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Seth I, Gibson D, Bulloch G, Joseph K, Cevik J, Qin KR, Shahbaz S, Rozen WM. Vasovasostomy: A systematic review and meta-analysis comparing macroscopic, microsurgical, and robot-assisted microsurgical techniques. Andrology 2024; 12:740-767. [PMID: 37804499 DOI: 10.1111/andr.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Vasovasostomy is a cost-effective procedure for the reversal of vasectomy. A water-tight adequately blood-supplied mucosal anastomosis is required for better outcomes. This review aimed to compare the outcome of vasovasostomy performed by three different techniques: macroscopic, pure microsurgical, and robot-assisted microsurgical techniques. METHODS Scopus, Web of Science, PubMed, Embase, and Cochrane library databases were searched for relevant studies from January 1901 to June 2023. We conducted our quantitative syntheses using the inverse variance method in OpenMeta software. The study's protocol was registered on PROSPERO. RESULTS This review involved 95 studies of different designs, with a total sample size of 48,132. The majority of operations were performed bilaterally, and participants were monitored for up to 10 years. The pooled patency rate was the highest following robot-assisted vasovasostomy (94.4%), followed by pure microsurgical vasovasostomy (87.5%), and macroscopic vasovasostomy (83.7%). The pooled pregnancy rate following purely microsurgical vasovasostomy was higher than that of macroscopic vasovasostomy (47.4 vs. 43.7%). Definitive pregnancy rates in robotic vasovasostomy are yet to be determined. CONCLUSION Patency outcomes for vasovasostomy were best with robot-assisted microsurgical technique, followed by pure microsurgical technique, and conventional macroscopic technique. Further investigations of robot-assisted microsurgical vasovasostomy outcomes and randomized control trials are required to support this evidence.
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Affiliation(s)
- Ishith Seth
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Damien Gibson
- Department of Surgery, Faculty of Medicine, University of New South Wales, University of New South Wales, Sydney, Australia
| | - Gabriella Bulloch
- Department of Surgery, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Konrad Joseph
- Department of Surgery, Faculty of Medicine, The University of Wollongong, New South Wales, Australia
| | - Jevan Cevik
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Kirby R Qin
- Department of Urology, Bendigo Hospital, Melbourne, Victoria, Australia
| | - Shekib Shahbaz
- Department of Urology, Monash Hospital, Melbourne, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic Surgery, Peninsula Health, Melbourne, Victoria, Australia
- Department of Surgery, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Department of Surgery, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Faix A, Methorst C, Hupertan V, Huyghe E. [Male contraception]. Prog Urol 2023; 33:718-732. [PMID: 38012914 DOI: 10.1016/j.purol.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 11/29/2023]
Abstract
CONTEXT Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden. METHODS A literature search was carried out to review the existing options and the criteria for optimal contraception, to establish the principles of a male pre-contraception consultation, and to review the various research avenues with their advantages and disadvantages. RESULTS The new male contraception options are detailed, whether hormonal (androgen therapy, combination of progestins and testosterone) or non-hormonal, particularly thermal, with current results and avenues for improvement. Condom use and vasectomy remain the only 2 validated options. The recent development of minimally invasive vasectomy without the need for a scalpel and of occlusion techniques has simplified the procedure, minimised the risk of complications (pain, haematomas, post-vasectomy pain syndrome) and improved efficacy. The issues of regret and the possibility of repermeabilisation are also raised. CONCLUSION The question of male contraception will become increasingly important in consultations with urologists. The urologist will have to inform the patient, as required by law, before the vasectomy is performed, and provide the best possible advice on the technique, which will often be minimally invasive without the need for a scalpel. New reversible options should also broaden the range of options available on a routine basis, with a view to gradually moving towards contraceptive equity.
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Affiliation(s)
- A Faix
- Clinique Saint-Roch, 560, avenue du colonel Pavelet dit Villars, 34000 Montpellier, France
| | - C Methorst
- Service de médecine de la reproduction, hôpital des 4 villes, Saint-Cloud, France
| | - V Hupertan
- « Urologie Paris Opéra », cabinet médical, 82, boulevard de Courcelles, 75017 Paris, France
| | - E Huyghe
- Département d'urologie, CHU de Toulouse, hôpital de Rangueil, Toulouse, France; Service de médecine de la reproduction, CHU de Toulouse, hôpital Paule-de-Viguier, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France.
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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: 6] [Impact Index Per Article: 6.0] [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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Charles DK, Anderson DJ, Newton SA, Dietrich PN, Sandlow JI. Vasectomy Regret Among Childless Men. Urology 2023; 172:111-114. [PMID: 36481202 DOI: 10.1016/j.urology.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To address historical concerns surrounding vasectomy in childless men, we sought to evaluate for the level of regret in this unique cohort. METHODS The records of patients who underwent vasectomy via single surgeon between 2006 and 2021 were retrospectively reviewed and those who had not fathered children in any capacity at time of vasectomy were selected. We devised a 6-question survey inquiring about regret and thoughts on vasectomy reversal and assisted reproductive technology (ART). The questions are listed in Table 1. Patients were queried via a telephone call to rate their level of regret, both immediately after vasectomy and present day. The cohort was analyzed via age at time of vasectomy, time since vasectomy and marital status. RESULTS There were 4812 overall patients who underwent vasectomy in this interval, with 205 (4.3%) who were childless. The response rate was 33.2% (68/205). Average age was 36.6 years with average time since vasectomy at time of phone call was 5.51 years. Regret rate was 4.4% immediately following vasectomy and 7.4% at time of telephone interview. A confirmatory, second consultation before vasectomy was present in 6.8% (14/205). The majority of patients 150/205 (73.1%) were married. When patients were stratified by marital status, there was no significant difference in any of the questions. The majority of patients were satisfied with their decision, with few contemplating or pursuing reversal or ART (Table 1). CONCLUSION Regret in childless patients who undergo vasectomy is very rare, with the majority of patients feeling that their life was improved.
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Affiliation(s)
- David K Charles
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Sydney A Newton
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Peter N Dietrich
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
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Siemons SE, Vleugels MPH, van Balken MR, Braat DDM, Nieboer TE. Male or female sterilization - the decision making process: Counselling and regret. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100767. [PMID: 36027724 DOI: 10.1016/j.srhc.2022.100767] [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: 01/18/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE(S) To analyze the decision-making process of both male and female sterilization in order to improve counselling and prevent regret after sterilization in the future. STUDY DESIGN An online questionnaire regarding sterilization (counselling, sources of information and regret) was promoted on Facebook, Twitter and LinkedIn. A total of 1107 men and women who had undergone or considered sterilization in the Netherlands filled in the questionnaire. RESULTS A total of 88.9 % of the sterilized group and 67.4 % in the considered group responded that they felt well informed when they considered sterilization. However, less than half of the participants in both groups knew about all different sterilization methods. In both groups participants reported they consulted their partner the most when they considered sterilization. After sterilization 7.7 % reported having regret. Regret was reported more often when participants were sterilized ≤ 30 years. Most important reasons for regret reported by males were complications, pain, a new wish to conceive and divorce/remarriage. Most important reasons for regret reported by females were pain, complications, a new wish to conceive and menstrual symptoms. A total of 21.1 % in the sterilized and 38.0 % in the considered group responded they would have liked to use a decision aid when they considered sterilization. CONCLUSIONS Findings of this study provide insight in the decision-making process regarding sterilization. There is a lack of knowledge of different methods of sterilization and 7.7% regrets their sterilization afterwards. Furthermore, the results show an importance of developing a decision aid for couples considering sterilization.
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Affiliation(s)
- Sara E Siemons
- Dept. of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
| | - Michel P H Vleugels
- Dept. of Obstetrics and Gynecology, Hospital Clinica Benidorm, Avinguda Alfonso Puchades 8, 03501 Benidorm, Spain
| | - Michael R van Balken
- Dept. of Urology, Rijnstate Arnhem, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
| | - Didi D M Braat
- Dept. of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Theodoor E Nieboer
- Dept. of Obstetrics and Gynecology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
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Hertz AM, Stamm AW, Anderson MI, Baker KC. Impact of surgical volume and resident involvement on patency rates after vasectomy reversal-A 14-year experience in an open access system. Asian J Urol 2021; 8:197-203. [PMID: 33996476 PMCID: PMC8099639 DOI: 10.1016/j.ajur.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/07/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022] Open
Abstract
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 to December 31, 2016 was conducted. 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 and 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 post-graduate year.
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Affiliation(s)
| | - Andrew W Stamm
- Division of Urology and Transplantation, Virginia Mason Medical Center, Seattle, WA, USA
| | - Mark I Anderson
- Department of Urology, Madigan Army Medical Center, Tacoma, WA, USA
| | - Karen C Baker
- Division of Urology, Duke University Hospital, Durham, NC, USA
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Engl T, Hallmen S, Beecken WD, Rubenwolf P, Gerharz EW, Vallo S. Impact of vasectomy on the sexual satisfaction of couples: experience from a specialized clinic. Cent European J Urol 2017; 70:275-279. [PMID: 29104791 PMCID: PMC5656365 DOI: 10.5173/ceju.2017.1294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 05/14/2017] [Accepted: 06/16/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Vasectomy is the simplest, safest, and most effective form of definitive fertility control in men [1]. Vasectomy is used for 10% of contraception worldwide but only for 2% in Germany [2]. The aim of this study was to investigate the impact of vasectomy on the sexual satisfaction of sterilized men and their partners. MATERIAL AND METHODS Vasectomized men and their partners were surveyed by means of the IIEF (International Index for Erectile Function) and the FSFI (Female Sexual Function Index) questionnaires. A total of 294 couples were surveyed; 90 men answered the IIEF, and 74 women answered the FSFI. The results of the questionnaires were compared to a historical comparison group. The men were also surveyed with a not validated questionnaire, which was returned by 95 men. The two-sample t-test for independent samples, the chi-squared test, and the Wilcoxon-Mann-Whitney test were carried out. RESULTS The vasectomized men had significantly better results than the healthy historical comparison group in the IIEF domains of erectile function, orgasm, sexual desire, and intercourse satisfaction. For the female partners of the sterilized men, there were almost no significant differences in any questions of the FSFI in comparison to the control group. A significant difference was observed only in the domain 'arousal'. CONCLUSIONS Vasectomy does not have a negative impact on the sexual satisfaction of the affected couples. In fact, sexual satisfaction improved for the sterilized men, while the satisfaction of the women was not reduced by the vasectomy.
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Affiliation(s)
- Tobias Engl
- UROGATE Associates Frankfurt, in cooperation with Frankfurt University Medical Center, Germany
| | - Sarah Hallmen
- Department of Urology, Frankfurt University Medical Center, Frankfurt, Germany
| | - Wolf-D. Beecken
- UROGATE Associates Frankfurt, in cooperation with Frankfurt University Medical Center, Germany
| | - Peter Rubenwolf
- UROGATE Associates Frankfurt, in cooperation with Frankfurt University Medical Center, Germany
| | - Elmar-W. Gerharz
- UROGATE Associates Frankfurt, in cooperation with Frankfurt University Medical Center, Germany
| | - Stefan Vallo
- Department of Urology, Frankfurt University Medical Center, Frankfurt, Germany
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Declining rates of sterilization procedures in Western Australian women from 1990 to 2008: the relationship with age, hospital type, and government policy changes. Fertil Steril 2016; 106:704-709.e1. [PMID: 27172400 DOI: 10.1016/j.fertnstert.2016.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates. DESIGN Population-based retrospective descriptive study. SETTING Not applicable. PATIENT(S) All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures). INTERVENTION(S) Records from statutory statewide data collections of hospitals separations and births were extracted and linked. MAIN OUTCOME MEASURE(S) Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative. RESULT(S) The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81). CONCLUSION(S) Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth.
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Canadian Contraception Consensus Chapter 6 Permanent Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015. [DOI: 10.1016/s1701-2163(16)39377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Adongo PB, Tapsoba P, Phillips JF, Tabong PTN, Stone A, Kuffour E, Esantsi SF, Akweongo P. "If you do vasectomy and come back here weak, I will divorce you": a qualitative study of community perceptions about vasectomy in Southern Ghana. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2014; 14:16. [PMID: 24885663 PMCID: PMC4019590 DOI: 10.1186/1472-698x-14-16] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 05/02/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Male involvement in contraceptive use is increasingly becoming a global reproductive health issue. Vasectomy is one of the two male modern contraceptive methods espoused by the National Family Planning Policy in Ghana. Despite these advocacies, there are reports of low patronage of this method in Ghana. This study adhering to RATS guidelines on qualitative research therefore explored the social and cultural factors that may be affecting the low vasectomy uptake in Southern Ghana. METHODS The study was conducted in Sefwi Bibiani-Ahwiaso Bekwai (SBAB) District and Komenda-Edina-Eguafo-Abrem (KEEA) Municipal area in the Western and Central regions of Ghana respectively. Twelve Focus Group Discussions were held with both male and female community members. In-depth interviews were also carried out with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and health managers at both the district and regional levels. The discussions and interviews were recorded, transcribed verbatim and analysed using Nvivo 10. RESULTS The study revealed that vasectomy was perceived as an act against God, which was punishable either by death or answerable on judgement day. Vasectomy was also perceived to be a form of castration, which can make men weak and incapable, thereby unable to satisfy their wives sexually, leading to marital conflicts. Women were more concerned about the negative effects of vasectomy on men. Cafalgin and panacin which are locally manufactured analgesics were perceived to have contraceptive abilities and therefore used by men as an alternative to modern contraceptive methods. CONCLUSIONS Stigma and the misconceptions in the community may be accounting for the low vasectomy uptake in Ghana despite several advocacy strategies. Women were highly influential in a man's decision on vasectomy. This calls for the need to increase health education to demystify the misconceptions about vasectomy. Vasectomy-related campaign messages should target both men and women.
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Affiliation(s)
- Philip Baba Adongo
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, P. O. Box LG 13, Accra, Ghana
| | - Placide Tapsoba
- Population Council, 14B Ridge Road, Roman Ridge, Accra, Ghana
| | - James F Phillips
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032, USA
| | - Philip Teg-Nefaah Tabong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, P. O. Box LG 13, Accra, Ghana
| | - Allison Stone
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue, B-2, New York, NY 10032, USA
| | | | | | - Patricia Akweongo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, P. O. Box LG 13, Accra, Ghana
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Bolduc S, Fischer MA, Deceuninck G, Thabet M. Factors predicting overall success: a review of 747 microsurgical vasovasostomies. Can Urol Assoc J 2013; 1:388-94. [PMID: 18542824 DOI: 10.5489/cuaj.454] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Advances in surgical techniques have improved the outcome of microsurgical vasovasostomy (VV). We performed a retrospective analysis of surgical procedures to determine outcomes and predictors of VV success, to develop Kaplan-Meier Curves for predicting VV outcomes and to evaluate the use of alpha-glucosidase (AG) to predict outcomes. PATIENTS AND METHODS We undertook a retrospective analysis of 747 modified 1-layer microsurgical VV procedures performed between 1984 and 2000. Obstructive interval, partner status, social status preoperatively and method of vasal obstruction, vasal fluid quality and sperm granuloma intraoperatively were compared with outcome results. Parameters evaluated at follow-up included semen analysis, AG concentration in ejaculate fluid and pregnancy rates. RESULTS The overall patency rate was 86% and pregnancy rates were 33% and 53% at 1 and 2 years after primary VV, respectively. Preoperative factors associated with successful outcome and pregnancy included shorter obstructive interval and same female partner (p < 0.05). Intraoperative factors predicting success included the use of surgical clips instead of suture at vasectomy, the presence of a sperm granuloma, the presence and quality of vasal fluid, and the presence and quality of sperm in vasal fluid. Further, increased AG in the postoperative semen predicted improved patency and pregnancy outcomes. CONCLUSION This study confirms the effectiveness of VV for vasectomized men who wish to father children. It also demonstrates that preoperative and intraoperative factors are predictive of the VV outcome. Postoperative AG is also a useful marker of patency and it appears to predict pregnancy outcome.
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Affiliation(s)
- Stéphane Bolduc
- Division of Urology, Centre Hospitalier Universitaire de Québec (CHUQ), Laval University, Québec, Que
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Sharma V, Le BV, Sheth KR, Zargaroff S, Dupree JM, Cashy J, Brannigan RE. Vasectomy demographics and postvasectomy desire for future children: results from a contemporary national survey. Fertil Steril 2013; 99:1880-5. [PMID: 23541407 DOI: 10.1016/j.fertnstert.2013.02.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 02/14/2013] [Accepted: 02/15/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the longitudinal demographics and family planning attitudes of vasectomized men with the use of the National Survey for Family Growth (NSFG). DESIGN Retrospective cohort analysis of the NSFG with the use of national projections and multivariable regressions. SETTING In-home survey. PATIENT(S) The NSFG sampled 10,403 men aged 15-45 years from 2006 to 2010 regarding family planning attitudes. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Vasectomy and desire for children. RESULT(S) There were 3,646,339 (6.6%) vasectomized men aged 18-45 years in the U.S. On multivariable regression the following factors increased the odds of having a vasectomy: currently married (odds ratio [OR] 7.814), previously married (OR 5.865), and increased age (OR 1.122) and income (OR 1.003). The odds of having a vasectomy increased with number of children. The following factors decreased the odds of having a vasectomy: immigrant status (OR 0.186), African American (OR 0.226), Hispanic (OR 0.543), Catholic (OR 0.549), and other non-Protestant religion (OR 0.109). Surprisingly, an estimated 714,682 (19.6%) vasectomized men in the U.S. desire future children. Men practicing a religion (OR 8.575-15.843) were more likely than atheists to desire children after vasectomy. 71,886 (2.0%) vasectomized men reported having a vasectomy reversal. CONCLUSION(S) This study highlights the importance of preoperative counseling for permanency of vasectomy and reveals an opportunity to counsel couples about vasectomy versus tubal ligation.
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Affiliation(s)
- Vidit Sharma
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Shin YS, Kim SD, Park JK. Preoperative factors influencing postoperative results after vasovasostomy. World J Mens Health 2012; 30:177-82. [PMID: 23596609 PMCID: PMC3623534 DOI: 10.5534/wjmh.2012.30.3.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 11/30/2012] [Accepted: 11/30/2012] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the preoperative factors that influenced postoperative sperm concentration after vasovasostomy. MATERIALS AND METHODS We retrospectively reviewed 97 consecutive single-layer vasovasostomy procedures performed by a single surgeon between March 2003 and September 2010. The patients were stratified into three groups based on sperm concentration at 1 month follow-up: group I-azoospermia, group II-oligospermia, and group III-normal. We evaluated the preoperative factors that may have influenced sperm concentration at postoperative 1 month. Patients with serial semen analysis were divided into four groups according to the change in postoperative sperm concentration at the 6-month visit: group II-N-from oligospermia to normal, group II-O-from oligospermia to oligospermia, group III-O-from normal to oligospermia, group III-N-from normal to normal. We compared the pregnancy rate among the four groups. RESULTS The mean obstructive interval was 9.69 years in group I, 6.02 years in group II, and 7.82 years in group III. There were significant differences found among the groups (p=0.035). There was significantly different change in sperm concentration, sperm motility, and sperm morphology between each of the groups. A total of 32 patients underwent serial semen analyses at 1 month, 3 months, and 6 months after vasovasostomy. There was no significant difference in patient age, obstructive interval, or follicle-stimulating hormone among the groups. The natural pregnancy rate in group II-O was lower than that in group II-N, and in group III-O was lower than that in group III-N. However, there was no significant difference among each of the groups. CONCLUSIONS The sperm concentration after vasovasostomy was significantly related to the obstructive interval between vasectomy and reversal.
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Affiliation(s)
- Yu Seob Shin
- Department of Urology, Chonbuk National University Medical School, Jeonju, Korea. ; Institute for Medical Sciences, Chonbuk National University, Jeonju, Korea. ; Biomedical Research Institute and Clinical Trial Center of Medical Device, Chonbuk National University Hospital, Jeonju, Korea
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Elzanaty S, Dohle G. Advances in male reproductive surgery: robotic-assisted vasovasostomy. Curr Urol 2012; 6:113-7. [PMID: 24917727 DOI: 10.1159/000343523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/31/2012] [Indexed: 12/22/2022] Open
Abstract
It is estimated that 3-6% of all vasectomised men request vasectomy reversal for different reasons. Microsurgical vasovasostomy is the gold standard technique of vasectomy reversal. However, the microsurgical technique is time-consuming and challenging to most urological surgeons. Therefore, alternative methods of vasal anastomosis have been studied including robotic-assisted vasovasostomy. This review discusses the feasibility and practice of robotic-assisted vasovasostomy. Based on the available studies robotic-assisted vasovasostomy is feasible. The reported rate of vasal patency associated with this new technique is similar to that of microsurgical vasovasostomy. There is no clear difference between the 2 approaches in terms of operating time. Robotic-assisted vasovasostomy does not appear to afford significant advantages in the era of vasectomy reversal.
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Affiliation(s)
- Saad Elzanaty
- Department of Urology, Ystad Hospital, Lund University, Ystad, Sweden
| | - Gert Dohle
- Department of Urology, Erasmus medical Center, Rotterdam, the Netherlands
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Dohle G, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. European Association of Urology guidelines on vasectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.acuroe.2012.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Dohle G, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. [European Association of Urology guidelines on vasectomy]. Actas Urol Esp 2012; 36:276-81. [PMID: 22521918 DOI: 10.1016/j.acuro.2012.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 01/25/2012] [Indexed: 10/28/2022]
Abstract
CONTEXT The European Association of Urology presents its guidelines for vasectomy. Vasectomy is highly effective, but problems can arise that are related to insufficient preoperative patient information, the surgical procedure, and postoperative follow-up. OBJECTIVE These guidelines aim to provide information and recommendations for physicians who perform vasectomies and to promote the provision of adequate information to the patient before the operation to prevent unrealistic expectations and legal procedures. EVIDENCE ACQUISITION An extensive review of the literature was carried out using Medline, Embase, and the Cochrane Database of Systematic Reviews from 1980 to 2010. The focus was on randomised controlled trials (RCTs) and meta-analyses of RCTs (level 1 evidence) and on well-designed studies without randomisation (level 2 and 3 evidence). A total of 113 unique records were identified for consideration. Non-English language publications were excluded as well as studies published as abstracts only or reports from meetings. EVIDENCE SYNTHESIS The guidelines discuss indications and contraindications for vasectomy, preoperative patient information and counselling, surgical techniques, postoperative care and subsequent semen analysis, and complications and late consequences. CONCLUSIONS Vasectomy is intended to be a permanent form of contraception. There are no absolute contraindications for vasectomy. Relative contraindications may be the absence of children, age <30 yr, severe illness, no current relationship, and scrotal pain. Preoperative counselling should include alternative methods of contraception, complication and failure rates, and the need for postoperative semen analysis. Informed consent should be obtained before the operation. Although the use of mucosal cautery and fascial interposition have been shown to reduce early failure compared to simple ligation and excision of a small vas segment, no robust data show that a particular vasectomy technique is superior in terms of prevention of late recanalisation and spontaneous pregnancy after vasectomy. After semen analysis, clearance can be given in case of documented azoospermia and in case of rare nonmotile spermatozoa in the ejaculate at least 3 mo after the procedure.
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Schwarzer JU. Vasectomy reversal using a microsurgical three-layer technique: one surgeon’s experience over 18 years with 1300 patients. ACTA ACUST UNITED AC 2012; 35:706-13. [DOI: 10.1111/j.1365-2605.2012.01270.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Elzanaty S, Dohle GR. Vasovasostomy and predictors of vasal patency: a systematic review. ACTA ACUST UNITED AC 2012; 46:241-6. [PMID: 22452615 DOI: 10.3109/00365599.2012.669790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
About 3-6% of vasectomized men requested vasectomy reversal, for various reasons. Vasal patency (VP) is an important surrogate outcome of vasectomy reversal. This article reviews the impact of surgical skills, surgical approaches, intraoperative vasal fluid characteristics and the length of obstructive interval on VP. Based on the best available evidence, the rate of patency is related to the operative frequency of the surgeons, with better results obtained by surgeons who perform the operations at least 10 times annually. Microsurgical vasovasostomy is the preferred technique for durable good results. One-layer vasovasostomy and two-layer vasovasostomy seem to be equal with regard to VP. The rate of patency following vasovasostomy in the convoluted vas and vasovasostomy in the straight vas is comparable. The patency rate is high in men with clear intraoperative vasal fluid in at least one vas. VP is still high among patients with a long obstructive interval. In conclusion, surgical skills and intraoperative vasal fluid characteristics are the most important predictors of VP. Postoperative semen quality and the age of the female partner determine the chance of spontaneous conception in these couples.
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Affiliation(s)
- Saad Elzanaty
- Department of Clinical Sciences, Division of Urological Research, Skåne University Hospital, Lund University, Sweden.
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19
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Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. European Association of Urology guidelines on vasectomy. Eur Urol 2011; 61:159-63. [PMID: 22033172 DOI: 10.1016/j.eururo.2011.10.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/06/2011] [Indexed: 10/16/2022]
Abstract
CONTEXT The European Association of Urology presents its guidelines for vasectomy. Vasectomy is highly effective, but problems can arise that are related to insufficient preoperative patient information, the surgical procedure, and postoperative follow-up. OBJECTIVE These guidelines aim to provide information and recommendations for physicians who perform vasectomies and to promote the provision of adequate information to the patient before the operation to prevent unrealistic expectations and legal procedures. EVIDENCE ACQUISITION An extensive review of the literature was carried out using Medline, Embase, and the Cochrane Database of Systematic Reviews from 1980 to 2010. The focus was on randomised controlled trials (RCTs) and meta-analyses of RCTs (level 1 evidence) and on well-designed studies without randomisation (level 2 and 3 evidence). A total of 113 unique records were identified for consideration. Non-English language publications were excluded as well as studies published as abstracts only or reports from meetings. EVIDENCE SYNTHESIS The guidelines discuss indications and contraindications for vasectomy, preoperative patient information and counselling, surgical techniques, postoperative care and subsequent semen analysis, and complications and late consequences. CONCLUSIONS Vasectomy is intended to be a permanent form of contraception. There are no absolute contraindications for vasectomy. Relative contraindications may be the absence of children, age <30 yr, severe illness, no current relationship, and scrotal pain. Preoperative counselling should include alternative methods of contraception, complication and failure rates, and the need for postoperative semen analysis. Informed consent should be obtained before the operation. Although the use of mucosal cautery and fascial interposition have been shown to reduce early failure compared to simple ligation and excision of a small vas segment, no robust data show that a particular vasectomy technique is superior in terms of prevention of late recanalisation and spontaneous pregnancy after vasectomy. After semen analysis, clearance can be given in case of documented azoospermia and in case of rare nonmotile spermatozoa in the ejaculate at least 3 mo after the procedure.
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Affiliation(s)
- Gert R Dohle
- Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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20
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Arratia-Maqueo J, Cortés-González J, Garza-Cortés R, Gómez-Guerra L. Evaluación de la satisfacción sexual masculina posterior a la vasectomía. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Nagler HM, Jung H. Factors Predicting Successful Microsurgical Vasectomy Reversal. Urol Clin North Am 2009; 36:383-90. [DOI: 10.1016/j.ucl.2009.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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22
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Moon HJ. Minimally invasive vas surgery using a newly designed double-ringed clamp. World J Urol 2009; 28:205-8. [PMID: 19543734 DOI: 10.1007/s00345-009-0437-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 06/02/2009] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION We have recently designed a novel surgical instrument, a double-ringed clamp (Moon's clamp), with which the vas deferens can be located and isolated both simply and safely while minimizing unnecessary injury to the surrounding tissue. MATERIALS AND METHODS With the use of the Moon's clamp, we successfully performed 1,140 cases of simplified, minimally invasive vasectomy and 216 cases of mini-incision vasectomy reversals (vasovasostomies) without any significant complications. CONCLUSION This surgical technique, using Moon's clamp, may be effective in reducing the operative time, the postoperative complications and the recovery time after different types of vas surgeries, such as vasectomy or vasectomy reversal.
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Saunders MM, Baxter ZC, Abou-Elella A, Kunselman AR, Trussell J. BioGlue and Dermabond save time, leak less, and are not mechanically inferior to two-layer and modified one-layer vasovasostomy. Fertil Steril 2009; 91:560-5. [DOI: 10.1016/j.fertnstert.2007.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 12/04/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Microsurgical vasovasostomy: a combined urologic and plastic surgical approach. Plast Reconstr Surg 2008; 122:160e-161e. [PMID: 18971703 DOI: 10.1097/prs.0b013e318188244a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Jarvi K, Grober ED, Lo KC, Patry G. Mini-Incision Microsurgical Vasectomy Reversal Using No-Scalpel Vasectomy Principles and Instruments. Urology 2008; 72:913-5. [DOI: 10.1016/j.urology.2008.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 05/01/2008] [Accepted: 05/03/2008] [Indexed: 11/25/2022]
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Lee R, Li PS, Schlegel PN, Goldstein M. Reassessing reconstruction in the management of obstructive azoospermia: reconstruction or sperm acquisition? Urol Clin North Am 2008; 35:289-301, x. [PMID: 18423249 DOI: 10.1016/j.ucl.2008.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Treatments for male factor infertility secondary to reconstructable obstructive azoospermia include either surgical reconstruction or direct sperm retrieval. We examine the risks and benefits of both types of therapies and discuss their respective medical and economic implications. Most male factor infertility studies comparing vasectomy reversal with sperm retrieval favor the former as the more cost-effective therapy for obstructive azoospermia. Analysis should include assessment of direct procedural costs and indirect costs, including the cost of complications, lost productivity, and multiple gestation pregnancies. When considering sperm retrieval, the impact of in vitro fertilization-related indirect costs, specifically that driven by multiple gestation pregnancies, is significant.
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Affiliation(s)
- Richard Lee
- James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, 525 E. 68th Street, Starr 900, New York, NY 10021, USA
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Lee R, Li P, Goldstein M, Tanrikut C, Schattman G, Schlegel P. A decision analysis of treatments for obstructive azoospermia. Hum Reprod 2008; 23:2043-9. [DOI: 10.1093/humrep/den200] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bromage SJ, Douglas J, Falconer DA, Lieberman BA, Payne SR. Factors affecting successful outcome from ICSI in men following previous vasectomy. World J Urol 2007; 25:519-24. [PMID: 17609963 DOI: 10.1007/s00345-007-0182-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 05/07/2007] [Indexed: 11/25/2022] Open
Abstract
There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ICSI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner's behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension.
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Affiliation(s)
- Stephen J Bromage
- Department of Urology, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
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Glasson EJ, de Klerk NH, Bass AJ, Rosman DL, Palmer LJ, Holman CDJ. Cohort Profile: The Western Australian Family Connections Genealogical Project. Int J Epidemiol 2007; 37:30-5. [PMID: 17611241 DOI: 10.1093/ije/dym136] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- E J Glasson
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Australia.
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O'Neill DA, McVicar CM, McClure N, Maxwell P, Cooke I, Pogue KM, Lewis SEM. Reduced sperm yield from testicular biopsies of vasectomized men is due to increased apoptosis. Fertil Steril 2007; 87:834-41. [PMID: 17241627 DOI: 10.1016/j.fertnstert.2006.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 08/25/2006] [Accepted: 11/03/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare sperm yields, apoptotic indices, and sperm DNA fragmentation from vasectomized men and fertile men undergoing vasectomy. DESIGN Testicular biopsies from vasectomized (n = 26) and fertile men (n = 46), were milked to calculate sperm/gram and also formalin-fixed to determine the numbers of developing sperm and incidence and intensities of testicular FasL, Fas, Bax, and Bcl-2. Testicular sperm DNA fragmentation was assessed using the alkaline Comet assay. SETTING An ART unit. PATIENT(S) Twenty-six men attending for intracytoplasmic sperm injection (ICSI) and 46 men attending for vasectomies. MAIN OUTCOME MEASURE(S) Spermatocyte, spermatid and sperm yields, Fas, FasL, and Bax staining. RESULT(S) Sperm yields from men vasectomized >5 years previously were markedly reduced compared to fertile men. Increased intensities of FasL and Bax staining were observed in the seminiferous tubules of vasectomy men. FasL positivity (percentage) also increased in Sertoli cells, and both FasL and Fas positivity (percentage) increased in primary spermatocytes and round spermatids of vasectomized men. Sperm DNA fragmentation, an end point marker of apoptosis, increased significantly in vasectomized men compared to fertile men. CONCLUSION(S) Reduced sperm yields after vasectomy are associated with increased apoptosis through the Fas-FasL and Bax pathways. Sperm after vasectomy displayed increased DNA fragmentation.
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Affiliation(s)
- Deirdre A O'Neill
- Obstetrics and Gynaecology, School of Medicine, Queen's University Belfast, Institute of Clinical Science, Belfast, United Kingdom
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Baldé A, Légaré F, Labrecque M. Assessment of needs of men for decision support on male sterilization. PATIENT EDUCATION AND COUNSELING 2006; 63:301-7. [PMID: 16872791 DOI: 10.1016/j.pec.2006.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 04/21/2006] [Accepted: 04/24/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To assess the needs of men for decision support on male sterilization. METHODS Forty-two men facing a decision about undergoing a vasectomy or not and 11 physicians who perform vasectomy were interviewed to assess the sources of difficulty in this decision-making process. On the day of their vasectomy, 209 men completed the decisional conflict scale (DCS) and a knowledge test. RESULTS Sources of difficulty about the decision to have a vasectomy or not included: lack of information about risks and benefits, clarification of personal values concerning parenthood after the vasectomy, and undue pressure from partner. On the day of their vasectomy, only 1.9% (95% confidence interval 0.5-4.8%) of men had unresolved decisional conflict. However, most men scored poorly on their knowledge test mean score (58.2+/-13.5%). CONCLUSION Men facing the decision about having a vasectomy or not would benefit from a decision support intervention that would address conflicting information and clarification of values. PRACTICE IMPLICATIONS Health professionals should provide decision support to men facing the decision about having a vasectomy or not. A decision aid on male sterilization would be useful in this respect.
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Abstract
PURPOSE We report on the early results of fibrin glue assisted, 3-suture microsurgical vasovasostomy (FGV) technique in humans. MATERIALS AND METHODS After Institutional Review Board approval, 42 patients were enrolled prospectively from October 2002 to March 2004. Patients underwent microsurgical 3-suture vasovasostomy with completion of the anastomosis with fibrin sealant. Patient and partner age, obstructive interval, female fertility status, gross appearance and presence of sperm on microscopic examination of vasal fluid, operative time, and pregnancy were noted. Semen analysis (SA) was obtained at 6 weeks, 3, 6, 9 and 12 months postoperatively. RESULTS Of 42 patients 39 had postoperative SA. Mean followup was 6.2 months (range 1.5 to 12). Mean operative time was 79.4 minutes (range 50 to 120). The overall patency rate was 85% (33 of 39). Patency rate according to obstructive interval less than 3 years was 100%, 3 to 8 years 94%, 9 to 14 years 69% and 15 years or more was 67%. Patency rate with sperm on intraoperative SA was 96% (27 of 28) and 55% (6 of 11) with sperm absent. Nine pregnancies have been documented. CONCLUSIONS FGV is potentially less time-consuming than standard microsurgical vasovasostomy, and may be appropriate for patients with sperm on intraoperative SA or a negative intraoperative SA, and an obstructive interval of 10 years or less. Patients without these findings should be considered for vasoepididymostomy. While the early results of FGV are promising, a larger study group with the ability to obtain longer followup is required to definitively establish equivalency to standard microsurgical vasovasostomy.
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Affiliation(s)
- Khai-Linh V Ho
- Department of Surgery, Urology Service, Keesler Medical Center, Biloxi, Mississippi, USA.
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Holden CA, McLachlan RI, Cumming R, Wittert G, Handelsman DJ, de Kretser DM, Pitts M. Sexual activity, fertility and contraceptive use in middle-aged and older men: Men in Australia, Telephone Survey (MATeS). Hum Reprod 2005; 20:3429-34. [PMID: 16172145 DOI: 10.1093/humrep/dei307] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With limited information regarding fertility and sexual activity in the older population, men's behaviour, attitudes and concerns were explored in a representative population of middle-aged and older men using the Men in Australia, Telephone Survey (MATeS). METHODS A stratified random national sample of 5990 men participated in a standardized computer-assisted telephone interview. Equal numbers in the age strata 40-49, 50-59, 60-69 and >or=70 years were surveyed with findings census-standardized to the national population. Broad aspects of men's health and well-being, including reproductive health, were explored. RESULTS The majority of men were sexually active in the last 12 months (age-standardized proportion, 78.3%) with approximately 37% of men aged >or=70 years still continuing sexual activity. Overall, 12.2% of men had never fathered children, of whom most (7.7%) had chosen not to have children. Questioning on failed attempts to produce a pregnancy suggested an involuntary infertility rate of 7.6%. The age-standardized vasectomy rate was 25.1%, with 5.6% of vasectomized men having no children. Although 9.2% of vasectomized men regretted sterilization, only 1.4% had undergone vasectomy reversal. CONCLUSIONS Continuing sexual activity, fertility and contraception needs in middle-aged and older men suggests that education and service delivery must be more appropriately directed to an ageing population.
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Affiliation(s)
- C A Holden
- Andrology Australia, Monash Institute of Medical Research, Monash University, Melbourne, Victoria, Auatralia.
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Abstract
Therapy for infertile couples comprises gender-specific as well as couple-specific aspects. Diagnostic and therapeutic procedures focus on the causes of the infertility such as refertilization or epididymovasostomy on the one hand and assisted fertilization with extracted spermatozoa on the other. Using an interdisciplinary approach including urology, gynecology, reproductive medicine and human genetics, the treating physicians are able to fulfil the desire of infertile couples for a healthy child in many cases.
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Affiliation(s)
- H Sperling
- Urologische Klinik, Universitätsklinikum Essen.
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Ly LP, Liu PY, Handelsman DJ. Rates of suppression and recovery of human sperm output in testosterone-based hormonal contraceptive regimens*. Hum Reprod 2005; 20:1733-40. [PMID: 15860500 DOI: 10.1093/humrep/deh834] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Practical hormonal male contraceptive regimens are likely to have delayed onset and offset of reliable contraception dictated by the length of the spermatogenic cycle and clearance rate of pre-formed sperm from the ductular system. While delayed onset of contraceptive efficacy is an accepted feature of vasectomy, reliable time estimates for a hormonal male contraceptive of time to onset and offset of reliable contraception and of resumption of normal male fertility are required. METHODS AND RESULTS We utilized the sperm output data from three male contraceptive efficacy studies to define quantitative estimates of suppression and recovery rates from an androgen alone (testosterone enanthate) and an androgen/progestin (testosterone/depot medroxyprogesterone acetate) study. Using nearly 14,000 semen samples from World Health Organization (WHO) studies #85921 and #89903 with identical protocols, the rate of suppression of sperm output was best modelled as a two-parameter, single exponential decay function with effective half-time to suppression of 5.5 weeks and times of 6.8 weeks to 10 x 10(6)/ml, 8.7 weeks to 5 x 10(6)/ml, 10.0 weeks to 3 x 10(6)/ml and 13.0 weeks to 1 x 10(6)/ml. The rate of recovery using absolute sperm concentration was best modelled as a three-parameter, sigmoidal curve with effective time to reach half of the recovery plateau of 10.5 weeks and times of 9.0 weeks to 3 x 10(6)/ml, 9.9 weeks to 5 x 10(6)/ml, 11.5 weeks to 10 x 10(6)/ml, and 13.6 weeks to 20 x 10(6)/ml. Using relative sperm output, defined as a percentage of the participants' own baseline, recovery approached an asymptotic plateau of approximately 85% of geometric mean pre-treatment sperm concentration. In the combination androgen/progestin study, suppression rate was significantly faster (effective time to reach half maximal suppression of 3.0 weeks) and recovery significantly slower (effective time to reach half of recovery plateau of 14.7 weeks) and less complete (asymptotic recovery plateau of 43% of baseline) than in the androgen-alone WHO studies. CONCLUSION These findings therefore provide large sample estimates of the suppression and recovery rates from an androgen-alone hormonal male contraceptive regimen as a basis for comparison with other second-generation combination androgen/progestin regimens that are the most promising approach to developing practical male hormonal regimens.
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Affiliation(s)
- Lam P Ly
- Departments of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, Sydney NSW 2139, Australia
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Abstract
There is a growing interest, as well as a booming industry, in the use of testosterone therapy for middle-aged and older men. This interest has led to the definition of a new condition, termed 'andropause', meaning the putative somatic consequences of gradually falling blood testosterone concentrations during male aging. This trend risks replicating both the rejuvenation fads of a century ago and the recent experience in estrogen therapy for menopause that has been propelled for decades by advocacy substituting for reliable scientific evidence. The current status and prospects for androgen therapy in middle-aged and older men should be evaluated critically from the perspective of male reproductive health during aging. This review appraises current knowledge with a focus on the questionable basis for using androgen therapy to improve male reproductive health during aging.
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Affiliation(s)
- David J Handelsman
- Department of Andrology, Concord Hospital, ANZAC Research Institute, University of Sydney, Sydney, NSW 2139, Australia.
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Raleigh D, O'Donnell L, Southwick GJ, de Kretser DM, McLachlan RI. Stereological analysis of the human testis after vasectomy indicates impairment of spermatogenic efficiency with increasing obstructive interval. Fertil Steril 2004; 81:1595-603. [PMID: 15193483 DOI: 10.1016/j.fertnstert.2003.10.046] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2003] [Revised: 10/29/2003] [Accepted: 10/29/2003] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To quantify germ cell loss and the extent of testicular fibrosis in vasectomized patients of varying obstructive intervals. DESIGN Retrospective study. SETTING Specialized male reproductive surgery and endocrinology service. PATIENT(S) Thirty-four vasectomized patients 1-20 years after surgery and 10 normal subjects. INTERVENTION(S) Thirty-four testicular biopsies taken at the time of vasectomy reversal (vasovasostomy). Control biopsies taken from 10 normal men at the time of vasectomy. MAIN OUTCOME MEASURE(S) Stereological assessment of testicular germ cell populations and testicular fibrosis. RESULT(S) Vasectomy caused a significant decrease in germ cells in the later stages of spermatogenesis, with significant reductions in pachytene spermatocytes (by 18%), round spermatids (by 40%), elongating spermatids (by 23%), and elongated spermatids (by 39%). The loss of spermatids showed a significant relationship with obstructive interval. A significant 2.7-fold increase in total (peritubular plus interstitial) fibrosis was observed, which showed a positive relationship with obstructive interval. Decreased germ cell populations and fibrosis did not seem to be related to sperm antibody levels nor to sperm counts obtained up to 2 years after vasovasostomy. CONCLUSION(S) Vasal obstruction results in significant reductions in germ cells in the later stages of spermatogenesis and increases in testicular fibrosis, both worsening with an increasing obstructive interval. Testicular damage after vasectomy might impact upon the prospects for reversal.
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Affiliation(s)
- Daniel Raleigh
- Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia
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Black A, Francoeur D, Rowe T, Collins J, Miller D, Brown T, David M, Dunn S, Fisher WA, Fleming N, Fortin CA, Guilbert E, Hanvey L, Lalonde A, Miller R, Morris M, O'Grady T, Pymar H, Smith T, Henneberg E. Canadian Contraception Consensus. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:347-87, 389-436. [PMID: 15115624 DOI: 10.1016/s1701-2163(16)30363-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
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Archivée: Consensus Canadien sur la Contraception. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004. [DOI: 10.1016/s1701-2163(16)30364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Vrijhof EJ, de Bruïne A, Lycklama à Nijeholt AAB, Koole LH. A polymeric mini-stent designed to facilitate the vasectomy reversal operation. A rabbit model study. Biomaterials 2004; 25:729-34. [PMID: 14607512 DOI: 10.1016/s0142-9612(03)00569-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vasectomy has become popular since it is the safest surgical method for contraception. It is known that approximately 6% of the men that undergo vasectomy will seek reversal (vasovasostomy). This operation is, however, technically demanding and relatively time-consuming. This study was based on the hypothesis that a polymeric mini-stent can facilitate and accelerate vasovasostomies. A mini-stent was manufactured out of a crosslinked hydrogel biomaterial, which was synthesized from N-vinyl-pyrrolidinone (NVP), n-butylmethacrylate, and (triethyleneglycol) dimethacrylate. The device was tested with 28 rabbits, which were divided over two equal groups. In one group, the vasa deferentia were dissected and reanastomosed via microsurgical one-layer technique (end-to-end group). In the other group, the vasa deferentia were dissected and reattached through implantation of the mini-stent. Sperm counts revealed 100% patency in both groups, i.e. all vasovasostomies were successful. It was experienced that the operation was easier and faster in the case of the mini-stent, probably since the mini-stent keeps the lumens of both vas ends exactly in line during suturing. This study demonstrates the feasibility of the mini-stent. Further work is necessary to evaluate the utility of this approach for clinical vasovasostomies.
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Affiliation(s)
- Eric J Vrijhof
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
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Abstract
Vasectomy is the simplest and most effective method of permanent sterilization in men. In most cases, the surgical technique includes conventional vasoresection with incision of the scrotal skin or no-scalpel vasectomy as a minimally invasive method. The most important complications following surgery are haemorrhage and haematoma (1.2%), infection (3.5%), epididymitis/epididymo-orchitis (2.1%), sperm granuloma (2-70%), and chronic pain (3-8%). No long-term negative organic effects have been proven in clinical studies. The surgeon's experience and the technique applied are essential for the postoperative course, whereas performing vasectomy either on an in-patient or out-patient basis does not seem to have an influence. To evaluate the success of the vasectomy, follow-up spermiograms are obligatory. If immotile spermatozoa are present further follow-ups are necessary. Vasectomy needs to be reperformed if motile spermatozoa are detected. The chance of an unsuccessful vasectomy is below 1%. Unprotected intercourse must not be performed before two consecutive spermiograms show azoospermia.
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Affiliation(s)
- J Leissner
- Urologische Universitätsklinik der Otto-von-Guericke-Universität, Magdeburg, Germany.
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Wood S, Montazeri N, Sajjad Y, Troup S, Kingsland CR, Lewis-Jones DI. Current practice in the management of vasectomy reversal and unobstructive azoospermia in Merseyside & North Wales: a questionnaire-based survey. BJU Int 2003; 91:839-44. [PMID: 12780844 DOI: 10.1046/j.1464-410x.2003.04227.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the current incidence of vasectomy reversal procedures, the techniques used and which practitioners use them. PATIENTS AND METHODS Using a questionnaire, 130 general surgeons and urologists practising in Merseyside and North Wales were surveyed. RESULTS The response rate was 74%, with 24 urological surgeons and 14 general surgeons undertaking vasectomy reversal. Annually, urological surgeons carried out significantly more procedures than did general surgeons, at 8.5 and 5.3 (P = 0.029), respectively. They were also more likely to use double-layer closure and microsurgical techniques, whilst significantly less likely to use stents. Urologists reported significantly greater patency rates, at 76% and 52% (P = 0.017), respectively, with no significant differences in subsequent pregnancy rates (30% vs 25%). Only one practitioner checked tubal patency in the female partner before vasectomy reversal. CONCLUSIONS The use of vasectomy reversal is a cost-effective treatment for men wanting paternity after vasectomy. The technique used by the clinician and proper audit of the results require close attention; it would also appear to be obvious that all the partners of men seeking a vasectomy reversal should have their fertility status established before reversal, something that is clearly not done at present.
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Affiliation(s)
- S Wood
- Reproductive Medicine Unit, Liverpool Women's Hospital, UK.
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Abstract
Microsurgical techniques have made vasectomy reversal a realistic option for the restoration of fertility in a man who has previously undergone vasectomy. Factors that can affect the success of these procedures may become known preoperatively and intraoperatively; this article reviews each of those factors.
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Affiliation(s)
- Harris M Nagler
- Department of Urology, Beth Israel Medical Center, 10 Union Square East, Suite 3A, New York, NY 10003, USA.
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Fried NM, Roberts WW, Sinelnikov YD, Wright EJ, Solomon SB. Focused ultrasound ablation of the epididymis with use of thermal measurements in a canine model. Fertil Steril 2002; 78:609-13. [PMID: 12215341 DOI: 10.1016/s0015-0282(02)03245-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the epididymis as an alternative anatomical target to the vas deferens for noninvasive male sterilization using therapeutic focused ultrasound. DESIGN Controlled preclinical study. SETTING Canine animal model in an academic research environment. PATIENT(S) Four healthy male mongrel dogs (30-35 kg). INTERVENTION(S) A transducer mounted on a plastic clip delivered ultrasound energy to the canine epididymis. Thermocouples placed transcutaneously into the epididymis, intradermally, and on the skin surface recorded temperatures during ablation with a wide range of acoustic powers and sonication times (control, 3 W/120 s, 5 W/90 s, 7 W/60 s). MAIN OUTCOME MEASURE(S) Thermocouple temperature measurements determined the optimal range of ablation parameters that produced successful thermal occlusion of the epididymis without adverse effects (e.g., skin burns, testicular injury). RESULT(S) A large "therapeutic window" was determined (power = 3-7 W, time = 20-120 seconds) over which noninvasive thermal occlusion of the epididymis can be achieved. Thermal occlusion rates were higher, and complications lower, than found previously with vas deferens ablation. CONCLUSION(S) The epididymis represents a larger and easier target than the vas deferens for performing noninvasive male sterilization using focused ultrasound. Long-term azoospermia studies will be necessary to confirm permanent sterilization with this technique.
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Affiliation(s)
- Nathaniel M Fried
- Department of Urology, Johns Hopkins Medical School, Baltimore, Maryland 21224, USA.
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Wood S, Vang E, Troup S, Kingsland CR, Lewis-Jones DI. Surgical sperm retrieval after previous vasectomy and failed reversal: clinical implications for in vitro fertilization. BJU Int 2002; 90:277-81. [PMID: 12133065 DOI: 10.1046/j.1464-410x.2002.02843.x] [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] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effect of the interval between previous vasectomy reversal on retrieval rates of epididymal and testicular spermatozoa using percutaneous epididymal sperm aspiration (PESA), or testicular sperm extraction (TESE), and the subsequent reproductive potential of these gametes in intracytoplasmic sperm injection (ICSI) cycles. PATIENTS AND METHODS Sixty-six consecutive sperm retrievals were considered in patients who were azoospermic after previous vasectomy, of whom 54 had had a previous failed reversal, the remainder deciding against a reversal. PESA and TESE retrieval rates were noted, as were the time since vasectomy and the interval between vasectomy and unsuccessful reversal. The presence of palpable epididymal cysts was noted, with their effect on sperm retrieval rates. Fertilization and pregnancy rates were analysed in subsequent ICSI cycles using freshly retrieved spermatozoa or frozen-thawed cryopreserved spermatozoa. RESULTS All 66 patients had sperm retrieved successfully; the success rates for PESA were not significantly affected by previous failed reversal when compared with patients who had not had a reversal, at 14 of 54 (26%) vs five of 12 (P=0.3). The interval since vasectomy did not affect PESA retrieval rates but there was a significantly poorer retrieval rate for PESA in the presence of palpable epididymal cysts, at seven of 35 (20%) vs 12 of 23 (52%) (P=0.012). Fertilization rates were significantly lower using cryopreserved spermatozoa retrieved from either the epididymis or testis (50% vs 70%, P=0.007), although subsequent implantation and pregnancy rates were not significantly different. CONCLUSION Surgical sperm retrieval is successful in all cases of azoospermia secondary to vasectomy, either by PESA or TESE. There are no clinical markers to indicate which patients will have successful PESA after vasectomy, although the presence of epididymal cysts is associated with significantly lower retrieval rates. The reduction in fertilising ability of cryopreserved spermatozoa does not affect clinical pregnancy rates in ICSI cycles.
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Affiliation(s)
- S Wood
- Reproductive Medicine Unit and Department of Obstetrics & Gynaecology, Liverpool Women's Hospital, Liverpool, UK.
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Singh I. Population-based outcomes after 28,246 in-hospital vasectomies and 1902 vasovasostomies in Western Australia. BJU Int 2001; 88:125. [PMID: 11446862 DOI: 10.1046/j.1464-410x.2001.02239.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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