Article

Estimating the Number of Vasectomies Performed Annually in the United States: Data From the National Survey of Family Growth

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Abstract

While hospital discharge and ambulatory surgery registries provide accurate estimates of female sterilization procedures, current estimates of male sterilization rates are lacking since these procedures are done in many settings. Population based data are used to estimate annual sterilization numbers. We analyzed data on 4,928 men and 7,643 women from the 2002 National Survey of Family Growth. We determined the year of vasectomy in men and the year of tubal ligation in women who reported a history of surgical sterilization. After accounting for the complex survey design of the National Survey of Family Growth we calculated the estimated number of individuals who underwent surgical sterilization in the United States. A total of 141 men reported vasectomy, representing an overall 6% prevalence in National Survey of Family Growth survey population, while 1,173 women (16%) reported tubal ligation. Using National Survey of Family Growth data an estimated 175,000 to 354,000 vasectomies were done yearly from 1998 to 2002. In the same period the National Survey of Family Growth estimated that 546,000 to 789,000 tubal ligations were done annually in the United States. This compares closely to the 596,000 to 687,000 tubal ligations calculated using ambulatory surgery and hospital discharge data from a similar period. The estimated annual number of tubal ligations from the National Survey of Family Growth is in line with the current literature using hospital discharge and ambulatory surgery registries, suggesting the accuracy of the method of estimating surgical sterilization numbers. This suggests that the National Survey of Family Growth may be used to provide an estimate of vasectomy use in the United States.

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... Vasectomy is the fourth most commonly utilized means of contraception in the United States with around 500,000 performed annually across the United States (Eisenberg & Lipshultz, 2010;Mosher & Jones, 2010). While there is little morbidity associated with the procedure (Awsare et al., 2005), there has been significant debate regarding the association of increased risk of prostate cancer in men with prior vasectomy. ...
... The discussion was reignited in 2014 when a prospective cohort study found an association between a history of vasectomy and an increased risk of both overall prostate cancer and high-risk prostate cancer. While investigators have suggested immune or endocrine pathways to explain the association (Mo et al., 1995;Flickinger et al., 1999), the lack of robust data to support a plausible biological mechanism leads most to conclude that selection bias as the most likely (Eisenberg & Lipshultz, 2010;Mosher & Jones, 2010;Giovannucci et al., 1993a). Contemporary studies have contested any association between prior vasectomy and the risk of developing prostate cancer; however, prior cohorts were not without some limitations. ...
... Lack of granular data on men's sociodemographic status, PSA screening habits and gleaning vasectomy status from a survey of wives may all impact the conclusions of the studies. (Eisenberg & Lipshultz, 2010;Mosher & Jones, 2010;Awsare et al., 2005). In addition to detailed data on each man's characteristics and PSA screening, our study also used additional analytic techniques (i.e. ...
Article
Background Several studies have linked vasectomy with the risk of prostate cancer; however, this association has been attributed to selection bias. Since vasectomy is a common and effective form of contraception, these implications are significant. Therefore, we sought to test this association in a large observational cohort. Objective To evaluate the potential association between prior vasectomy and the risk of developing prostate cancer. Materials and Methods We evaluated the relationship between vasectomy and prostate cancer in the NIH‐AARP Diet and Health Study. Of the 111,914 men, prostate cancer was identified in 13,885 men and vasectomies were performed in 48,657. We used multivariate analysis to examine the relationship between prostate cancer and vasectomy. We also performed propensity score‐adjusted and propensity score‐matched analysis. Results Men utilizing vasectomy were more likely to be ever married, fathers, educated, white, and screened for prostate cancer. During 4,251,863 person‐years of follow‐up, there was a small association between vasectomy and incident prostate cancer with a hazard ratio of 1.05 (95% CI, 1.01–1.11). However, no significant association was found when looking separately at prostate cancer by grade or stage. Conclusions were similar when using propensity adjustment and matching. Importantly, a significant interaction between vasectomy and PSA screening was identified. Discussion Estimates of the association between vasectomy and prostate cancer are sensitive to analytic method underscoring the tenuous nature of the connection. Given the differences between men who do and do not utilize vasectomy, selection bias appears likely to explain any identified association between vasectomy and prostate cancer. Conclusions With over 20 years of follow‐up, no convincing relationship between vasectomy and prostate cancer of any grade was identified.
... Since 1830, when it was first performed, and through its progressive modifications as a procedure, vasectomy has become the most effective method of male contraception [1]. In many countries, it is the most common male contraception other than the use of condoms [2,3], and vasectomy has been reported to account for 5% to 10% of all contraceptive approaches used by couples worldwide [3][4][5]. In the United States, 11% of couples utilize vasectomy as a primary method of contraception, with 527,476 vasectomies performed in 2015 [6]. ...
... Since 1830, when it was first performed, and through its progressive modifications as a procedure, vasectomy has become the most effective method of male contraception [1]. In many countries, it is the most common male contraception other than the use of condoms [2,3], and vasectomy has been reported to account for 5% to 10% of all contraceptive approaches used by couples worldwide [3][4][5]. In the United States, 11% of couples utilize vasectomy as a primary method of contraception, with 527,476 vasectomies performed in 2015 [6]. ...
... This delayed clearance of sperm suggests that when a man fails the initial PVSA, there is no need to rush to repeat vasectomy, and waiting may prove the procedure successful in the majority of patients. Our data showed that 7 cases (out of 1,114, 0.63%) needed repeat vasectomy, which is in agreement with previous reports in the literature [21], since the reported failure rate with vasectomy varies from 0.01% to 5% [3]. ...
Article
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Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy. Ashok Agarwal, et al: Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices www.wjmh.org
... I n the U.S., vasectomy is performed less often than female sterilization despite it being a safer, simpler, more economical, and equally effective option for permanent contraception. 1 U.S. data from the 2006-2010 National Survey for Family Growth (NSFG) estimated that 6.6% of men aged 15-44 years reported having had a vasectomy; this proportion increased with age, reaching up to 16% among men aged 36-45 years. 2 This prevalence estimate is relatively unchanged from the 2002 NSFG estimate of 6.2%. 3,4 However, these survey-based estimates are limited by a low response rate and sample size. 4,5 Results of U.S. studies using claims data show that the prevalence of vasectomies decreased from 2007 through 2015 among men aged 18-64 years with employer-based insurance, and prevalence estimates decreased across all age groups and in all locations of the country. ...
... 3,4 However, these survey-based estimates are limited by a low response rate and sample size. 4,5 Results of U.S. studies using claims data show that the prevalence of vasectomies decreased from 2007 through 2015 among men aged 18-64 years with employer-based insurance, and prevalence estimates decreased across all age groups and in all locations of the country. 5,6 The incidence of vasectomy in the U.S. is poorly characterized. ...
... These demographic subgroup-specific findings mirror the results of vasectomy studies in the general U.S. population. 2,4,18,19 Multiple studies have described the association between race and vasectomy utilization, with non-Hispanic white men being more likely to use vasectomy as a means of permanent contraception compared to men in other race/ethnicity groups. 2,7,20,21 Santomauro et al. 's study of active duty service men also reported a higher vasectomy rate among non-Hispanic whites compared to non-Hispanic blacks; data on other race/ethnicity groups were not available for analysis. ...
Article
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During 2000–2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the overall rates of vasectomy were highest among service men aged 30–39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35–49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.
... Approximately 500,000 vasectomies are performed each year in the United States (Ostrowski et al., 2018). Knowledge about who gets a vasectomy is primarily derived from the National Survey of Family Growth (NSFG; Anderson et al., 2010Anderson et al., , 2012Eisenberg et al., 2009;Eisenberg & Lipshultz, 2010). The NSFG is a nationally representative survey of women and men aged 15-49 years (Centers for Disease Control and Prevention, 2017). ...
... The NSFG is a nationally representative survey of women and men aged 15-49 years (Centers for Disease Control and Prevention, 2017). Analyses of the NSFG data estimate that 6% of all men rely on vasectomy for pregnancy prevention (Eisenberg & Lipshultz, 2010), although men who have not been married are unlikely to use the method (Eeckhaut, 2015). Generally, men who have a vasectomy are married, White, over 35 years, and have two or more children (Anderson et al., 2010;Eeckhaut, 2015;Eisenberg et al., 2009). ...
... While men in such relationships may be more likely to consider vasectomy, our results may have been different if we had a larger population of participants who were single or casually dating. The proportion of respondents who have had a vasectomy, however, was slightly higher than existing national estimates (Anderson et al., 2010;Eisenberg & Lipshultz, 2010). Finally, the recovery subscale had relatively low internal consistency (α = 0.64), although alphas for other subscales were all in the respectable or very good range (α = 0.78-0.81). ...
Article
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Vasectomy is one of the few options men have to manage their reproductive capacity and take on a more equitable role in pregnancy prevention. While the method is underused throughout the United States, the southern states have a lower prevalence rate compared to the rest of the country. Existing survey research does not assess what men know or think about the procedure as a means of understanding why this is the case. We created and conducted an exploratory survey to assess men’s knowledge, attitudes, and information-seeking behaviors about vasectomy in the Southern United States. We used targeted Facebook advertising to recruit men ages 25–70 years living in 7 southern states to complete an online survey (n = 397). Using regression analyses, we identify that participants who had a vasectomy knew more about the procedure than participants who had not. Participants who had not had a vasectomy had less positive attitudes about the procedure across all six attitude subscales compared to participants with vasectomies. We highlight potential avenues for future research to understand why this may be the case. Finally, the majority of participants knew someone who had had a vasectomy. This suggests that men disclose having a vasectomy to others. The interpersonal dynamics around vasectomy decision-making and disclosure remain unknown and a viable area for future research. Findings from this exploratory survey may be used by public health officials interested in implementing campaigns to increase knowledge about vasectomy and reduce stigma, which may encourage more positive attitudes about the procedure.
... The effect of age on the incidence of vasectomy has previously been evaluated. Prior reports have found the mean age at time of vasectomy to be 31-33 years and have demonstrated that increasing age enhances the likelihood of undergoing a vasectomy (3,4,6). The median age of men at first marriage has increased from 26.3 in 1991 to 28.7 as of 2011 (7), and a recent analysis from Khandwala et al. revealed that the mean paternal age has steadily increased over the last nearly half century in the US, rising from 27.4 in 1972 to 30.9 in 2015 (5). ...
... It was also reported that higher levels of education for both men and women were associated with having fewer children before reaching 20 years of age (10). Another study found that fathers with college degrees were typically older compared to those with only a high school diploma at the time of having their first child, 33.3 versus 29.2 years, respectively (6). ...
... However, perhaps more relevant to our results, one study recently demonstrated that, between 2011 and 2015 men of Asian descent had older average paternal age. Specifically, the mean paternal age men of Chinese, Korean, and Asian Indian descent was 34.7, 35.0, and 34.2, compared to mean paternal ages of 31.1 and 30.4 for Caucasians and African Americans, respectively (6). Given the older paternal ages of these ethnicities, it would be reasonable to conclude that the ages at vasectomy of these individuals would correspondingly be later in life. ...
Article
Background: Each year in the US, approximately 500,000 men choose to undergo a vasectomy for permanent sterilization. Despite being a very common procedure, studies reporting demographic data and characteristics that motivate men to choose a vasectomy are somewhat limited. With this analysis, the primary objective was to determine if a difference existed between the ages and number of children among men choosing to have a vasectomy at urology practices in urban (Austin, TX = City A, population 947,890) and rural (Temple, TX = City B, population 76,277) settings. A secondary objective was to establish if there was a trend in these variables over time. Methods: After IRB approval was obtained from each institution, a retrospective chart review was undertaken to identify men who had undergone a vasectomy at each facility from 2011-2017. Demographic data was recorded. Statistical analysis was done using student's t-test and linear regression. Results: The mean age at time of vasectomy in City A was 37.41 years versus 36.18 in City B (P<0.001). Men in City A underwent vasectomy after a mean of 1.96 children as opposed to a mean of 2.60 children in City B (P<0.001). There was no statistically significant trend in average age or number of children over time. Conclusions: Men in an urban setting underwent vasectomy at an older age and with fewer children when compared to a rural practice environment. While studies evaluating demographics of men undergoing vasectomy have previously been performed, our results are unique in terms of a direct comparison between different population concentrations.
... It is estimated that up to 500,000 vasectomies are performed in the United States each year [1,2]. Of these, approximately 2-6% of patients will desire a return of fertility and pursue some form of assisted reproductive therapy. ...
... The only complication which required intervention (Clavien-Dindo grade II) was a superficial surgical site infection which was managed with oral antibiotics. The remaining six Clavien-Dindo grade I complications consisted of wound dehiscence (3), scrotal seroma/hematoma (2), and one bilateral hydrocele. ...
Article
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Of all patients who have vasectomies performed in the United States, upwards of 6% will pursue a vasectomy reversal. Currently, the gold-standard reversal procedure is a microscopic vasovasostomy utilizing either a one or two-layer vasal anastomosis. Unfortunately, most urologists do not perform these procedures as they require extensive training and experience in microsurgery. The objective of our study was to evaluate the feasibility and success rate of robot-assisted vasovasostomy performed at our institution. We completed a retrospective review of our experience with vasectomy reversal utilizing the da Vinci(®) Surgical System and a single layer vasal anastomosis. A successful reversal was defined as a return of sperm on semen analysis or light microscopy. Since 2009 we have completed 79 robotic vasectomy reversals, 60 of which utilized a single-layer vasal anastomosis. The average obstructive interval was 5.7 ± 2.2 years. Average operative time was 192 min. 42 patients returned for a post-operative semen evaluation at an average time of 4.3 months post-procedure revealing a success rate of 88% (37 out of 42). Post-operative semen parameters were significant for an average sperm density of 31.0 million/mL with an average motility of 29.1%. Robot-assisted vasovasostomy with a single layer anastomosis has overall success rates that are similar to that of reported microscopic vasovasostomy rates. Although more study is warranted with regard to cost, we feel as though our study demonstrates an alternative approach to vasectomy reversal that can be performed successfully by urologists trained in robotic surgery.
... In the United States, vasectomy is three times less common than tubal ligation, despite its lower cost and lower risk of complications (1,2). An estimated 175,000-526,000 vasectomies are performed in the United States annually (3,4); however, unintended pregnancy after vasectomy can occur. Immediately following vasectomy, remaining sperm within the male reproductive tract may still fertilize ova after intercourse and ejaculation (5). ...
... The few small studies that have attempted to characterize the timing of partner vasectomy found the procedure was generally sought during or immediately following the birth of a child (17,18). While we cannot distinguish from these studies the exact proportion of couples who sought partner vasectomy immediately postpartum, our restriction of the PRAMS sample to women who were less than four months postpartum at survey completion provides a reasonable window for estimating the upper bound of the need for use of secondary contraception (4,21). ...
Article
Background To assess postpartum use of secondary contraception with vasectomy within Pregnancy Risk Assessment Monitoring System (PRAMS). Methods Secondary contraception and type of method used were assessed among married women reporting partner vasectomy 4 months after a recent live birth in female residents of 15 US states and New York City who participated in the 2007–2011 PRAMS. Results Between 2007 and 2011, 1,004 married women who had a recent live birth participating in PRAMS reported they and their partners relied on vasectomy for postpartum contraception. Among these couples, 57.8% reported not using additional forms of contraception postpartum. Of those reporting additional contraception, condoms were most commonly used (50.0%), followed by oral contraceptive pills (26.5%), and withdrawal (9.5%). Multivariable modeling showed that use of secondary contraception was twice as high among women reporting a second birth versus women reporting a fourth or higher birth [adjusted prevalence odds ratio (POR) =2.0 (1.1–3.2)]. No other sociodemographic characteristics (maternal age, maternal race, parental education, household income) were significantly associated with use of secondary contraception with vasectomy. Conclusions Most couples within PRAMS reporting partner vasectomy as postpartum contraception did not use secondary contraception in the months immediately after vasectomy, and, of those who did, most relied on less effective methods. Clinicians need to better understand reasons for limited use of secondary contraception with vasectomy to improve counseling strategies for reducing unintended pregnancy.
... Methods to ensure occlusion can include the use of clips, fascial interposition, ligation or mucosal cautery (1). Urologists in the United States perform 175,000 to 500,000 procedures annually (2,3). Vasectomy is the fourth most common form of contraception, only behind condoms, oral contraceptives and tubal ligation (4). ...
... The mean difference in pain scores was 6.00±1.25 (4)(5)(6)(7)(8) for the patent group and 4.43±0.98 (3)(4)(5)(6) for the non-patent group (20). This may suggest that obstruction and congestion of the epididymis does indeed play a key role in the pathology. ...
Article
Post-vasectomy pain syndrome (PVPS) is a rare, but devastating outcome following vasectomy. Given the widespread utilization of vasectomy for permanent contraception, with more than 500,000 procedures performed annually in the United States, it can be a significant challenge for both patients and providers. Vasectomy reversal is a surgical option for men who fail conservative or medical management. Despite improvements in technique, vasectomy carries some inherent risks making pre-procedure counseling regarding the risks of PVPS paramount. Chronic post-operative pain, or PVPS, occurs in 1-2% of men undergoing the procedure. This review will examine the utility of vasectomy reversal as a means of addressing PVPS.
... 11 Infertility may also not be a problem for most men in same-sex relationships, as only a small percent raise children; only about 10% in the USA. 12 Still other examples include males who actively seek medical treatments that explicitly result in infertility, such as vasectomy for birth control purposes, 13,14 or orchiectomy as part of sex-reassignment surgery in male-to-female transsexuals (MtFs). 15,16 Presumably, they are fully aware of the impact of such treatment on their fertility, but their reasons for electing the treatment (discussed further below) overrule any perceived burden from the loss of fertility. ...
... Hundreds of thousands of men undergo vasectomy for birth control purposes, 13,14 and being infertile is their desired state, at least at the time of their vasectomy. Factors that motivate men to be vasectomized include financial burden of having more children, having achieved a desired number of offspring, and preference for vasectomy over other contraceptive methods. ...
Article
Full-text available
From a Darwinian perspective we live to reproduce, but in various situations genetic males elect not to reproduce by choosing medical treatments leading to infertility, impotence, and, in the extreme, emasculation. For many men, infertility can be psychologically distressing. However, for certain genetic males, being infertile may improve their quality of life. Examples include (1) men who seek vasectomy, (2) individuals with Gender Dysphoria (e.g., transwomen, and modern day voluntary eunuchs), (3) most gay men, and (4) men treated for testicular and prostate cancer. Men who desire vasectomy typically have a Darwinian fitness W >1 at the time of their vasectomies; i.e., after they have their desired number of offspring or consider themselves past an age for parenting newborns. In contrast, prostate and testicular cancer patients, along with individuals with extreme Gender Dysphoria, do not necessarily seek to be sterile, but accept it as an unavoidable consequence of the treatment for their condition undertaken for survival (in case of cancer patients) or to achieve a better quality of life (for those with Gender Dysphoria). Most gay men do not father children, but they may play an avuncular role, providing for their siblings' offspring's welfare, thus improving their inclusive fitness through kin selection. In a strictly Darwinian model, the primary motivation for all individuals is to reproduce, but there are many situations for men to remove themselves from the breeding populations because they have achieved a fitness W ≥1, or have stronger medical or psychological needs that preclude remaining fertile.
... Contraception also plays a pivotal role in public health by decreasing the fertility rate, thus minimizing the ever increasing world population. Among the various forms of contraception, vasectomy is the fourth most widely used option, 1 following oral contraceptives, tubal ligation, and condoms. ...
Article
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Max Nutt, Zachary Reed, Tobias S Köhler Division of Urology, Southern Illinois University School of Medicine, Urology, Springfield, IL, USA Abstract: The potential influence of vasectomy being a risk factor for the development of prostate cancer is not a new concept, with more than 30 publications addressing the topic. Given the global frequency of vasectomy and the prevalence of prostate cancer, this subject justifiably deserves scrutiny. Several articles have claimed that vasectomy puts men at risk for future development of prostate cancer. We explore articles that have shown the contrary (no link), explore the studies’ strengths and weaknesses, describe possible prostate cancer pathophysiologic mechanisms, and apply Bradford Hill criteria to help discern correlation with causation. The risk and interest of association of prostate cancer with vasectomy has waxed and waned over the last three decades. Based on our review, vasectomy remains a safe form of sterilization and does not increase prostate cancer risk. Keywords: vasectomy, prostate cancer, pathophysiology
... There are more than 20 million men who underwent vasectomy in China and India alone (34). The number of vasectomy procedures per year in the United States has been estimated to be between 175,000 and 550,000 procedures per year (35,36). Although vasectomy failure is lower than 1%, it is highly recommended that men perform a follow-up semen analysis to confirm the success of the procedure. ...
Article
Full-text available
Male infertility affects up to 12% of the world's male population and is linked to various environmental and medical conditions. Manual microscope-based testing and computer-assisted semen analysis (CASA) are the current standard methods to diagnose male infertility; however, these methods are labor-intensive, expensive, and laboratory-based. Cultural and socially dominated stigma against male infertility testing hinders a large number of men from getting tested for infertility, especially in resource-limited African countries. We describe the development and clinical testing of an automated smartphone-based semen analyzer designed for quantitative measurement of sperm concentration and motility for point-of-care male infertility screening. Using a total of 350 clinical semen specimens at a fertility clinic, we have shown that our assay can analyze an unwashed, unprocessed liquefied semen sample with <5-s mean processing time and provide the user a semen quality evaluation based on the World Health Organization (WHO) guidelines with ~98% accuracy. The work suggests that the integration of microfluidics, optical sensing accessories, and advances in consumer electronics, particularly smartphone capabilities, can make remote semen quality testing accessible to people in both developed and developing countries who have access to smartphones.
... Due to their population, China and India together account for 20 million users. 2 Changes in life circumstances such as the death of a child or divorce and remarriage lead many vasectomized patients to desire fertility again. Their options include undergoing either a vasectomy reversal (VR), or in vitro fertilization with intracytoplasmic sperm injection (IVF/ICSI). ...
Article
Full-text available
Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.
... According to data from the National Study of Family Growth, vasectomy is utilized by 6-13% of American couples for their form of contraception (1,2). Physician surveys have shown that over 500,000 men undergo vasectomies per year (3), and more than 75% of vasectomies are performed by urologists (4). ...
Article
According to data from the National Study of Family Growth, vasectomy is utilized by 6-13% of American couples for their form of contraception. Physician surveys have shown that over 500,000 men undergo vasectomies per year, and more than 75% of vasectomies are performed by urologists. This chapter provides a brief history of vasectomy, as well as recommendations for preoperative counseling, an overview of the modified no-scalpel vasectomy technique, and a brief description of the complications of vasectomy.
... For the current-duration approach, we used methods that have been previously described and applied to NSFG data (20)(21)(22)(23)(24). Briefly, two questions in the NSFG directly assessed the duration of the respondent's current pregnancy attempt. ...
Article
Objective: To determine if regular use of marijuana has an impact on time to pregnancy. Design: Retrospective review of cross-sectional survey data from male and female respondents aged 15-44 years who participated in the 2002, 2006-2010, and 2011-2015 National Survey of Family Growth. Setting: Not applicable. Participant(s): The National Survey of Family Growth is a nationally representative population-based sample derived from stratified multistage area probability sampling of 121 geographic areas in the U.S. Our analytic sample was participants who were actively trying to conceive. Intervention(s): Exposure status was based on the respondents' answers regarding their marijuana use in the preceding 12 months. Main outcome measure(s): The main outcome was estimated time to pregnancy, which was hypothesized before analysis to be delayed by regular marijuana use. Result(s): A total of 758 male and 1,076 female participants responded that they were actively trying to conceive. Overall, 16.5% of men reported using any marijuana while attempting to conceive, versus 11.5% of women. The time ratio to pregnancy for never smokers versus daily users of marijuana in men was 1.08 (95% confidence interval 0.79-1.47) and in women 0.92 (0.43-1.95), demonstrating no statistically significant impact of marijuana use on time to pregnancy. Conclusion(s): Our study suggests that neither marijuana use nor frequency of marijuana use was associated with time to pregnancy for men and women.
... In the USA, it is estimated that 175 000- 354 000 men undergo a vasectomy each year. 2 However, ≤6% of patients who undergo a vasectomy request a reversal procedure. 3 Therefore, the vasectomy is the most common cause of OA in the USA. ...
Article
Full-text available
Background In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception. Methods This article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches. Main findings The reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot‐assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery. Conclusion In the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.
... Annually, 175,000-354,000 vasectomies are performed in the United States, and it is estimated that 3% of the male population will have a vasectomy as a permanent method of contraception in Iran [1,2]. Almost 6% of men who undergo a vasectomy seek the reversal of the vasectomy for a variety of reasons [3]. ...
Article
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Background: A vasectomy (closing or removing a portion of the vas deferens) is the most common method of contraception for men. Almost 6% of the men who undergo a vasectomy seek the reversal of the vasectomy. Many factors can influence the success rate of a vasectomy reversal. It is important for the surgeon to be aware of these factors to clarify postsurgical expectations for the patient and his partner. Materials and Methods: Records of 50 cases of vasovasostomies performed in Rasoul-e-Akram from January 2014 to January 2015 were extracted. We reviewed all items from the checklists in their records and followed up with the patients after surgery. The factors affecting surgical success were analyzed using SPSS software version 16 (SPSS, Chicago, IL, USA). Results: The mean time between the vasovasostomy was 8.2 ± 4.81 years (Min:1, Max:22 years). The age of the patients was significantly correlated with the success rate of the vasovasostomy (OR = 0.81, P = 0.005). There was a significant relationship between the time since the vasectomy and the success rate of the vasovasostomy (OR = 0.75, P = .001). Through a logistic regression analysis, a significant correlation was found between smoking and success (P < .05). Postoperative complications and inguinal surgery were also factors that were inversely correlated with success. Conclusions: In this study, the reverse relationship between certain factors such as age, time after the vasectomy, smoking, post discharge complications, and a history of inguinal surgery, and the success rate of microscopic surgical vasovasostomies has been proven. Considering these factors, surgeons can estimate the likelihood of success before the surgery. © 2018 Middle East Fertility SocietyMiddle East Fertility Society
... Higher rates of vasectomy continue to be found in contexts such as North America (12%) 1 . In Canada, for instance, 22% of women rely on vasectomy, and it is the most widely used method 10 . ...
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There is growing support of male involvement in reproductive health and the integration of voluntary vasectomy services into national family planning programs in lower resource contexts; yet, the prevalence of women of reproductive age who rely on vasectomy in African countries such as Nigeria, is less than 1 percent. This review was conducted to gain a broader understanding of current sociocultural and health systems' conditions that need to be addressed to expand the integration and acceptability of vasectomy as an option for family planning in Nigeria. To explore this, a scoping of existing literature on vasectomy in Nigeria between 2009 to 2021 was conducted. The review focused on qualitative studies and grey literatures. The findings reveal that there is a strong awareness of vasectomy among men in Nigeria. Yet, several factors such as fear and religious and cultural beliefs prevent men from having the same confidence in vasectomy as they have in female biomedical methods. These findings have implications for future family planning policies, strategies and programmes in the country. Résumé L'implication des hommes dans la santé reproductive et l'intégration des services de vasectomie volontaire dans les programmes nationaux de planification familiale dans des contextes de ressources plus faibles sont de plus en plus soutenues; pourtant, la prévalence des femmes en âge de procréer qui dépendent de la vasectomie dans les pays africains tels que le Nigéria, est inférieure à 1 %. Cette étude a été menée afin de mieux comprendre les conditions socioculturelles et les systèmes de santé actuels qui doivent être abordés pour étendre l'intégration et l'acceptabilité de la vasectomie comme option de planification familiale au Nigeria. Pour ce faire, une revue de la littérature existante sur la vasectomie au Nigeria entre 2009 et 2021 a été réalisée. L'examen s'est concentré sur les études qualitatives et les littératures grises. Les résultats révèlent une forte sensibilisation à la vasectomie chez les hommes au Nigeria. Pourtant, plusieurs facteurs tels que la peur et les croyances religieuses et culturelles empêchent les hommes d'avoir la même confiance dans la vasectomie que dans les méthodes biomédicales féminines. Ces résultats ont des implications pour les futures politiques, stratégies et programmes de planification familiale dans le pays.
... The result of a National survey in the United States of America showed that only 13.3% of married men reported having had a vasectomy done (Anderson et al., 2010). Also, another American survey reported that only 6% of married men have undergone vasectomy (Eisenberg and Lipshultz, 2010). This corroborates the opinion of Shih et al. (2014) that despite the lower risk, high cost-efficiency, and high efficacy of vasectomy compared with female sterilization, more couples from the United States of America rely on female sterilization than vasectomy. ...
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Knowledge and attitude of men about vasectomy as a method of family planning among married men working in Babcock University, Ogun state, Nigeria This study investigated the level of knowledge and attitude of married male workers about vasectomy and also the factors influencing the attitude of married men working in Babcock University towards vasectomy. Stratified random sampling technique was used to select 200 participants from the academic and administrative work divisions of the University and a self-constructed questionnaire was administered and 150 were retrieved and analysed using both descriptive and inferential statistics. Findings revealed that majority (42.7%) of the participants were between the ages of 31 to 40 years, Christians (97.3%), of the Yoruba tribe (55.3%), had a bachelor's degree (46%) and were non-academic staff (53.3%). Majority (38%) of participants had adequate knowledge and 62.7% had positive attitude towards vasectomy. There was no association between participants' level of education and their level of knowledge of vasectomy, however, a significant association was observed between participants' level of knowledge and their attitude towards vasectomy (χ 2 cal = 53.89, P≤0.05). The risk of spouse's health (54%) was the major factor influencing positive attitude and the need of more children (41.3%) was the main factor influencing negative attitude towards vasectomy. There is therefore need to develop awareness programs in order to equip the population with valid information and thus increasing their knowledge about vasectomy. Specific strategies should be developed in order to tackle the identified barriers hindering the acceptance of vasectomy among married men.
... In the USA, 175 000 to 350 000 vasectomies are done every year. 4 The situation diff ers markedly in the world's 69 least developed countries: only 0·7% of women are able to rely on a partner's vasectomy. Vasectomy prevalence in Africa is 0·0%, with fewer than 100 000 men having accessed it. ...
... More than 33 million married couples worldwide prefer vasectomy for contraception, believing it to be safer, cheaper, and simpler than female sterilization [21]. In the US, between 175,000 and 550,000 vasectomy procedures are performed per year [22]. Although the vasectomy failure is <1%, semen should be analyzed subsequently. ...
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Male infertility affects up to 12% of men. Although manual testing using microscope examination and computer-assisted semen analysis are standard methods of measuring sperm count and motility, these methods are limited by being laboratory based. To investigate the usefulness of a novel semen analysis device using a smartphone camera. This prospective multicenter randomized parallel design trial enrolled 200 men aged ≥19 years of age between August and December 2018. Each subject was advised to use the Smart Sperm Test for OVIEW-M at home after 5 days of abstinence. The accuracy of the OVIEW-M test relative to the in-hospital test was determined. A questionnaire was administered to assess subject likelihood of using the OVIEW-M. Measurements using standard methods and the OVIEW-M showed similar sperm counts and similar motile sperm counts. Correlation analysis showed significant correlations between sperm count and sperm motility when measured by OVIEW-M tests (r = 0.893, p < 0.01) and standard microscope examination (r = 0.883, p < 0.01). Of the subjects who responded to questionnaires, 43% regarded the results of the OVIEW-M tests as reliable and 18% as unreliable. Semen analysis with the smartphone-based application and accessories yielded results not inferior to those of laboratory tests. Men who visit the hospital for evaluation of infertility can easily perform OVIEW-M semen tests at home.
... (13) According to the 2002 US report on National Survey of Family Growth, the prevalence of vasectomy was 6% while the tubal ligation rate was 16%,and vasectomy became the fourth most commonly used contraceptive method. (14) The gap between male and female sterilisation rates was huge in India showing good acceptance of vasectomy. ...
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Introduction: This study explored the attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students, and determined the association between their demographic characteristics, and attitudes and acceptance. Methods: A cross-sectional survey was conducted among clinical-year medical students from a Malaysian private medical college using a self-administered questionnaire. Results: Among 330 participants with a female preponderance, mean age was 22.0 ± 1.1 years. The largest proportion of respondents was from Year 3. A vast majority (91.8%) were ethnically Malay and followed Islam (92.4%). Overall, 61.0% of participants exhibited positive attitude and 76.0% displayed good acceptance towards vasectomy. Gender, academic year, ethnicity and religion variables were not associated with attitudes and acceptance (p > 0.05). A significantly higher proportion of male respondents thought that vasectomy was religiously forbidden and entailed a bad impression for the person. A significantly higher proportion of Year 5 students agreed to the statement 'I would recommend vasectomy to relatives, friends and people close to me' compared to Year 3 and Year 4 students. Conclusion: Students' perception of vasectomy as a contraceptive method was encouraging. Our results suggest that their knowledge improved as medical training progressed, and attitudes evolved for the better irrespective of their traditional, cultural and religious beliefs - highlighting the importance of providing students with evidence-based learning about male sterilisation, which is more cost-effective and less morbid than female sterilisation. A future qualitative study involving students from different ethnicities and religions would provide a better understanding of this subject.
... One-half of the annual bilateral tubal sterilizations are performed postpartum. 22,23 Vasectomy also has fewer health risks than tubal sterilization, and almost always vasectomy is performed as an ambulatory procedure, 18 because it is comparatively less invasive. The result is different clinical practices based on gender, which, in this clinical context, is ethically irrelevant to being a patient. ...
Article
Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization. Copyright © 2015 Elsevier Inc. All rights reserved.
... We include permanent contraception in this category because once it has been performed the woman no longer needs to return to see the physician for contraception. The type of permanent contraception (male or female) was not specified in the questionnaire, but previous data suggest it was most probably permanent female contraception [18]. -Absence of contraception. ...
Article
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Background In France, a Pap test for cervical cancer screening is recommended every three years for all sexually active women aged 25 to 65 years. Modes of contraception (any or no contraception, with or without a visit to a physician, and with or without a gynecological examination) may influence adhesion to screening: women who use intrauterine device (IUD) should be more up to date with their cervical cancer screening more often than those using other means of contraception. Our objectives were to analyze the association between modes of contraception and Pap tests for screening. Methods This cross sectional study is based on the CONSTANCES cohort enabled us to include 16,764 women aged 25–50 years. The factors associated with adhesion to cervical cancer screening (defined by a report of a Pap test within the previous 3 years) was modeled by logistic regression. Missing data were imputed by using multiple imputations. The multivariate analyses were adjusted for sex life, social and demographic characteristics, and health status. Results Overall, 11.2% (1875) of the women reported that they were overdue for Pap test screening. In the multivariate analysis there was no significant difference between women using an IUD and those pills or implant of pap test overdue ORa:0.9 CI95% [0.8–1.1], ORa 1.3 CI95% [0.7–2.7] respectively. Women not using contraceptives and those using non-medical contraceptives (condoms, spermicides, etc.) were overdue more often ORa: 2.6 CI95% [2.2–3.0] and ORa: 1.8 CI95% [1.6–2.1] respectively than those using an IUD. Conclusion Women seeing medical professionals for contraception are more likely to have Pap tests.
... Vasectomy is a safe and effi cient contraceptive method. Worldwide, it is estimated that nearly 60 million men had been submitted to this procedure (1). According to DATASUS database, only in November 2018, 3,127 surgeries were performed in public health services in Brazil (2). ...
Article
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Objectives: to validate an experimental non-animal model for training of vasectomy reversal. Materials and methods: The model consisted of two artificial vas deferens, made with silicon tubes, covered by a white resin, measuring 10 cm (length) and internal and external diameters of 0.5 and 1.5 mm, respectively. The holder of the ducts is made by a small box developed with polylactic acid, using a 3D print. The objective of the invention is to simulate the surgical field of vasovasostomy, when the vas deferens are isolated from other cord structures. For validation, it was verified the acquisition of microsurgical skills during its use, in a capacitation course with 5 urology residents from a Hospital of the region. Along the training sessions, it was analyzed the time (speed) of microsurgical sutures, and quantification of the performance using a checklist. Collected data were analyzed using de BioEstat®5.4 software. Results: Medium time for the completion of microsurgical sutures improved considerably during the course, and reached a plateau after the third day of training (p=0.0365). In relation to the checklist, it was verified that during capacitation, there was significant improvement of the scores of each participant, that reached a plateau after the fourth day of training with the model (p=0.0035). Conclusion: The developed model was able to allow the students that attended the course to gain skills in microsurgery, being considered appropriate for training vasectomy reversal.
... Vasectomy is an effective tool of birth control worldwide, [1] with approximately 500,000 men in the United States [2] and 30,000 men in Europe [3] undergoing vasectomy yearly. ...
Article
Vasectomy is a practical and straightforward approach to birth control. This paper presented a 31-year-old patient who desired to restore his fertility five years after being vasectomized. He met several obstacles. He developed severe psychological distress with symptoms of stress, anxiety, and aggression. He underwent microsurgical vasovasostomy, and vassal patency was confirmed by return of spermatozoa in semen samples 6 and 10 weeks after surgery, and symptoms of psychological distress disappeared. Preoperative vasectomy counseling should include information about vasectomy reversal. At the most, vasectomy reversal can be considered in selected men with psychological problems due to vasectomy. Microsurgical training should be offered to more urological surgeons, especially those who are interested in andrology.
... Using a robust dataset, the National Survey for Family Growth, which provides national representation in the USA, the authors report that rates of vasectomy were decreasing between 2002 and 2017 (ref. 7 ). These findings persisted across multiple age groups and after adjustment for potential confounding factors. ...
Article
Trends in vasectomy use are controversial, but rates might be declining over time. Several factors could contribute to this apparent decrease, which warrant consideration before definitive conclusions are made.
... Vasectomy is a simple surgical procedure used for male sterilization. From the National Survey of Family Growth in the United States, at least 500,000 American men were estimated to annually undergo vasectomy as their permanent form of contraception [1,2]. Historically speaking, vasectomy has also been performed at the time of prostatic surgery, such as transurethral resection for benign prostatic hyperplasia, to provide protection against postoperative acute epididymitis [3]. ...
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Some observational studies have implied a link between vasectomy and an elevated risk of prostate cancer. We investigated the impact of vasectomy on prostate cancer outgrowth, mainly using preclinical models. Neoplastic changes in the prostate were compared in transgenic TRAMP mice that underwent vasectomy vs. sham surgery performed at 4 weeks of age. One of the molecules identified by DNA microarray (i.e., ZKSCAN3) was then assessed in radical prostatectomy specimens and human prostate cancer lines. At 24 weeks, gross tumor (p = 0.089) and poorly differentiated adenocarcinoma (p = 0.036) occurred more often in vasectomized mice. Vasectomy significantly induced ZKSCAN3 expression in prostate tissues from C57BL/6 mice and prostate cancers from TRAMP mice. Immunohistochemistry showed increased ZKSCAN3 expression in adenocarcinoma vs. prostatic intraepithelial neoplasia (PIN), PIN vs. non-neoplastic prostate, Grade Group ≥3 vs. ≤2 tumors, pT3 vs. pT2 tumors, pN1 vs. pN0 tumors, and prostate cancer from patients with a history of vasectomy. Additionally, strong (2+/3+) ZKSCAN3 expression (p = 0.002), as an independent prognosticator, or vasectomy (p = 0.072) was associated with the risk of tumor recurrence. In prostate cancer lines, ZKSCAN3 silencing resulted in significant decreases in cell proliferation/migration/invasion. These findings suggest that there might be an association between vasectomy and the development and progression of prostate cancer, with up-regulation of ZKSCAN3 expression as a potential underlying mechanism.
... It has been estimated that 175,000-354,000 vasectomies are undergone each year in the United States. 1 Thus, vasectomy is a major cause of OA. ...
Article
We assessed the contribution of microsurgical seminal reconstruction to achieving natural conception in conjunction with advanced assisted reproductive technologies. Ninety obstructive azoospermic subjects who underwent microsurgical seminal reconstruction were evaluated. Vasovasostomy (VV) was undertaken in 45 subjects whereas vasoepididymostomy (VE) in 45, respectively. VV was performed by employing a two microlayer anastomotic technique, whilst VE was undertaken using double needle longitudinal vaspepididymostomy (LIVE). Patency was achieved in 41 VV (91.1%), and 25 VE (55.6%) cases. In cases where patency was achieved, pregnancy and healthy delivery were recorded following natural intercourse in 7/41 (17.0%) VV, and in 7/25 (28.0%) VE cases. Where patency was not achieved, the use of cryopreserved sperm for intracytoplasmic sperm injection (ICSI), resulted in a healthy delivery in 4/4 (100%) VV and 14/21 (66.6%) in VE subjects. Although natural pregnancy was achieved only in a limited number of subjects treated (14/90; 15.6%), sperm harvested during surgery and cryopreserved for future ICSI use proved valuable, doubling the overall delivery rate (32/90; 36.6%). Surgical intervention is considered to be a useful technique in order to allow the possibility of a natural conception and by harvesting sperm at the same time contributes to the cost-effectiveness.
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Introduction: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. Purpose: To determine the VRR effectiveness and whether specific parameters can be associated with its success. Materials and methods: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). Results: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). Conclusions: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.
Article
IntroductionMen who are considering vasectomy as a means of contraception may have significant anxiety about their future sexual potency. As a result, couples may choose other forms of contraception with lower efficacy.AimWe sought to determine the relationship between vasectomy and the frequency of sexual intercourse.Methods We analyzed data from cycles 6 (2002) to 7 (2006–2008) of the National Survey of Family Growth to compare the frequency of sexual intercourse of men who had undergone vasectomy with men who had not. Analysis was performed using data from male and female responders, and excluded men who had never had sex and those below age 25. We constructed a multivariate logistic regression model to adjust for demographic, socioeconomic, reproductive, and health factors.Main Outcome MeasureThe main outcome measure was the sexual frequency in the last 4 weeks.ResultsAmong male responders, a total of 5838 men met criteria for our study; 353 had undergone vasectomy. For vasectomized men, the average frequency of sexual intercourse was 5.9 times per month compared with 4.9 times for nonvasectomized men. After adjusting for age, marital status, race, education, health, body mass index, children, and income, vasectomized men had an 81% higher odds (95% confidence interval [CI] 6–201%) of having intercourse at least once a week compared with nonvasectomized men. A total number of 5211 female respondents reported 670 of their partners had undergone vasectomy. For partners of vasectomized men, the average frequency of intercourse was 6.3 times per month, compared with 6.0 times for partners of nonvasectomized men. After adjustment, women with vasectomized partners had a 46% higher odds (95% CI 5–103%) of having sexual intercourse at least once a week compared with women with nonvasectomized partners (P = 0.024).Conclusion Vasectomy is not associated with decreased sexual frequency. This finding may be helpful to couples as they consider contraceptive options. Guo DP, Lamberts RW, and Eisenberg ML. Relationship between vasectomy and sexual frequency. J Sex Med **;**:**–**.
Article
To determine the applicability of post-vasectomy special clearance parameters (<100,000 non-motile sperm/mL on semen analysis) suggested by the American Urological Association and define the associated cost savings with avoidance of futher testing. We retrospectively reviewed the cohort of men undergoing vasectomy from December 2009 to August 2012 at a single institution. Patient demographics and post-vasectomy semen analysis (PVSA) results were collected for clearance parameter comparisons. During the study period, 230 patients underwent vasectomy with a mean ± SD patient age of 36.4 ± 6.5 years. Among the cohort, 83.5% were married and 95.2% had one or more children. The initial PVSA was completed by 111 (48.3%) patients at a mean of 17.8 weeks (range 4-45) following vasectomy. Sperm was identified on initial PVSA in 40 patients (36.0%); one patient was found to have motile sperm. Thirty-eight of 39 patients (97.4%) with non-motile sperm on PVSA could be cleared to cease other contraceptives based on the most recent clearance guidelines. For those completing an initial PVSA, post-vasectomy clearance increased from 64.0% to 98.2% representing a potential cost savings of $2356 in repeat semen testing. Post-vasectomy contraceptive clearance can be greatly increased when rare non-motile sperm parameters are included although post-vasectomy semen testing compliance remains poor. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
To review our institution's experience and success with vasectomy reversal to treat postvasectomy pain syndrome (PVPS) over the last 20 years. A single surgeon (E.F.F.) performed all the vasectomy reversals. We identified 123 procedures done for PVPS treatment and were able to contact 76 patients. We sent surveys or conducted phone interviews inquiring about satisfaction, levels of pain preoperatively and postoperatively, and the need for additional procedures for pain. Thirty-one patients completed phone or written surveys. In addition, we compared the location of vasectomy among patients presenting for pain to that of fertile patients. Thirty-one men had vasectomy reversal for postvasectomy pain, with median age of 38 years (range, 31-55 years), of which 26 underwent vasovasostomy (VV). Seven patients required epididymovasostomy (EV) on at least 1 side based on intraoperative findings. Eighty-two percent of patients reported improvement in their pain at 3.2 months (±3.4 months) after vasectomy reversal. Thirty-four percent patients had complete resolution of all pain. Mean pain score before procedure was 6.4 (±2.4), decreasing to a median of 2.7 (±2.7) afterward. There was a 59% improvement in pain scores (P <.001). Two patients required additional procedures for continued pain, one orchiectomy and one epididymectomy. Four patients required an additional reversal procedure, one a repeat VV at 1 year and 3 an EV at 1, 5, and 9 years, respectively. Follow-up ranged from 1 to 19 years, with a mean follow-up of 8.4 years. We found no relationship between vasectomy location and pain. Vasectomy reversal, through the use of both VV and EV, can provide long-term relief from PVPS. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
Male involvement in family planning results in improved reproductive health and gender outcomes for women. In India, the use of family planning methods remains largely female-dominated. Recent media reports have indicated a rapid decline in male sterilization use in the past few years. This study aimed to assess the trends in, patterns of and factors associated with the use of male sterilization and male spacing methods in India using data from four rounds of the National Family Health Survey, conducted from 1992 to 2016. Bivariate analysis was done to see the trends in, and patterns of, male sterilization and spacing methods, while multinomial logistic regression was used to understand the factors associated with male spacing methods and sterilization. The results show a marked decline in the prevalence of male sterilization from 1992–93 (3.5%) to 2015–16 (0.3%) in India. Of the 640 districts, only 21 had a more than 2% prevalence of male sterilization. Scheduled tribe couples were two times more likely to use male sterilization than other (upper/no caste) groups. Couples from the northern region were significantly more likely to use male sterilization (aOR: 1.68, 95% CI: 1.43–1.97) compared with those from the south. There was a regional disparity in male condom use, with a very small proportion of couples in the southern (1.1%), north-eastern (2.4%) and eastern (3.3%) regions using the method compared with couples from the northern region (9.7%). Couples from the northern (aOR: 8.89, 95% CI: 8.44–9.38), north-eastern (aOR: 11.37, 95% CI: 10.62–12.18), eastern (aOR: 6.96, 95% CI: 6.60–7.34), western (aOR: 4.65, 95% CI: 4.40–4.92) and central (aOR: 10.89, 95% CI: 10.35–11.46) regions were also significantly more likely to use male spacing methods than those from southern India. Therefore, a greater focus on increasing the use of male sterilization and condoms is required in India to reduce the gender disparity in the use of family planning methods.
Article
The interpretation of risk influences women's reproductive decisions. Research has yet to show how men understand and interpret risk, particularly in their decision to use contraception. Contraceptive sterilization provides a case through which we compare risk narratives between men and women, as it is the only analogous birth control for both men and women. A study of risk narratives held by sterilized adults and their partners reveals how risk narratives are gendered and how they contribute to contraceptive use. Using 75 in-depth interviews with sterilized heterosexual men (n = 25), women (n = 25), and unsterilized partners (n = 17 women, n = 8 men), the present study finds that men and women report similar risk narratives grounded in (1) birth control risks to health and life plans and (2) risks to maternal health from past pregnancies and age. As expected, women's risk narratives appear to stem from their embodied experiences and their interactions with medical authorities. Rather than addressing their own embodied experiences or experiences with medicine, men's beliefs mirror women's, and are centered on the dangers of hormonal birth control and pregnancy to women. This study is novel in showing the couple dyad as a site of men's beliefs about risk, as how heterosexual couples form ideas about health and life plan risk through a mutually shared gendered lens.
Chapter
La vasectomie consiste à faire l’exérèse d’un fragment déférentiel entre deux ligatures, par voie scrotale, interrompant ainsi la voie d’excrétion des spermatozoïdes sans modifier l’aspect macroscopique de l’éjaculat. La vasectomie est une intervention chirurgicale simple. Les complications sont rares, le prix de revient bas. Le nombre d’échecs, pratiquement toujours dus à un problème technique, est inférieur à 1 %. La stérilité peut être réversible par un geste chirurgical dans plus de la moitié des cas. La conservation de son sperme, avant vasectomie, permet à un homme de ne plus considérer cette intervention comme entraînant une stérilité définitive.
Article
Cambridge Core - Surgery - Reproductive Surgery - edited by Jeffrey M. Goldberg
Article
Objective: To determine if there was an association between vasectomy utilization and offspring sex ratio (Male offspring: Total offspring) as offspring sex preference may have an impact on family planning in the United States. Study design: Using data from the NIH-AARP Diet and Health Study, we calculated the numbers of sons and daughters for all men stratified by vasectomy status. We utilized a logistic regression model to determine if vasectomy utilization varies based on offspring sex ratio while accounting for known factors that impact vasectomy utilization. Results: 30,927 (30.8%) of men underwent a vasectomy. Marital status, race, age, education level, region/state, and number of offspring were all significantly correlated with vasectomy utilization (p<0.01). The sex ratio for vasectomized fathers (51.3%) was significantly higher than for fathers who had not undergone vasectomy (50.7%, p<0.01). This difference remained even after we stratified by total number of offspring: vasectomized men with 4 or more children had a sex ratio of 947 girls per 1000 boys vs 983 girls per 1000 boys in the no vasectomy group (p<0.01). For men with at least two children, each additional son increased the likelihood of vasectomy by 4% (p<0.01), while each additional daughter led to a 2% decrease in vasectomy utilization (p=0.03). Conclusions: Vasectomized fathers have a higher proportion of sons compared to nonvasectomized fathers, suggesting that offspring sex ratio is associated with a man's decision to undergo vasectomy. Further research is indicated to understand how offspring sex ratio impacts a man's contraceptive decisions.
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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Objective Evaluate the influence of fellowship training, resident participation, reconstruction type, and patient factors on outcomes after vasectomy reversals in a high volume, open access system. Methods Retrospective review of all vasectomy reversals performed at a single institution from January 1, 2002 through December 31, 2016. Patient and spouse demographics, patient tobacco use and comorbidities, surgeon training and case volume, resident participation, reconstruction type, and postoperative patency were collected and analyzed. Results Five hundred and twenty-six vasectomy reversals were performed during the study period. Follow-up was available in 80.6% of the cohort and overall patency, regardless of reconstruction type was 88.7%. The mean time to reversal was 7.87 years (range of 0–34 years). The majority of cases included resident participation. Case volume was high with faculty and residents logging a mean of 37.0 and 38.7 (median 18 and 37) cases respectively. Bilateral vasovasostomy was the most common reconstruction type (83%) and demonstrated a significantly better patency rate (89%) than all other reconstructions (p=0.0008). Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training, resident participation or post-graduate year.Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency (p=0.0023, p=0.043, respectively). Conclusions Surgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility. Patency was better for bilateral vasovasostomies. Patency was not negatively impacted by tobacco use, comorbidities, resident participation, or PGY.
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
Objective: To assess variability in the use of surgical sterilization among privately insured U.S. men and women. Study design: We queried the MarketScan Commercial Claims database using CPT, ICD9, and HCPCS codes to identify 658,509 individuals between 18-65years old (0.37% of total) who underwent male or female sterilization between 2009-2014. We examined annual trends using Cochran-Mantel-Haenszel test. We analyzed differences in age, geographic distribution, and family size using Wilcoxon sum-rank and generalized chi-squared tests. Results: Between 2009-2014, 422,290 men (0.55% of total men) and 236,219 women (0.24% of total women) with employer-sponsored insurance underwent male and female sterilization, respectively. Annual male sterilizations decreased from 77,565 (0.60%) in 2009 to 61,436 (0.51%) in 2014 (p<.001), while annual female sterilizations decreased from 43,766 (0.26%) to 30,465 (0.19%) (p<.001) over the same time period. Median age at time of male or female sterilization was 38 and 37years, respectively. The decision to undergo sterilization at age 35 or older was associated with family size of 4 or more individuals (p<.001). Sterilization was more common in urban areas, with 84% of male sterilizations and 79% of female sterilizations performed in urban areas. 79% of men compared to 60% of women who underwent sterilization were the primary policyholders of their employer-sponsored healthcare plans (p<.001). Conclusion: Male sterilization was twice as common as female sterilization in this privately insured cohort. Use of surgical sterilization was associated with increased age and larger family size. There was a decline in the annual number of male and female sterilizations during the study period. Implications: Male sterilization is more common among U.S. men with employer-based insurance than among the general population. The decline in sterilization may reflect cultural factors and the rise of long-acting reversible contraception. Analyzing the sociodemographic factors impacting sterilization may provide insight into contraceptive choice and improve reproductive health services.
Article
Objective: To demonstrate the substantial litigious risks associated with vasectomy, a common urologic procedure. We examined the risk factors and types of negligence involved in vasectomy cases that go to trial and their associated outcomes. Methods: Using the Westlaw legal database, we searched all jury verdicts and settlements for the term "vasectomy" from January 1, 1990 to December 31, 2017. Each case was evaluated for defendant specialty, alleged malpractice breach, resulting complications, outcome including verdict and monetary payment, and whether or not a pregnancy was involved. Results: The Westlaw database query returned 67 unique cases which were settled (13.3%) or went to trial in court (86.7%). Of these, the majority (64.2%) were decided in favor of the defending physician. The most commonly alleged breach of duty was negligence in postoperative care (38.8%). This was followed by negligent surgical performance (37.3%) and negligence in performing informed consent (29.9%). The cases filed for negligence in postoperative care, surgical performance, and informed consent were all generally decided in favor of the defendant (61.5%, 56%, and 90%, respectively). Of the 57 cases that specified, 82.5% of the physicians listed in the litigation were urologists. The average settlement won by each plaintiff was $401,913, although most cases were settled for the medical and litigation costs themselves. Conclusion: Medical malpractice cases related to the perioperative aspects of vasectomy involve many areas of negligence. This data may guide vasectomists in where to focus time and communication to best serve patients and minimize litigation.
Article
Objective: To analyze variation in total healthcare costs for vasectomies performed in the United States, based on procedure setting and use of ancillary pathology services. Methods: We queried the MarketScan Commercial Claims database using CPT, ICD, and HCPCS codes to identify men who underwent vasectomy between 2009 and 2015, either in the office or ambulatory surgical center (ASC) setting, with or without use of pathology services. All payments for each treatment episode were calculated based on relevant claims. Patient out-of-pocket expenses were defined as the sum of copayments, coinsurance, and deductibles for each claim. Trends in vasectomy use, and differences in procedure costs by practice setting were compared over the study period. Results: 453,492 men underwent a vasectomy between 2009 and 2015. The number of procedures decreased from 76,197 in 2009 to 37,575 in 2015 (P = .002). Average procedural costs increased from $870 in 2009 to $938 in 2015 (P = .001). Overall, 82.6% and 17.4% of procedures were performed in the office vs ASCs, respectively. In-office procedures were associated with lower total healthcare costs ($707 vs $1851) and lower patient out-of-pocket expenses ($173 vs $356) than those performed in ASCs. Vasal segments were submitted for pathologic evaluation in 40% of cases, which increased average payments by 55%. The use of ASCs and ancillary pathology services for vasectomies performed during the study period increased vasectomy-associated costs by $64 million. Conclusion: The unnecessary use of ASCs and ancillary pathology services for vasectomy may lead to tens of millions of dollars in potentially avoidable healthcare costs annually.
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
As men age, medical and surgical diseases involving the genitourinary tract become more common. The conditions themselves, if not their treatments, can negatively impact the fertility potential of an affected man. Many older men maintain the desire to father children, so it is critical to understand the disturbed anatomy and physiology involved to properly counsel that individual. Should this or that treatment regimen be employed? Should sperm banking be undertaken before institution of a permanently ablative/suppressive therapy? What are the long-term consequences of one therapy over another vis-à-vis sperm production, sperm quality, and/or sperm transport? In this context, some of the more common genitourinary afflictions of the older male and the treatment options that are available will be discussed.
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This report presents national estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 2006. Data are presented by types of facilities, age and sex of the patients, and geographic regions. Major categories of procedures and diagnoses are shown by age and sex. Selected estimates are compared between 1996 and 2006. The estimates are based on data collected through the 2006 National Survey of Ambulatory Surgery by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). The survey was conducted from 1994-1996 and again in 2006. Diagnoses and procedures presented are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). In 2006, an estimated 57.1 million surgical and nonsurgical procedures were performed during 34.7 million ambulatory surgery visits. Of the 34.7 million visits, 19.9 million occurred in hospitals and 14.9 million occurred in freestanding ambulatory surgery centers. The rate of visits to freestanding ambulatory surgery centers increased about 300 percent from 1996 to 2006, whereas the rate of visits to hospital-based surgery centers remained largely unchanged during that time period. Females had significantly more ambulatory surgery visits (20.0 million) than males (14.7 million), and a significantly higher rate of visits (132.0 per 1000 population) compared with males (100.4 per 1000 population). Average times for surgical visits were higher for ambulatory surgery visits to hospital-based ambulatory surgery centers than for visits to freestanding ambulatory surgery centers for the amount of time spent in the operating room (61.7 minutes compared with 43.2 minutes), the amount of time spent in surgery (34.2 minutes compared with 25.1 minutes), the amount of time spent in the postoperative recovery room (79.0 minutes compared with 53.1 minutes), and overall time (146.6 minutes compared with 97.7 minutes). Although the majority of visits had only one or two procedures performed (56.3 percent and 28.5 percent, respectively), 2.6 percent had five or more procedures performed. Frequently performed procedures on ambulatory surgery patients included endoscopy of large intestine (5.8 million), endoscopy of small intestine (3.5 million), extraction of lens (3.1 million), injection of agent into spinal canal (2.7 million), and insertion of prosthetic lens (2.6 million). The leading diagnoses at ambulatory surgery visits included cataract (3.0 million); benign neoplasms (2.0 million), malignant neoplasms (1.2 million), diseases of the esophagus (1.1 million), and diverticula of the intestine (1.1 million).
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This study sought to assess whether the controversy surrounding publications linking vasectomy and prostate cancer has had an effect on vasectomy acceptance and practice in the United States. National probability surveys of urology, general surgery, and family practices were undertaken in 1992 and 1996. Estimates of the total number of vasectomies performed, population rate, and proportion of practices performing vasectomy were not significantly different in 1991 and 1995. This study provides no solid evidence that the recent controversy over prostate cancer has influenced vasectomy acceptance or practice in the United States. However, the use of vasectomy appears to have leveled off in the 1990s.
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This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 2004 and selected trend data. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Average lengths of stay are presented for all discharges and for selected diagnostic categories by age and by sex. The estimates are based on medical abstract data collected through the 2004 National Hospital Discharge Survey (NHDS). The survey has been conducted annually by the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS) since 1965. Diagnoses and procedures presented are coded using the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM. Trends in the utilization of non-Federal short-stay hospitals show that the rate of hospitalization of the elderly (those 65 years and over) increased 24 percent from 1970 through 2004 despite a decrease in the 1980s. The rates for the other age groups declined overall. In 2004, those 65 years and over comprised 12 percent of the U.S. population, 38 percent of all hospital discharges, and used 44 percent of all inpatient days of care. In 2004, there were an estimated 34.9 million hospital discharges, excluding newborn infants. The average length of stay was 4.8 days for all inpatients and 5.6 days for the elderly. Almost one-half of hospital stays for heart disease had a first-listed discharge diagnosis of either congestive heart failure (25 percent) or coronary atherosclerosis (24 percent). There were 45 million procedures performed on inpatients during 2004. From 1995 through 2004, for those 65 years and over, the rate of hip replacements increased 38 percent, and the rate of knee replacements increased 70 percent. One-quarter of all procedures performed on females were obstetrical. Almost one-quarter of all procedures performed on males were cardiovascular.
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This report presents the most current nationally representative data on inpatient care in the United States. Data are from the National Hospital Discharge Survey (NHDS), the longest continuously running nationally representative survey of hospital utilization. The figure on the right shows trends in discharges and days of care from NHDS from 1965 through 1999, the most current year of data. In 1999, there were 32.1 million discharges that resulted in 160.1 million days of care. Numbers of discharges and days of care peaked in the early 1980’s. The drop in number of discharges is partly accounted for by an increase in ambulatory or same-day surgery visits. The decline in number of days of care is partly due to the decline in the number of inpatients, but it is also a result of reduced lengths of stay for hospital inpatients. The average length of stay for inpatients in 1980 was 7.3 days. In 1999, the average length of stay for inpatients was 5.0 days. Trends in inpatient utilization, 35 years of hospital care: United States, 1965–99 This report presents information about hospital utilization during 1999 as well as trend data for selected variables. Additional information about hospital utilization is available from the National Center for Health Statistics (NCHS) website:
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An FPGA based trigger system for an imaging particle detector has been designed and produced. The main capabilities of the system are the recognition of the track pattern of the incoming particles, the calculation of its stopping pixel and the time discrimination of events. The description of the implemented algorithms, the FPGA architecture, the developed hardware and the main operation results are included in this paper. The trigger system has already been installed in the FAST detector and operated during the 2005 data taking period with very satisfactory performance. Therefore, this trigger system will be used in the detector for further operation in the incoming years
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To explore whether health care, socioeconomic, or personal characteristics account for disparities observed in the utilization of vasectomy. More than 500,000 vasectomies are performed annually in the United States. The safety and efficacy of vasectomy make it a good family planning option, yet the factors related to use of male surgical sterilization are not well understood. In this analysis, we examined differences in vasectomy rates according to factors such as race and socioeconomic status. We analyzed data from the male sample of the 2002 National Survey of Family Growth to examine the use of vasectomy among the sample of men aged 30-45 (n = 2161). Demographic, socioeconomic, and reproductive characteristics were analyzed to assess associations with vasectomy. About 11.4% of men aged 30-45 years reported having a vasectomy, representing approximately 3.6 million American men. Although 14.1% of white men had a vasectomy, only 3.7% of black and 4.5% of Hispanic men reported undergoing vasectomy. On multivariate analysis, a significant difference in the odds of vasectomy by race/ethnicity remained, with black (odds ratio = 0.20, 0.09-0.45) and Hispanic men (odds ratio = 0.41, 0.18-0.95) having a significantly lower rate of vasectomy independent of demographic, partner, and socioeconomic factors. Having ever been married, fathering 2 or more children, older age, and higher income were the factors associated with vasectomy. After accounting for reproductive history, partner, and demographic characteristics, black and Hispanic men were less likely to rely on vasectomy for contraception. Further research is needed to identify the reasons for these race/ethnic differences and to identify factors that impede minority men's reliance on this means of fertility control.
Article
A refined method of delivering the vas deferens for vasectomy has been developed and used in China since 1974. This method eliminates the scalpel, results in fewer hematomas and infections, and leaves a smaller wound than conventional techniques. An extracutaneous fixation ring clamp encircles and firmly secures the vas without penetrating the skin. A sharp curved hemostat punctures and dilates the scrotal skin and vas sheath. The vas is delivered, cleaned and occluded by the surgeon's preferred technique. The contralateral vas is delivered through the same opening. The puncture wound contracts to about 2 mm., is not visible to the man and requires no sutures for closure. The reported incidence of hematoma in 179,741 men followed in China was 0.09%. No hematomas or infections were identified in the first 273 procedures performed by a surgeon in the United States. The operating time in China and for the last 50 United States procedures has ranged from 5 to 11 minutes. The disadvantage of the technique is the hand-on training and number of cases necessary to gain proficiency. However, the advantages for surgeons and patients should enhance the popularity of vasectomy.
Article
Recent conflicting findings on possible health risks related to vasectomy have underscored the need for reliable and representative estimates of numbers and rates of vasectomies in the United States. The purpose of this study was to estimate the annual US number, rate, and characteristics of vasectomies in 1991. A national survey of urology, general surgery, and family practice physician practices was conducted with probability sampling methods (n = 1685 physicians). An estimated 493,487 (95% confidence interval = 450,480, 536,494) vasectomies were performed in 1991, for a rate of 10.3 procedures per 1000 men aged 25 through 49 years. Most vasectomies were performed by urologists, and most were done in physicians' offices with local anesthesia and ligation as the method of occlusion. The rate of vasectomies was highest in the Midwest. This survey provides the first national estimates of the number and rate of vasectomies in the United States, as well as the first estimates of occlusion method used. Results confirm previous findings that urologists perform most vasectomies and that most vasectomies are performed with local anesthesia. Recommendations include the monitoring of vasectomy numbers and rates as well as demographic studies of men obtaining vasectomies.
Article
This report presents statistics on conditions diagnosed and surgical and nonsurgical procedures performed in non-Federal short-stay hospitals. The statistics are based on data collected through the National Hospital Discharge Survey from a national sample of the hospital records of discharged inpatients. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital.
Article
Currently, no surveillance system collects data on the numbers and characteristics of vasectomies performed annually in the United States. This study provides nationwide data on the numbers of vasectomies and the use of no-scalpel vasectomy, various occlusion methods, fascial interposition, and protocols for analyzing semen after vasectomy. A retrospective mail survey (with telephone follow-up) was conducted of 1800 urology, family practice, and general surgery practices drawn from the American Medical Association's Physician Master File and stratified by specialty and census region. Mail survey and telephone follow-up yielded an 88% response rate. In 1995, approximately 494,000 vasectomies are estimated to have been performed by 15,800 physicians in the United States. Urologists performed 76% of all vasectomies, and nearly all (93%) urology practices performed vasectomies in 1995. Nearly one third (29%) of vasectomies in 1995 were no-scalpel vasectomies, and 37% of physicians performing no-scalpel vasectomies taught themselves the procedure. The most common occlusion method in 1995 (used for 38% of all vasectomies) was concurrent use of ligation and cautery. In 1995, slightly less than half (48%) of all physicians surveyed interposed the fascial sheath over one end of the vas when performing a vasectomy. Protocols for ensuring azoospermia varied: 56% of physicians required one postvasectomy semen specimen; 39% required two, and 5%, three or more. No-scalpel vasectomy, used by nearly one third of U.S. physicians, has become an accepted part of urologic care. Physicians' variations in occlusion methods, use of fascial interposition, and postvasectomy protocols underscore the need for large scale, controlled, and statistically valid studies to determine the efficacy of occlusion methods and fascial interposition, as well as whether azoospermia is the only determination of a successful vasectomy.
Article
Objectives: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1995. Estimates of first-listed diagnoses, all-listed diagnoses, days of care for first-listed diagnoses, and all-listed procedures are shown by sex and age of patient and geographic region of hospital. Methods: The estimates are based on data collected through the National Hospital Discharge Survey for 1995. The survey has been conducted annually by the National Center for Health Statistics since 1965. In 1995, data were collected for approximately 263,000 discharges from 466 non-Federal short-stay hospitals. Diagnoses and procedures are presented according to their code number in the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM).
Article
Objectives: This report presents estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 1996. Data are presented by types of facilities, age and sex of the patient, and geographic region. Major categories of procedures and diagnoses are shown by age, sex, and region. Methods: The estimates are based on data collected by the 1996 National Survey of Ambulatory Surgery conducted by the National Center for Health Statistics. The 1996 data were abstracted from 125,000 medical records in 488 hospitals and freestanding ambulatory surgery centers.
Article
Objectives: This report presents national estimates of the use of non-Federal short-stay hospitals in the United States during 1995. Numbers and rates of discharges, diagnoses, and procedures are shown by age and sex. Discharges are also shown by geographic region of hospital. Average lengths of stay are presented for discharges and selected diagnostic categories. Methods: The estimates are based on medical abstract data collected through the National Hospital Discharge Survey for 1995. The survey has been conducted annually by the National Center for Health Statistics since 1965. Diagnoses and procedures presented are coded according to the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9-CM.
Article
Objectives: This report presents estimates of surgical and nonsurgical procedures performed on an ambulatory basis in hospitals and freestanding ambulatory surgery centers in the United States during 1995. Data are presented by types of facilities, age, sex, and geographic region. Major categories of procedures and diagnoses are shown by age, sex, and region. Methods: The estimates are based on data collected from the 1995 National Survey of Ambulatory Surgery conducted by the National Center for Health Statistics. The 1995 data were abstracted from 122,000 medical records in 489 hospitals and freestanding ambulatory surgery centers.
Article
Objective: To review the social and behavior contexts of decisions about contraceptive sterilization and to analyze factors associated with sterilization choices. Design: Multinomial logit regression of sterilization. Patient(s): Various subsamples as appropriate to specific analyses drawn from the 10,847 women interviewed in the 1995 National Survey of Family Growth, and the 5,227 men interviewed in the National Survey of Families and Households. Intervention(s): None. Main outcome measure(s): Tubal sterilization and vasectomy. Result(s): Surprisingly high proportions of recent tubal sterilizations were performed on unmarried women: 1 in 3 overall, 1 in 5 among white non-Hispanic women, and 2 in 3 among black women. Sterilization choice among continuously married couples also revealed large differences by race and ethnicity. Parity at the time of the last wanted birth is a major factor affecting sterilization choices, although significant effects were found as well as for a number of other variables, including age differences between spouses, education, and religion. Compared with other regions, the ratio of tubal sterilizations to vasectomies is extremely low in the Western region of the United States. Conclusion(s): Analysis of sterilization decisions must be based on time since the completion of childbearing. The findings call attention to the need for measuring variables that mediate observed associations with sterilization outcomes.
Article
Objective: To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience. Design: A review of U.S. health care statistics and English-language literature using a MEDLINE search, bibliographies of key references, and U.S. government publications. Patient(s): Women seeking tubal sterilization. Intervention: Tubal sterilization. Main outcome measure(s): Effectiveness and long-term risks and benefits. Result(s): Half of the 700,000 annual bilateral tubal sterilizations (TS) are performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. Evidence of menstrual or hormonal disturbance after TS is weak, although some studies find higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. Conclusion(s): Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evidence for hormonal or menstrual changes due to TS is weak. Tubal sterilization is associated with decreased risk of ovarian cancer.
Article
The aim of this study was to conduct a quantitative review of prostate cancer studies to pool relative risk (RR) estimates on the association between prostate cancer and vasectomy, in an attempt to determine whether there is an association, and if so, its magnitude. Random-effects models were examined along with a linear model for time since vasectomy. The pooled RR estimate was 1.37 (95% CI=1.15-1.62) based on five cohort studies and 17 case-control studies. The RR estimate varied by study design with the lowest risk for population-based case-control studies. No difference was seen in risk by age at vasectomy. A linear trend based on the 16 studies reporting time since vasectomy suggested an 10% increase for each additional 10 y or a RR of 1.32 (95% CI=1.17-1.50) for 30 y since vasectomy. When null effects were assumed for the six studies not reporting information, the linear RR for the 22 studies was 1.07 (1.03-1.11) and 1.23 (1.11-1.37) for 10 and 30 y since vasectomy, respectively. These results suggest that men with a prior vasectomy may be at an increased risk of prostate cancer, however, the increase may not be causal since potential bias cannot be discounted. The overall association was small and therefore could be explained by bias. The latency effect shown here for time since vasectomy should be examined further.
Article
This report presents national estimates of fertility, family planning, and reproductive health indicators among females 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). For selected indicators, data are also compared with earlier cycles of the NSFG. Descriptive tables of numbers and percentages are presented and interpreted. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males, and this report focuses on data from the female sample. The overall response rate for the Cycle 6 NSFG was 79 percent, and the response rate for women was 80 percent. Given the range of topics covered in the report, only selected findings are listed here. About 14 percent of recent births to women 15-44 years of age in 2002 were unwanted at time of conception, an increase from the 9 percent seen for recent births in 1995. Among recent births, 64 percent occurred within marriage, 14 percent within cohabiting unions, and 21 percent to women who were neither married nor cohabiting. The overall rate of breastfeeding initiation among recent births increased from 55 to 67 percent between 1995 and 2002. About 50 percent of women 15-44 had ever cohabited compared with 41 percent of women in the 1995 survey; the percentage of women currently cohabiting also increased, from 7 to 9 percent between 1995 and 2002.
Article
We estimated the number of vasectomies performed in the United States in 2002 and gathered information on the vasectomy procedures and protocols used. It follows similar studies done in 1991 and 1995. A retrospective mail survey with telephone followup was performed in 2,300 urologists, family physicians and general surgeons randomly sampled from the American Medical Association Physician Masterfile. The response rate was 73.8%. An estimated 526,501 vasectomies were performed in 2002 for a rate of 10.2/1,000 men 25 to 49 years old. Overall 37.8% of physicians reported currently using no scalpel vasectomy and almost half of the vasectomies performed in 2002 were no scalpel vasectomies. Methods of vas occlusion varied in and among specialties with a combination of ligation and cautery being most common (41.0% of cases). Of the physicians 45.6% reported routinely performing fascial interposition, 94.4% reported removing a vas segment, 23.3% reported routinely folding back 1 or 2 ends of the vas and 7.5% reported using open-ended vasectomy. Followup protocols varied widely. Of respondents 53.5% reported charging $401 to $600 for vasectomy in 2002. Although the estimated number of vasectomies performed in the United States during 2002 represents an increase from 1991 and 1995, incidence rates remained unchanged at approximately 10/1,000 men 25 to 49 years old. The percent of vasectomies performed using no scalpel vasectomy as well as the number of physicians who reported that they use no scalpel vasectomy increased substantially since 1995. Wide variation in surgical techniques and followup protocols were found.
Article
This report presents national estimates of fertility, family formation, contraceptive use, and father involvement indicators among males 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). Data are also shown for women for purposes of comparison. Descriptive tables of numbers and percentages are presented. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males. This report focuses primarily on data from the male sample, but compares findings with the female data whenever appropriate. The overall response rate for Cycle 6 of the NSFG was 79 percent, and the response rate for men was 78 percent. This report covers a wide range of topics including first sexual intercourse and its timing in relation to marriage; contraceptive use; wantedness of births in the past 5 years; marital and cohabiting status at first birth; living arrangement of fathers with their children; father's activities with children they live with and those they do not live with; HIV-risk related behaviors; and infertility services. The reproductive experiences of men and women 15-44 years of age in the United States vary significantly, and often sharply, by demographic characteristics such as education, income, and Hispanic origin and race.
Article
To study the frequency of vasectomy in men with primary progressive aphasia (PPA). PPA is a dementia syndrome in which aphasia emerges in relative isolation during the initial stages of illness. On the basis of a clinical observation in a patient who dated the onset of symptoms to the period after a vasectomy, and because of the curious sharing of the tau protein exclusively by brain and sperm, vasectomy rates were examined in men with PPA. This study used a case control design. Forty-seven men with PPA and 57 men with no cognitive impairment (NC) between 55 and 80 years of age were surveyed about a history of vasectomy. The age-adjusted rate of vasectomy in PPA patients (40%) was higher than in NC (16%, P=0.02). There was a younger age at onset for the patients with vasectomy (58.8 vs. 62.9 y, P=0.03). Vasectomy may constitute one risk factor for PPA in men. Potential mechanisms mediating risk include vasectomy-induced immune responses to sperm, which shares antigenic epitopes with brain. Antisperm antibodies can also develop in women and become risk factors for PPA.
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.
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