Vasectomy—1980

Vasectomy is associated with an increased risk for urolithiasis

We evaluated vasectomy as a potential risk factor for urolithiasis. Vasectomy is a common method of contraception among otherwise healthy men. This is also the population at highest risk for urolithiasis. We conducted a case-control study of patients in a large prepaid health maintenance organization. Cases were men experiencing initial episodes of urolithiasis, ascertained by reviewing radiology logs and medical records. The age-matched controls were men with no history of urolithiasis. In logistic regression models, the relative risk of urolithiasis for men with vasectomies compared with men without vasectomies was 1.9 for men younger than 46 years of age (95% confidence interval = 1.2 to 3.1, P = 0.005), and the relative risk was 0.9 (95% confidence interval = 0.5 to 1.5, P > 0.8) for men who were at least 46 years old. The relative risk of urinary calculi was 2.0 (95% confidence interval 1.0 to 4.1, P < 0.05) for men with vasectomies 0 to 4 years before evaluation compared with men without vasectomies, and the excess risk persisted as long as 14 years postvasectomy. Vasectomy was associated with a twofold increased risk for urolithiasis in men younger than 46 years of age. This increased risk may persist for up to 14 years postvasectomy. Given the large number of men who undergo vasectomy worldwide each year, the increased risk for urolithiasis among vasectomized men may result in substantial excess morbidity.

No-scalpel vasectomy at the King's birthday vasectomy festival

No-scalpel vasectomy was developed to increase acceptability of vasectomy by elimination of the fear of the incision. Although this method has been used for over 8,000,000 men, the technique is largely unknown in developed countries. During the King's birthday vasectomy festival no-scalpel vasectomy was compared with standard incisional vasectomy in 1203 patients. An average of 57 procedures per day could be done by each physician with the no-scalpel method, compared to 33 procedures with the standard method (p less than 0.001). The complication rate was 0.4/100 procedures for no-scalpel vasectomy compared with 3.1/100 for standard vasectomy (p less than 0.001). No-scalpel vasectomy is a rapid and economic alternative to standard vasectomy, with fewer complications and increased patient acceptability.

Nd:YAG coagulation of the verumontanum: an endoscopic attempt at sterilization

In order to develop a new and less invasive method of sterilization in men we performed photocoagulation of the verumontanum in 10 rams, using a Nd:YAG laser, wavelength 1,060 nm. Under general anesthesia a perineal urethro-cutaneous fistula was achieved, and, by means of a 16F laser-endoscope, transurethral coagulation of the ejaculatory ducts, located in the verumontanum, was carried out, using pulses of 1.5 sec in duration and 20-30 W in power. The animals were killed at different postoperative time intervals, ranging from 1 day to 8 weeks. Injection of methylene-blue into the testicular ducts of the resected prostate-bladder specimen and histologic studies of the coagulated tissue revealed that complete bilateral occlusion of the ejaculatory ducts had been achieved in 4 rams. Failures were due to over-extended irradiation of the verumontanum. Except for urinary tract infections occurring in 4 animals, no serious complications were encountered. Further investigations are still necessary to determine the role of lasers in male sterilization.

Vasectomy: what are community standards?

Vasectomy has become an increasingly popular mode of contraception in our society. It is also a procedure which places the urologist at an uncommonly high risk for litigation. To better assess the manner in which urologists within a geographical region treat their vasectomy patients, a survey was conducted of the members of the New England Section, American Urological Association. The results of that survey are presented.

Vasitis nodosa and spermatic granuloma of the skin: an histologic study of a rare complication of vasectomy

A 29-year-old man noticed localized painful swelling of the scrotal skin after elective vasectomy. The lesion was excised and its histologic examination revealed a diffuse inflammatory, partly granulomatous infiltrate with numerous tubular structures in the dermis and subcutaneous tissues. These ductules were lined by cuboidal epithelial cells and contained spermatozoa. The inflammatory infiltrate consisted of lymphocytes, plasma cells and histiocytes, but also contained spermatozoa and a few spermatic granulomas. These changes were the sequelae of a vasocutaneous adhesion and fistula; the ductules were the result of epithelial regeneration from the vas deferens and the inflammation with spermatic granulomas was due to extravasated spermatozoa.

Comparative risks and costs of male and female sterilization

Couples who are considering elective sterilization should compare the risks and costs of male and female sterilization procedures as part of the decision process. Morbidity, mortality, failure rates, and short-term costs associated with male and female sterilization procedures were estimated from data available in previous case series. Male sterilization procedures were found to have zero attributable deaths and significantly less major complications when compared to female sterilization procedures. No less than 14 deaths a year can be attributed to female sterilization procedures in the US. Male and female sterilization procedures have efficacy rates that are not significantly different from each other. The short-term costs of female sterilization are 3.0 to 4.1 times that of vasectomy.