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Hupertan V, Graziana JP, Schoentgen N, Boulenger De Hauteclocque A, Chaumel M, Ferretti L, Methorst C, Huyghe E. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy]. Prog Urol 2023; 33:223-236. [PMID: 36841700 DOI: 10.1016/j.purol.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/22/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request. METHOD The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021 identified 508 references, of which 79 were selected and analyzed with the GRADE grid. RECOMMENDATIONS Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.
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Affiliation(s)
- V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - N Schoentgen
- Hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, Paris, France
| | | | - M Chaumel
- Service d'urologie, CHU de Tours, Tours, France
| | - L Ferretti
- Maison de santé pluridisciplinaire Bordeaux Bagatelle, Talence, France
| | - C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France; Service de médecine de la reproduction, CHU de Toulouse, site de l'hôpital Paule-de-Viguier, 31059 Toulouse, France; UMR DEFE Inserm 1203, université de Toulouse 3, université de Montpellier, Toulouse, France.
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Zeitler M, Rayala B. Outpatient Vasectomy: Safe, Reliable, and Cost-effective. Prim Care 2021; 48:613-625. [PMID: 34752273 DOI: 10.1016/j.pop.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization. Vasectomies are typically done under local anesthesia in outpatient settings, and patients usually go home within an hour of the surgery. Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information from observational studies, with few controlled clinical trials.
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Affiliation(s)
- Matthew Zeitler
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, Chapel Hill, NC 27599-7595, USA.
| | - Brian Rayala
- Department of Family Medicine, University of North Carolina, 590 Manning Drive, Chapel Hill, NC 27599-7595, USA
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Kinney ME, Wack RF, Grahn RA, Lyons L. Parthenogenesis in a Brazilian rainbow boa (Epicrates cenchria cenchria). Zoo Biol 2012; 32:172-6. [PMID: 23086743 DOI: 10.1002/zoo.21050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/11/2012] [Accepted: 09/21/2012] [Indexed: 11/07/2022]
Abstract
A 22-year-old captive Brazilian rainbow boa (Epicrates cenchria cenchria) gave birth to four offspring after being housed with a vasectomized male. Sexual reproduction as a result of failed prior vasectomy, recanalization of the vas deferens, or prolonged sperm storage was ruled out using the clinical history, histopathology, and gross necropsy. Short tandem repeat (STR) DNA markers were genotyped in the male, female, and four offspring. None of the offspring possessed a diagnostic STR allele present in the potential sire. In addition, all offspring were homozygous at each STR locus evaluated, supporting parthenogenetic reproduction. This is the first report of parthenogenesis in a Brazilian rainbow boa and has implications for the conservation of reptiles maintained in captive breeding programs.
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Affiliation(s)
- Matthew E Kinney
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California 95822, USA.
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Abstract
The effectiveness of various vasectomy techniques is reviewed, with a focus on methods used for vas occlusion. Spontaneous recanalization of the vas is more common than generally recognized and is often transient. Simple ligation and excision has an unacceptably high risk for failure. Techniques that include cautery seem to have a lower risk for failure than techniques that do not include cautery. There is insufficient evidence to recommend a particular standardized cautery technique, but adding fascial interposition to cautery seems to be associated with the lowest risk for failure.
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Affiliation(s)
- David C Sokal
- Behavioral and Biomedical Research Department, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA.
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Abstract
Vasectomy is one of the most common forms of permanent sterilization methods currently in use and has a failure rate of <1% in most reported series. Since failure of vasectomy may result in pregnancy, adequate counseling is essential. Couples are advised that an analysis of a semen specimen after vasectomy is required to confirm success before the use of alternative contraception is abandoned. However, measuring the success of vasectomy is complicated by a lack of consistency with regards to both the number and timing of tests and the end points accepted.
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Affiliation(s)
- Nivedita Bhatta Dhar
- Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Barone MA, Hutchinson PL, Johnson CH, Hsia J, Wheeler J. Vasectomy in the United States, 2002. J Urol 2006; 176:232-6; discussion 236. [PMID: 16753407 DOI: 10.1016/s0022-5347(06)00507-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Mark A Barone
- EngenderHealth, 440 Ninth Avenue, New York, NY 10001, USA.
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Labrecque M, Pile J, Sokal D, Kaza RCM, Rahman M, Bodh SS, Bhattarai J, Bhatt GD, Vaidya TM. Vasectomy surgical techniques in South and South East Asia. BMC Urol 2005; 5:10. [PMID: 15916711 PMCID: PMC1180458 DOI: 10.1186/1471-2490-5-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Accepted: 05/25/2005] [Indexed: 11/23/2022] Open
Abstract
Background Simple ligation of the vas with suture material and excision of a small vas segment is believed to be the most common vasectomy occlusion technique performed in low-resource settings. Ligation and excision (LE) is associated with a risk of occlusion and contraceptive failure which can be reduced by performing fascial interposition (FI) along with LE. Combining FI with intra luminal thermal cautery could be even more effective. The objective of this study was to determine the surgical vasectomy techniques currently used in five Asian countries and to evaluate the facilitating and limiting factors to introduction and assessment of FI and thermal cautery in these countries. Methods Between December 2003 and February 2004, 3 to 6 major vasectomy centers from Cambodia, Thailand, India, Nepal, and Bangladesh were visited and interviews with 5 to 11 key informants in each country were conducted. Vasectomy techniques performed in each center were observed. Vasectomy techniques using hand-held, battery-driven cautery devices and FI were demonstrated and performed under supervision by local providers. Information about interest and open-mindedness regarding the use of thermal cautery and/or FI was gathered. Results The use of vasectomy was marginal in Thailand and Cambodia. In India, Nepal, and Bangladesh, vasectomy was supported by national reproductive health programs. Most vasectomies were performed using the No-Scalpel Vasectomy (NSV) technique and simple LE. The addition of FI to LE, although largely known, was seldom performed. The main reasons reported were: 1) insufficient surgical skills, 2) time needed to perform the technique, and 3) technique not being mandatory according to country standards. Thermal cautery devices for vasectomy were not available in any selected countries. Pilot hands-on assessment showed that the technique could be safely and effectively performed by Asian providers. However, in addition to provision of supplies, introducing cautery with FI could be associated with the same barriers encountered when introducing FI in combination with LE. Conclusion Further studies assessing the effectiveness, safety, and feasibility of implementation are needed before thermal cautery combined with FI is introduced in Asia on a large scale. Until thermal cautery is introduced in a country, vasectomy providers should practice LE with FI to maximize effectiveness of vasectomy procedure.
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Affiliation(s)
- Michel Labrecque
- Department of Family Medicine, Laval University, Quebec City, Canada
| | - John Pile
- EngenderHealth, 440 Ninth Avenue, New York, NY 10001 USA
| | - David Sokal
- Family Health International, 2224 Chapel Hill-Nelson Hwy Durham, NC, 27713 USA
| | | | - Mizanur Rahman
- EngenderHealth, Bangladesh Country Office, Dhaka, Bangladesh
| | - SS Bodh
- EngenderHealth, India Country Office, New Delhi, India
| | | | - Ganesh D Bhatt
- Chhetrapati Family Welfare Center, Chhetrapati, Kathmandu Nepal
| | - Tika Man Vaidya
- Nepal Fertility Care Center, Jwagal Kopundole, Laitpur Nepal
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Labrecque M, St-Hilaire K, Turcot L. Delayed vasectomy success in men with a first postvasectomy semen analysis showing motile sperm. Fertil Steril 2005; 83:1435-41. [PMID: 15866581 DOI: 10.1016/j.fertnstert.2004.10.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Revised: 10/26/2004] [Accepted: 10/26/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the frequency of and factors associated with delayed vasectomy success in men with first postvasectomy semen analysis showing motile sperm. DESIGN Descriptive study. SETTING One hospital-based family planning clinic and two private clinics from the Quebec City area, Canada. PATIENT(S) Three hundred nine men vasectomized between 1990 and 2001 and who had a first semen analysis showing motile sperm. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Vasectomy success, based on the last available semen analysis-either in the medical record or as requested for the study-and on sterility as established by a telephone-based questionnaire in 2003. RESULT(S) Among the 309 men, 174 (56.3%, 95% confidence interval 50.7%-61.7%) had delayed vasectomy success. Significant independent factors associated with delayed vasectomy success were lower sperm count in the first postvasectomy semen analysis and shorter interval between vasectomy and first postvasectomy semen analysis. CONCLUSION(S) Delayed vasectomy success occurs in more than half of men with a first postvasectomy semen analysis showing motile sperm. The decision to repeat vasectomy should not rely on a single semen analysis showing motile sperm.
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Affiliation(s)
- Michel Labrecque
- Evaluation Research Unit, Research Center, Hôpital Saint-François d'Assise, Centre Hospitalier Universitaire de Québec (CHUQ), Quebec City, Quebec, Canada.
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Barone MA, Irsula B, Chen-Mok M, Sokal DC. Effectiveness of vasectomy using cautery. BMC Urol 2004; 4:10. [PMID: 15260885 PMCID: PMC503392 DOI: 10.1186/1471-2490-4-10] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2004] [Accepted: 07/19/2004] [Indexed: 12/03/2022] Open
Abstract
Background Little evidence supports the use of any one vas occlusion method. Data from a number of studies now suggest that there are differences in effectiveness among different occlusion methods. The main objectives of this study were to estimate the effectiveness of vasectomy by cautery and to describe the trends in sperm counts after cautery vasectomy. Other objectives were to estimate time and number of ejaculations to success and to determine the predictive value of success at 12 weeks for final status at 24 weeks. Methods A prospective, non-comparative observational study was conducted between November 2001 and June 2002 at 4 centers in Brazil, Canada, the UK, and the US. Four hundred men who chose vasectomy were enrolled and followed for 6 months. Sites used their usual cautery vasectomy technique. Earlier and more frequent than normal semen analyses (2, 5, 8, 12, 16, 20, and 24 weeks after vasectomy) were performed. Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation. Results A total of 364 (91%) participants completed follow-up. The overall failure rate based on semen analysis was 0.8% (95% confidence interval 0.2, 2.3). By 12 weeks 96.4% of participants showed azoospermia or severe oligozoospermia (< 100,000 sperm/mL). The predictive value of a single severely oligozoospermia sample at 12 weeks for vasectomy success at the end of the study was 99.7%. One serious unrelated adverse event and no pregnancies were reported. Conclusion Cautery is a very effective method for occluding the vas. Failure based on semen analysis is rare. In settings where semen analysis is not practical, using 12 weeks as a guideline for when men can rely on their vasectomy should lessen the risk of failure compared to using a guideline of 20 ejaculations after vasectomy.
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Affiliation(s)
- Mark A Barone
- EngenderHealth, 440 Ninth Avenue, New York, NY 10001, USA
| | - Belinda Irsula
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA
| | - Mario Chen-Mok
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA
| | - David C Sokal
- Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA
| | - the Investigator study group
- Investigator study group: Elsimar M. Coutinho, Centro de Pesquisa e Assistência em Reprodução Humana (CEPARH), Salvador, Brazil; Michel Labrecque, Unité de Médecine Familiale, Laval University, Québec City, Canada; Thomas R. Pritchett, Virginia Mason Medical Center, Seattle, WA, US; and Edward Streeter; Elliot-Smith Clinic, Churchill Hospital, Oxford, UK
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Amundsen GA, Ramakrishnan K. Vasectomy: a "seminal" analysis. South Med J 2004; 97:54-60. [PMID: 14746423 DOI: 10.1097/01.smj.0000085766.47775.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vasectomy is one of the most reliable and cost-effective permanent methods of contraception. Despite its popularity, certain issues pertaining to the procedure remain unresolved. Appropriate selection of candidates for vasectomy requires thorough counseling and screening, though a foolproof method of eliminating dissatisfaction and regret remains a mystery. Debate continues over the relative merits of the various techniques of isolating and sealing the vasal ends. Postoperative complication rates remain minimal regardless of the technique used, and no single strategy attempting to maximize patient compliance with postoperative semen analysis has enjoyed unmitigated success. Long-term consequences, other than regret, are rare. Finally, issues regarding residency training in the procedure and its impact on procedure morbidity are scarcely addressed in the literature. This study reviews the evolution of vasectomy as a contraceptive procedure and attempts to summarize current literature addressing these unresolved issues.
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Affiliation(s)
- Gerald A Amundsen
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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