sur la pratique de la vasectomie en France. Nous rapportons l'expérience de la vasectomie et son impact médico-économique au sein d'un centre hospitalo-universitaire. Matériels et méthodes : Étude de cohorte rétrospective monocentrique de 45 patients ayant bénéficié consécutivement d'une vasectomie contraceptive dans notre centre entre juillet 2001 et mai 2016. Pour chaque patient ont été étudiés : 1) les modalités de réalisation de l'acte, 2) le respect des recommandations de MAS et de la loi de 2001, 3) les coûts directs et indirects et les bénéfices engendrés par l'intervention pour l'établissement basés sur le libellé GHM correspondant, 4) l'efficacité du geste par l'analyse des spermogrammes de contrôle, 5) la satisfaction et le devenir des patients à l'aide d'un questionnaire téléphonique. Résultats : L'âge moyen était de 41,3 ans. La seconde consultation était réalisée dans 91% des cas. Le délai de réflexion n'était pas respecté dans 24% des cas. Le consentement écrit était signé dans 89% des cas. La congélation préventive était proposée dans 78% des cas. La vasectomie était réalisée en ambulatoire dans 73% des cas, sous anesthésie locale dans 6,7% des cas. Tous les patients ont eu une résection chirurgicale du déférent. Le coût moyen par patient était de 660,63 euros (36,8% charges directes, 30,1% charges induites, 27,3% charges indirectes, 5,8% coûts structure) pour un gain moyen de 524,50 euros soit une perte de 136,13 euros. Le spermogramme de contrôle n'était pas effectué dans 22% des cas. Parmi les patients l'ayant fait, seulement 54,3% étaient azoospermes mais le délai de 3 mois n'était pas respecté chez 23% d'entre eux. Aucun patient interrogé n'a exprimé de regret après l'intervention. Conclusion : Dans notre expérience, les recommandations issues de la loi de 2001 concernant la vasectomie n'étaient pas systématiquement suivies. Ce manque de standardisation des pratiques, potentiel reflet d'un manque d'intérêt, est à mettre en relief avec le surcoût engendré. La revalorisation de l'acte devrait être intégrée dans la réflexion d'amélioration des pratiques de stérilisation masculine.
Article
Objective: To survey urologists and family medicine physicians within a single institution to determine current vasectomy practice patterns and determine compliance with 2012 American Urological Society (AUA) vasectomy guidelines. Materials and methods: In 2016, a single institution survey was conducted to understand the vasectomy practice patterns among urologists and non-urologists. The survey questions and 3 clinical scenarios were designed based on the 2012 AUA vasectomy guidelines. Results of the survey were compiled between urologists and non-urologists and then compared to the guideline recommendations. Results: A total of 23 family medicine physicians (FMPs) and 6 urologists responded. Fewer pre-vasectomy counseling topics were discussed by FMPs compared to urologists. A variety of vasectomy techniques were used among FMPs. Vas deferens segments were more likely to be sent for histology by FMPs than urologists (65% vs. 17%, p=0.02). FMPs were more likely to send post-vasectomy semen analyses (PVSA) earlier than urologists (p=0.02) and more likely to send multiple PVSAs (p=0.006) before forgoing alternate contraceptive methods. Regarding the clinical scenario questions, FMPs were more likely to answer discordantly from guideline recommendations compared to urologists. Conclusions: Significant vasectomy practice pattern heterogeneity still exists among non-urologists surveyed within our institution. The 2012 AUA vasectomy guidelines have yet to be broadly implemented within non-urology practices. Further studies are warranted to investigate national trends in non-urologist vasectomy practice patterns and determine how the guidelines can be better implemented in non-urologic practices.
Article
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Abstract Background Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). Methods The trial was conducted between December 1999 and June 2002 with a single planned interim analysis. Men requesting vasectomies at eight outpatient clinics in seven countries in North America, Latin America, and Asia were included in the study. The men were randomized to receive vasectomy with versus without fascial interposition. All surgeons performed the vasectomies using the no-scalpel approach to the vas. Participants had a semen analysis two weeks after vasectomy and then every four weeks up to 34 weeks. The primary outcome measure was time to azoospermia. Additional outcome measures were time to severe oligozoospermia (
Article
Full-text available
This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. Data were collected through in-person interviews with 12,571 men and women 15-44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999-2002, the proportion using a method at first premarital intercourse had risen to 79 percent.
Article
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Our understanding of early post-vasectomy recanalization is limited to histopathological studies. The objective of this study was to estimate the frequency and to describe semen analysis patterns of early recanalization after vasectomy. Charts displaying serial post-vasectomy semen analyses were created using the semen analysis results from 826 and 389 men participating in a randomized trial of fascial interposition (FI) and an observational study of cautery, respectively. In the FI trial, participants were randomly allocated to vas occlusion by ligation and excision with or without FI. In the cautery study, sites used their usual cautery occlusion technique, two with and two without FI. Presumed early recanalization was based on the assessment of individual semen analysis charts by three independent reviewers. Discrepancies were resolved by consensus. Presumed early recanalization was characterized by a very low sperm concentration within two weeks after vasectomy followed by return to large numbers of sperm over the next few weeks. The overall proportion of men with presumed early recanalization was 13% (95% CI 12%-15%). The risk was highest with ligation and excision without FI (25%) and lowest for thermal cautery with FI (0%). The highest proportion of presumed early recanalization was observed among men classified as vasectomy failures. Early recanalization, occurring within the first weeks after vasectomy, is more common than generally recognized. Its frequency depends on the occlusion technique performed.
Article
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 destorys 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.
Article
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. PIP 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.
Article
We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treatment of chronic orchialgia. Microsurgical denervation of the spermatic cord was performed on 95 testicular units in 79 men (mean age 40.3 years, mean duration of pain 62 months, 16 bilateral) for chronic orchialgia. Conservative management failed in all, and patients were evaluated with an extensive medical history and physical examination. To be a candidate for microsurgical denervation of the spermatic cord each man would have responded either completely or partially to spermatic cord block (greater than 50% decrease in pain) and had no identifiable reversible etiology. Postoperative pain rating scales (0 to 10) were used to determine efficacy. Mean followup was 20.3 months (range 1 to 102 months) and complete, durable relief was noted in 67 (71%) testicular units, partial relief in 17 (17%), and unchanged in 11 (12%). No patients reported worse pain. Complications included testicular atrophy without hypogonadism in 2 patients, superficial wound infection in 2, hydrocele in 2 and an incisional hematoma in 1. Microsurgical denervation of the spermatic cord is a minimally invasive, effective and durable management option for treatment of chronic orchialgia refractory to medical management, preserving the physiological function and psychological role of the testes.
Article
The requisite presence of active spermatogenesis for antisperm antibody production may be useful in identifying obstructive azoospermia. The diagnostic performance of serum antisperm antibody was evaluated as a test for obstructive azoospermia. A total of 484 men with male infertility who had undergone antisperm antibody testing were evaluated. Demographic data, patient history, and followup were recorded. Obstruction was confirmed by surgical exploration. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated to quantify diagnostic performance. ROC curves were calculated and compared. Of 484 men 272 possessed documented obstruction of the vas or epididymis and 212 had documented infertility without azoospermia. The obstructed group had significantly increased antisperm antibody levels compared to the nonobstructed group. IgG, IgA, and IgM were analyzed as diagnostic tests for obstruction. The AUC for IgG, IgA and IgM ROC curves was 0.92, 0.85 and 0.67, respectively. The AUC for serum IgG against sperm tails was 0.92, 0.87 against sperm heads and 0.79 against sperm midpieces. IgG demonstrated the highest sensitivity (85%) with a specificity of 97% (chi-square test p <0.01). IgA possessed the highest specificity (99%), positive predictive value (99%) and positive likelihood ratio (70.0). The presence of serum antisperm antibody was highly accurate in predicting obstructive azoospermia, particularly after vasectomy. It can obviate the need for testis biopsy, the current but more invasive and costly gold standard of detection. This allows the surgeon to proceed directly to surgical reconstruction or sperm retrieval after a simple blood test.
Article
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. PIP 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.
Article
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.
Article
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.
Article
Hematoma and edema are the most frequently encountered complications of scrotal surgery. Unless properly managed, both conditions can lead to significant morbidity for the patient. A simple method is described that effectively and reliably eliminates these untoward effects for men undergoing orchiectomy, hydrocelectomy, spermatocelectomy or epididymectomy.
Article
A total of 45 patients was seen in consultation between May 1980 and April 1989 for chronic unilateral or bilateral orchialgia, defined as intermittent or constant testicular pain 3 months or longer in duration that significantly interferes with the daily activities of the patient so as to prompt him to seek medical attention. We analyzed 34 patients available for followup in terms of socioeconomic parameters, etiology and duration of pain, associated urological symptomatology, specific treatment and results of therapy. Of the patients 31 underwent surgical treatment after failing medical management (24 orchiectomies, 10 epididymectomies, 5 orchiopexies and 1 hydrocelectomy). Of 10 patients who underwent epididymectomy 9 underwent subsequent orchiectomy as definitive treatment. Of 15 patients who underwent inguinal orchiectomy 11 (73%) reported complete relief of pain, while 4 had partial relief. Of the 9 patients who underwent scrotal orchiectomy 5 (55%) reported complete relief of pain, 3 had partial relief and 1 denied improvement. On the basis of these results we recommend inguinal orchiectomy as the procedure of choice for the management of chronic testicular pain when conservative measures are unsuccessful.
Article
Previously spermatozoa in the semen of vasectomized men were reported in 62 of 63 specimens from 24 men 2 to 31 years postvasectomy (Freund and Couture, 1982). A morphologic basis and term, "microrecanalization," was proposed for this observation. Serial sections (5 mu at 200-mu intervals) of 40 specimens removed at vasovasostomy from 20 men (2 to 14 years postvasectomy) were examined and microcanals (small epithelial-lined channels) were demonstrated in 27 specimens from 18 men. In nine of the 27 specimens, spermatozoa or sperm heads were found within the microcanals. Microcanals occurred in smooth muscle, connective tissue and scar tissue, in each segment, testicular, central and abdominal, in the presence or absence of the vas deferens. Microcanal continuity was traced for 200 to 1140 microns by computerized image analysis. Microrecanalization is characterized by the absence of inflammation or sperm extravasation and is histologically distinct from vasitis nodes or sperm granuloma. Microrecanalization provides morphologic and physiologic bases for the protection of the testis and maintenance of spermatogenesis in man after vasectomy.
Article
A total of 338 specimens obtained from 182 patients undergoing reversal of previous vasectomies have been studied. The major histologic features are sprouting of tubules and extravasation of sperm. Neo-tubules grow only from the proximal end of the divided vas and were seen in 136 specimens. Sperm were present in the neo-tubules in 61 specimens, but in the lumen of the proximal vas in 88 per cent of all patients. Extravasation of sperm had occurred from the neo-tubules in 64 specimens. In 57/154 patients operated on bilaterally at the same time, regeneration was unilateral. The conclusion from the analysis of factors responsible for this selectively proximal process is that sperm secretion was probably a major factor but was certainly not the only factor responsible.
Article
Physicians in the United States were surveyed in 1983 to gather information concerning the number of vasectomies they performed in 1982 as well as their use of anesthesia and complications of those vasectomies. Most urologists performed vasectomies, whereas family physicians and general surgeons were less likely to do so. As expected, most physicians used local anesthesia, occasionally in combination with a sedative; however, 22 percent of physicians reported using general anesthesia for at least some vasectomies. Complication rates were in the ranges reported by previous case series. Physicians who performed between one and ten vasectomies in 1982 had higher rates of hematoma and hospitalization for treatment of a complication than physicians who performed more vasectomies. Maintenance of surgical skills appears to be important in preventing complications of this usually low-risk procedure.
Article
A group of 20 surgical specimens in 18 patients with a previously unappreciated syndrome of unremitting epididymal pain and induration 5 to 7 years after vasectomy was collected during a 2-year interval. These symptoms uniformly were unresponsive to conservative measures, including empiric antibiotics. Total unilateral or bilateral epididymectomy and partial vasectomy led to complete relief of symptoms, usually within 24 hours. Pathological examination of the specimens revealed features consistent with sequelae of long-standing obstruction. Recognition of this late post-vasectomy syndrome, which represents a major complication of vasectomy, might be expected to increase as cohorts of vasectomized individuals age.
Article
A 29-year-old man noticed localized painful swelling of the scrotal skin after elective vasectomy. The lesion was excised and its histologic examination revealed a diffuse inflammatory, partly granulomatous infiltrate with numerous tubular structures in the dermis and subcutaneous tissues. These ductules were lined by cuboidal epithelial cells and contained spermatozoa. The inflammatory infiltrate consisted of lymphocytes, plasma cells and histiocytes, but also contained spermatozoa and a few spermatic granulomas. These changes were the sequelae of a vasocutaneous adhesion and fistula; the ductules were the result of epithelial regeneration from the vas deferens and the inflammation with spermatic granulomas was due to extravasated spermatozoa.
Article
Reports of a series of patients having elective vasectomy a compari son of complications after the use of various techniques and an explanation of the basic role of spermatic granuloma in the process of spontaneous recanalization are presented. 432 patients who underwent vasectomy were observed for a period of 5 months or longer. 417 of the patients were followed for more than 1 year. In 288 operations the vasa were divided and the cut ends were doubly ligated with cotten; in 144 operations the vasa were divided and the cut ends were not ligated but were fulgurized with a needle electrode introduced 2 mm into the lumen of the vas. In 155 operations the cut ends of the vasa were dropped back into the wound after ligation or fulguration; in the other 277 the sheath was closed over the distal stump of the vas so that a barrier of fascia was placed between the cut ends. 1 patient requested reanastomosis during a subsequent marriage. Pain prevented only 1 man from returning to work promptly after operation. Spermatic granuloma arising from the cut end of the proximal vas occurred in 4.9% of the patients and hematomas occurred in 1.9%. Spermatic granuloma may occur at the cut end of the vas or in the epididymis shortly after or years after vasectomy. It is recommended that vasectomy be done through bilateral incisions that both ends of the sectioned vas be fulgurized and that the sheath of the vas be closed over the cut end of the distal vas. This technique should be employed in both elective and prophylactic vasectomy. Recanalization or reanastomosis occurs most frequently if the cut ends of the vas are ligated rather than fulgurized. It was noted that most psychological complications can be prevented if the patient and his wife both want the operation done if they are fully informed of the steps in the procedure before it is done and if they are assured that spermatogenesis continues and that reanasto mosis is possible.
Article
Examination of the findings of investigators during the last 30 years uncovers several points with regard to the immunological consequences of vasectomy. Serum antibodies to spermatozoa develop in humans and in monkeys after vasectomy. These antibodies have been found to persist in men for as long as 20 years. The incidence and degree of atherosclerotic changes in lower primates are increased after vasectomy. Whether vasectomy has the same effect in men has not yet been ascertained. Vasovasostomy may be ineffective in correcting sterility clinically because of persistant antisperm autoantibodies.
Article
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.
Article
The treatment of patients with chronic unilateral or bilateral orchialgia, defined as intermittent or constant testicular pain of greater than 3 months and of unclear cause, is difficult. This pain significantly interferes with the daily activities of the patient. We have seen 12 patients with chronic orchialgia of unknown etiology and each had a normal history, physical examination and normal scrotal sonogram. Three patients were treated with nonsteroidal anti-inflammatory drugs and obtained partial pain relief. Three patients underwent spermatic cord nerve blockade using a combination of 1% lidocaine and 40 mg methylprednisolone and experienced partial pain relief. Four patients underwent inguinal orchiectomy after failing conservative management: three reported complete relief of pain, and the other partial relief. Two patients had bilateral transrectal injections of local anesthetic (5 ml bupivacaine) and methylprednisolone into the region of the pelvic plexus under transrectal ultrasound guidance. They were successfully treated with this injection technique. On the basis of our results, we recommend transrectal blockade of nerves from the pelvic plexus or inguinal orchiectomy as the procedure of choice for patients in whom medical treatment fails.
Article
To determine the incidence of complications, including recanalization, in a series of 6248 consecutive vasectomies performed with a section-fulguration-fascial interposition technique. Over a 38-year period, 6248 vasectomies were performed by one surgeon (S.S.S.) as a clinic procedure under local anaesthesia with no resection of a vasal segment. The mucosa of the cut ends of the vas was destroyed by cauterization and the fascial sheath of the vas was interposed as a barrier. Semen specimens were examined until two specimens, one month apart, showed no sperm. Complications were minimal, with few cases of haematoma or wound infection. Spermatic granulomas were uncommon. No post-vasectomy pregnancies were reported and no patient showed a persistence of sperm. The section-fulguration-fascial interposition technique of vasectomy was uniformly effective, with few post-operative problems.
Article
Family physicians should be aware of the potential effects and complications of vasectomy so they can appropriately counsel patients seeking sterilization. Vasectomy produces anatomic, hormonal and immunologic changes and, although not substantiated by clinical studies, has been reputed to be associated with atherosclerosis, prostate cancer, testicular cancer and urolithiasis. Complications of vasectomy include overt failure, occasional sperm in the ejaculate, hematoma, bleeding, infection, sperm granuloma, congestive epididymitis, antisperm antibody formation and psychogenic impotence. Compared with tubal ligation, vasectomy has fewer serious complications and a comparable failure rate.
Article
Postoperative hematoma, edema, and echymosis are the most common complications in scrotal surgery. Without proper hemostasis intraoperatively or appropriate scrotal compression postoperatively, significant morbidity, including re-exploration and prolonged convalescence, can occur. The scrotal hitch provides hemostasis, minimizes edema and hematomas, and reaffirms other clinicians' findings.
Article
The case of a 28-year-old US man who developed infective endocarditis after vasectomy complicated by epididymitis is presented. The man had undergone vasectomy 7 weeks before presentation to the hospital for fever and myalgia. 2 days after vasectomy the patient had been struck in the groin with a snowball and the suture line was disrupted. The physical examination produced normal findings but Staphylococcus hominis was recovered from multiple blood cultures. Treatment with vancomycin and rifampin was commenced and furosemide therapy was provided to address pretibial sacral and pulmonary edema. On the 10th hospital day a Bjork-Shiley aortic valve was placed. Evaluation of the resected aortic valve revealed a bicuspid valve with friable vegetation that contained vancomycin-resistant S. hominis. Intravenous penicillin and rifampin were then administered and resulted in resolution of the infection. This is only the second reported case of endocarditis complicating vasectomy.
Article
We compare the safety, ease of use and effectiveness of the no scalpel and standard incision approaches to vasectomy. A multicenter, randomized, partially masked controlled trial was conducted at 8 sites in Brazil, Guatemala, Indonesia, Sri Lanka and Thailand. Semen samples were collected 10 weeks postoperatively and tested to ascertain sterility using verification of no living spermatozoa. The study included 1,429 men seeking vasectomy. The efficacy of the 2 approaches was virtually identical. In the no scalpel group operating time was significantly shorter, and complications and pain were less frequent than in the standard incision group. The no scalpel group resumed intercourse sooner, probably as a result of less pain following the procedure. The no scalpel approach is an important advance in the surgical approach to vasectomy, and offers fewer side effects and greater comfort compared to the standard incision technique, without compromising efficacy.
Article
Unlabelled: The purpose of this review is to analyze critically the two techniques of sterilization (bilateral tubal ligation [BTL] and vasectomy) so that a physician may provide informed consent about methods of sterilization. A MEDLINE search and extensive review of published literature dating back to 1966 was undertaken to compare preoperative counseling, operative procedures, postoperative complications, procedure-related costs, psychosocial consequences, and feasibility of reversal between BTL and a vasectomy. Compared with a vasectomy, BTL is 20 times more likely to have major complications, 10 to 37 times more likely to fail, and cost three times as much. Moreover, the procedure-related mortality, although rare, is 12 times higher with sterilization of the woman than of the man. Despite these advantages, 300,000 more BTLs were done in 1987 than vasectomies. In 1987, there were 976,000 sterilizations (65 percent BTLs and 35 percent vasectomies) with an overall cost of $1.8 billion. Over $260 million could have been saved if equal numbers of vasectomies and BTLs had been performed, or more than $800 million if 80 percent had been vasectomies, as was the case in 1971. The safest, most efficacious, and least expensive method of sterilization is vasectomy. For these reasons, physicians should recommend vasectomy when providing counseling on sterilization, despite the popularity of BTL. Target audience: Obstetricians & Gynecologists, Family Physicians Learning objectives: After completion of this article, the reader will be able to predict the failure rates and likelihood of successful reversal of tubal ligation and vasectomy; to recall the difference in cost between the two sterilization procedures, and to describe the short-term and long-term complications associated with each of the two methods of sterilization.
Article
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.
Article
To investigate the efficacy of epididymectomy in patients with significant scrotal pain after vasectomy. Sixteen patients were identified retrospectively to have undergone epididymectomy for pain after vasectomy; 19 epididymectomies were performed (three bilateral and 13 unilateral). Details from the preoperative investigations, histological examination and follow-up of symptoms were analysed and correlated. Outcomes were initially assessed at the routine outpatient clinic review 3 months after surgery and the long-term outcomes were assessed by a telephone interview 3-8 years after epididymectomy (mean 5.5 years). Of the 16 patients, 14 had excellent initial symptomatic benefit from epididymectomy. At 3-8 years afterward, nine of 10 patients interviewed had a sustained improvement of their scrotal pain. The following were indicators of a poor outcome: atypical symptoms including testicular or groin pain; erectile dysfunction and normal appearance of the epididymis on ultrasonography. Patients with bilateral scrotal pain can have a good outcome after epididymectomy. Epididymectomy in well-selected patients is a reliable and effective treatment for pain after vasectomy.
Article
The cause of the post-vasectomy pain syndrome is unclear. Some postulated etiologies include epididymal congestion, tender sperm granuloma and/or nerve entrapment at the vasectomy site. To our knowledge nerve proliferation has not been evaluated previously as a cause of pain. Vasectomy reversal is reportedly successful for relieving pain in some patients. We report our experience and correlate histological findings in resected vasal segments with outcome to explain the mechanism of pain in these patients. We retrospectively reviewed the records of 13 men who underwent vasectomy reversal for the post-vasectomy pain syndrome. We compared blinded histological evaluations of the vasal ends excised at vasectomy reversal in these patients with those of pain-free controls who underwent vasectomy reversal to reestablish fertility. Controls were matched to patients for the interval since vasectomy. Histological features were graded according to the degree of severity of vasitis nodosum, chronic inflammation and nerve proliferation. Mean time to pain onset after vasectomy was 2 years. Presenting symptoms included testicular pain in 9 cases, epididymal pain in 2, pain at ejaculation in 4 and pain during intercourse in 8. Physical examination demonstrated tender epididymides in 6 men, full epididymides in 6, a tender vasectomy site in 4 and a palpable nodule in 4. No patient had testicular tenderness on palpation. Unilateral and bilateral vasovasostomy was performed in 3 and 10 of the 13 patients, respectively. Postoperatively 9 of the 13 men (69%) became completely pain-free. Mean followup was 1.5 years. We observed no differences in vasectomy site histological features in patients with the post-vasectomy pain syndrome and matched controls, and no difference in histological findings in patients with the post-vasectomy pain syndrome who did and did not become pain-free postoperatively. No histological features aid in identifying a cause of pain or provide prognostic value for subsequent pain relief. Vasectomy reversal appeared to be beneficial for relieving pain in the majority of select patients with the post-vasectomy pain syndrome.
Article
We evaluate the effectiveness of microsurgical denervation of the spermatic cord for treatment of chronic orchialgia. Patients referred to our clinic diagnosed with chronic orchialgia are evaluated with a thorough medical and psychiatric history, physical examination and scrotal ultrasound when indicated. A total of 27 patients with chronic orchialgia refractory to nonsurgical management who had temporary pain relief after undergoing outpatient cord block were candidates for denervation. There were 6 patients who had bilateral pain, therefore, 33 testicular units were denervated. Followup ranged from 1 to 74 months (mean 20). Complete pain relief was noted in 25 (76%) testicular units, partial relief in 3 (9.1%) and no relief in the remaining 5 (15%), with a mean followup of 19, 24 and 10 months, respectively. There was no significant difference in outcome when evaluated by the etiology of orchialgia. When conservative treatment fails, microsurgical denervation of the spermatic cord should be considered first rate surgical therapy for patients with chronic orchialgia.
Article
Studies have shown that the Li vasectomy can match the effectiveness of and reduce the duration of operation and rate of complications compared to standard vasectomy with bilateral incision. A prospective, randomised trial was conducted to compare the Li vasectomy with the standard vasectomy with bilateral incision. Data regarding effectiveness, time of operation, the patient's pain and discomfort, and peroperative and postoperative complications were recorded. Overall, 99 patients were entered in the trial, 51 with vasectomy with bilateral incision, 48 with the Li vasectomy. No significant difference was found between the two methods with regard to effectiveness, time of operation, the patient's pain and discomfort, and peroperative and postoperative complications. Overall, vasectomy was inadequate in 5%, haematoma was found in 13%, infection in 9%, and scrotal pain or painful ejaculation in 9%. The Li vasectomy can be learned and practiced under routine conditions by residents in training with the same effectiveness and the same rate of complications as standard vasectomy with bilateral incision. The total morbidity was at the same level as in previous Danish studies, but higher than in the international studies with the Li vasectomy.
Article
We compared the effectiveness and complications associated with 2 common vasectomy occlusion techniques, namely clipping and excision of a small vas segment and thermal cautery with fascial interposition and an open testicular end. We retrospectively reviewed the computerized records of 3,761 men who underwent initial vasectomy at a single university hospital family planning clinic and at 2 private clinics in the Quebec City, Canada area, including concurrent and historical controls. All procedures were performed by 1 surgeon, who used the scalpel-free technique to expose the vas. The risk of vas occlusion failure in men with at least 1 semen analysis was much greater in the clipping and excision group than in the cautery, interposition and open testicular end group (126 of 1,453 or 8.7% versus 3 of 1,165 or 0.3%, OR 37, 95% CI 12 to 116). Medical consultations for hematoma or infection were more frequent in the cautery group (28 of 1,721 cases or 1.6% versus 10 of 2,040 or 0.5%, OR 3.4, 95% CI 1.6 to 6.9). Consultations for noninfectious pain were similar for the 2 techniques (71 of 1,721 cases or 4.1% versus 72 of 2,040 or 3.5%, OR 1.2, 95% CI 0.8 to 1.6). Cautery and interposition with an open testicular end are much more effective than clipping and excision. The effectiveness and morbidity associated with the components of the cautery, interposition and open testicular end technique need further evaluation.
Article
Vasectomy remains an important option for contraception. Research findings have clarified many questions regarding patient selection, optimal technique, postsurgical follow-up, and risk of long-term complications. Men who receive vasectomies tend to be non-Hispanic whites, well educated, married or cohabitating, relatively affluent, and have private health insurance. The strongest predictor for wanting a vasectomy reversal is age younger than 30 years at the time of the procedure. Evidence supports the use of the no-scalpel technique to access the vasa, because it is associated with the fewest complications. The technique with the lowest failure rate is cauterization of the vasa with or without fascial interposition. The ligation techniques should be used cautiously, if at all, and only in combination with fascial interposition or cautery. A single postvasectomy semen sample at 12 weeks that shows rare, nonmotile sperm or azoospermia is acceptable to confirm sterility. No data show that vasectomy increases the risk of prostate or testicular cancer.
Article
Vasectomy can be followed by an autoimmune-antibody response. We aimed to determine whether men with immune-related diseases were more or less likely than others to have a vasectomy and then to determine whether vasectomy is associated with the subsequent development of immune-related diseases. A database of linked records of hospital statistics was analysed. By comparing a population of men who underwent vasectomy with a reference population, we calculated the rate ratios for selected immune-related diseases before and after vasectomy. Some diseases studied (e.g. asthma and diabetes mellitus) were a little less common, prior to operation, in the vasectomy group than in the reference group. Others were not different. The mean period of follow-up was 13 years. We found no long-term elevation of risk following vasectomy of asthma, diabetes mellitus, ankylosing spondylitis, thyrotoxicosis, multiple sclerosis, myasthenia gravis, inflammatory bowel disease, rheumatoid arthritis or testicular atrophy. There was a short-term elevation of risk of orchitis/epididymitis. In this large study, with many years of follow-up, we found no evidence that vasectomy increases the subsequent long-term risk of immune-related diseases.
Article
Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time. The objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas. We searched the computerized databases of CENTRAL, MEDLINE, EMBASE, POPLINE and LILACS in May 2006. In addition, we searched the reference lists of relevant articles and book chapters. Randomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials. We assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. Two randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (Odds ratio (OR) 0.49; 95% Confidence Interval (CI) 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas. The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.
Article
We investigated the role of growth factors in the process of post-vasectomy micro-recanalization using real-time polymerase chain reaction, enzyme-linked immunosorbent assay and histopathological analyses of the vasectomy sites and controls at different time points in a rat model. Unilateral vasectomies were performed in 18 rats with sham surgery on the contralateral side. Vasectomy sites and vas segments of similar length from the sham operated sides were taken for analysis at 2, 8 and 12 weeks. Real-time polymerase chain reaction was used to test the expression of mRNA of 7 common growth factors and select growth factor receptors. Enzyme-linked immunosorbent assay was performed for growth factors with strong positive polymerase chain reaction findings. Histopathological examination was performed by a staff pathologist (BRD) to detect micro-recanalization, defined as tubules visible on hematoxylin and eosin staining with an epithelial lining of cuboidal or columnar cells. Micro-canals were found in 2 of 18 rat specimens. Real-time polymerase chain reaction of all specimens demonstrated a 12-fold increase in platelet-derived growth factor-beta, a 6-fold increase in platelet-derived growth factor-beta receptor, an 11-fold increase in platelet-derived growth factor-alpha, a 7-fold increase in platelet-derived growth factor-alpha receptor and a 9-fold increase in transforming growth factor-beta compared to the sham operated side. All increases were sustained and statistically significant (p <0.05). Enzyme-linked immunosorbent assay revealed statistically significantly increased expression of platelet-derived growth factor-beta protein. The demonstrated micro-recanalization and sustained growth factor up-regulation at vasectomy sites suggest a possible mechanism for post-vasectomy ejaculate sperm identification. There is a need for further research on the potential role of select growth factors in reconstruction of the male reproductive tract.
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Effectiveness and complications associated with 2 vasectomy occlusion techniques
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Scalpel versus no-scalpel incision for vasectomy
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