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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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2
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Mock KO, Moyer A, Lobel M. Explaining sex discrepancies in sterilization rates in the United States: An evidence-informed commentary. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:116-121. [PMID: 37594046 DOI: 10.1363/psrh.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CONTEXT With abortion no longer deemed a constitutional right in the United States (US), the importance of effective contraceptive methods cannot be overstated. Both male sterilization (vasectomy) and female sterilization (tubal ligation) have the lowest failure rates of available means of contraception. Despite the less invasive and reversible nature of vasectomy compared to tubal ligation procedures and even though some healthcare professionals dissuade certain women, especially those who are white and/or economically advantaged, from undergoing a sterilization procedure, female sterilization is approximately three times more prevalent than male sterilization in the US. PURPOSE We suggest that the discrepancy in sterilization rates is attributable to the burdens of pregnancy and birth experienced by women, beliefs that pregnancy prevention is a woman's responsibility, a dearth of sex education that results in lack of knowledge and poor understanding of contraception, perceptions of masculinity in which contraception is viewed as feminizing, and the increase in long-term singlehood that shapes the desire of individuals to avoid unwanted pregnancy that may result in single parenting. IMPLICATIONS Recent reports suggest that court rulings restricting abortion access and looming threats to contraceptive legality and accessibility may be prompting a national increase in male sterilization.
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Affiliation(s)
- K Olivia Mock
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anne Moyer
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
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3
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Kiessling RJ, Hauser A, Eyre RC, Kiessling AA. A new approach to postvasectomy semen analyses eliminates the need to evaluate a fresh specimen. Andrology 2023; 11:464-470. [PMID: 36345600 DOI: 10.1111/andr.13331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND According to current guidelines, confirmation that vasectomy results in sterility depends on microscopic examination of postvasectomy semen for the presence of spermatozoa. Guidelines established in 2012 require examination of a fresh specimen within 2 h of collection, which necessitates the patient making an appointment with either the surgeon's office or a licensed clinical laboratory. Twenty-five to 42% of patients fail to comply with postvasectomy semen analysis (PVSA). OBJECTIVES To determine if an at-home semen collection kit can substitute for the evaluation of a fresh specimen and improve patient compliance with postvasectomy spermatozoa assessment. MATERIALS AND METHODS The kit contains a patented aldehyde-fixative that maintains spermatozoa and semen cells in suspension for quantitation. Patients order a PVSA kit to be delivered to their home and can collect a semen specimen and return it to the laboratory through regular US mail. RESULTS From January 2011 through December 2018, 6096 men undergoing vasectomy by 184 urologists in 33 states in the US ordered PVSA kits, of which 5408 (89%) returned at least one for analysis. Of those, 398 men (7.4%) returned the first kit with greater than 10,000 spermatozoa/ml within a year of vasectomy, of which only 4.4% contained greater than 100,000 spermatozoa/ml 12 weeks postsurgery. This suggests that fewer than 5% of postvasectomy patients might need follow-up fresh semen analyses, greatly easing the logistical burden of PVSA. Ninety percent of surgeons returning a patient satisfaction questionnaire said their patients "never" complained about using PVSA kits. DISCUSSION AND CONCLUSION These data support the adoption of a new standard for PVSA that does not involve an initial evaluation of a fresh semen specimen.
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Affiliation(s)
- Ryan J Kiessling
- Bedford Research Foundation Clinical Laboratory, Bedford, Massachusetts, USA
| | - Alexander Hauser
- Bedford Research Foundation Clinical Laboratory, Bedford, Massachusetts, USA
| | | | - Ann A Kiessling
- Bedford Research Foundation Clinical Laboratory, Bedford, Massachusetts, USA
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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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5
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Agarwal A, Gupta S, Sharma RK, Finelli R, Kuroda S, Vij SC, Boitrelle F, Kavoussi P, Rambhatla A, Saleh R, Chung E, Mostafa T, Zini A, Ko E, Parekh N, Martinez M, Arafa M, Tadros N, de la Rosette J, Le TV, Rajmil O, Kandil H, Blecher G, Liguori G, Caroppo E, Ho CCK, Altman A, Bajic P, Goldfarb D, Gill B, Zylbersztejn DS, Molina JMC, Gava MM, Cardoso JPG, Kosgi R, Çeker G, Zilaitiene B, Pescatori E, Borges E, Duarsa GWK, Pinggera GM, Busetto GM, Balercia G, Franco G, Çalik G, Sallam HN, Park HJ, Ramsay J, Alvarez J, Khalafalla K, Bowa K, Hakim L, Simopoulou M, Rodriguez MG, Sabbaghian M, Elbardisi H, Timpano M, Altan M, Elkhouly M, Al-Marhoon MS, Sadighi Gilani MA, Soebadi MA, Nasr-Esfahani MH, Garrido N, Vogiatzi P, Birowo P, Patel P, Javed Q, Ambar RF, Adriansjah R, AlSaid S, Micic S, Lewis SE, Mutambirwa S, Fukuhara S, Parekattil S, Ahn ST, Jindal S, Takeshima T, Puigvert A, Amano T, Barrett T, Toprak T, Malhotra V, Atmoko W, Yumura Y, Morimoto Y, Lima TFN, Kunz Y, Kato Y, Umemoto Y, Colpi GM, Durairajanayagam D, Shah R. Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices. World J Mens Health 2022; 40:425-441. [PMID: 35021311 PMCID: PMC9253792 DOI: 10.5534/wjmh.210191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. MATERIALS AND METHODS We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. RESULTS Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. CONCLUSIONS Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA.
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Rakesh K Sharma
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | | | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicina, Cairo University, Cairo, Egypt
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Neel Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Tan V Le
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
- Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | | | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | | | - Christopher C K Ho
- Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Andrew Altman
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Petar Bajic
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Goldfarb
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Marcello M Gava
- Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Joao Paulo Greco Cardoso
- Divisao de Urologia, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Raghavender Kosgi
- Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Gökhan Çeker
- Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey
| | - Birute Zilaitiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | | | - Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Sanglah General Academic Hospital, Udayana University, Denpasar, Indonesia
| | | | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
| | - Giancarlo Balercia
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Franco
- UOC Urologia, Department Materno-Infantile e Scienze Urologiche, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gökhan Çalik
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | | | | | - Kasonde Bowa
- Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Lukman Hakim
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marcelo Gabriel Rodriguez
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | | | - Mesut Altan
- Department of Urology, Hacettepe University, Ankara, Turkey
| | | | | | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Ayodhia Soebadi
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Qaisar Javed
- Department of Urology, Ahalia Hospital, Hamdan Street Branch, Abu Dhabi, UAE
| | - Rafael F Ambar
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sami AlSaid
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Sheena E Lewis
- Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Shingai Mutambirwa
- Division of Urology, Safeko Makgatho Health Scienses University and Dr George Mukhari Academic Hospital, Pretoria, South Africa
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Teppei Takeshima
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ana Puigvert
- Fundació Puigvert, Hospital de la Santa Cruz y San Pablo, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Vineet Malhotra
- Department of Andrology and Urology, Diyos Hospital, New Delhi, India
| | - Widi Atmoko
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | - Yannic Kunz
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yukihiro Umemoto
- Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Zini A, Grantmyre J, Chow V, Chan P. UPDATE - 2022 Canadian Urological Association best practice report: Vasectomy. Can Urol Assoc J 2022; 16:E231-E236. [PMID: 35544354 PMCID: PMC9119596 DOI: 10.5489/cuaj.7860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - John Grantmyre
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Victor Chow
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter Chan
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
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Yang F, Li J, Dong L, Tan K, Huang X, Zhang P, Liu X, Chang D, Yu X. Review of Vasectomy Complications and Safety Concerns. World J Mens Health 2021; 39:406-418. [PMID: 32777870 PMCID: PMC8255399 DOI: 10.5534/wjmh.200073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/25/2023] Open
Abstract
Vasectomy is a simple, safe, effective, and economical method used worldwide for long-term male contraception. As a surgical operation, it has short-term and long-term complications such as hematoma formation, infection, sterilization failure, sperm granulomas, short-term postoperative pain (nodal pain, scrotal pain, and ejaculation pain), and chronic pain syndrome. Whether it increases the risk of autoimmune disease, cardiovascular disease, testicular cancer, or prostate cancer is still controversial. Changes in plasma concentrations of luteinizing hormone, follicle-stimulating hormone, and testosterone after vasectomy have also been studied, as well as the relation between vasectomy and sexual function. Sperm quality decreases very slowly after vasectomy, and vasovasostomy and intracytoplasmic sperm injection could help a couple achieve a pregnancy if they change their minds at any point. We include a follow-up strategy and suggestions for follow-up care at the end of this review.
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Affiliation(s)
- Fang Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Junjun Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liang Dong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kun Tan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaopeng Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peihai Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaozhang Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xujun Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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8
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[Vasectomy : Current information]. Urologe A 2021; 60:523-532. [PMID: 33738559 DOI: 10.1007/s00120-021-01494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 10/21/2022]
Abstract
Vasectomy is considered to be the simplest, most effective and cheapest method of fertility control in men, with a significantly lower risk of morbidity and mortality compared to tubal ligation in women. Patient informed consent is particularly important and should include potential irreversibility, surgical options, anesthesia, possible complications as well as postoperative behavior and the need for re-evaluation. There are different access routes available with conventional and no-scalpel vasectomy as well as different techniques for closing the ends of the vas deferens. To confirm sterility the European Association of Urology (EAU) recommends that an ejaculate analysis should be performed 3 months after the procedure and after approximately 20 ejaculations. Complications are relatively rare, although particularly vasectomy failure due to recanalization has to be considered. Approximately 3-6% of vasectomized men strive for a refertilization, which with experienced surgeons is successful in about 90% of cases.
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Jacobsen FM, Jensen CFS, Fode M, Sønksen J, Ohl DA. Scheduling Appointments for Postvasectomy Semen Analysis Has No Impact on Compliance. EUR UROL SUPPL 2020; 22:74-78. [PMID: 34337480 PMCID: PMC8317907 DOI: 10.1016/j.euros.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A postvasectomy semen analysis (PVSA) is recommended 8-16 wk after vasectomy to ensure azoospermia. Patient compliance with submitting a semen sample for PVSA has historically been low. To increase patient compliance, a policy change was made to schedule patients for PVSA appointments instead of a previous "drop-in" option. OBJECTIVE To compare patient compliance for PVSA when scheduling appointments as opposed to a "drop-in" appointment 8-16 wk after the procedure. DESIGN SETTING AND PARTICIPANTS Ethical approval was obtained to retrospectively evaluate patients undergoing vasectomy. A total of 400 patients were evaluated, 200 consecutive patients before and 200 after the policy change. Patients were excluded from analysis if they had other surgeries at the same time of vasectomy or if the vasectomy was a repeat procedure. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Percent of patients attending PVSA and time to PVSA were assessed. Nominal data were compared using chi-square analysis and interval data were compared using Student unpaired t test. RESULTS AND LIMITATIONS Thirteen patients were excluded from analysis: six before and seven after the policy change. Compliance rates were similar before and after the policy change (144/194 [74%] and 154/193 [80%], p = 0.19). There was no difference in the time from vasectomy to PVSA between groups (before: mean [standard deviation] 69 [55] d vs after: 74 (63) d, p = 0.44). This study is limited by its retrospective design. CONCLUSIONS Scheduling appointments for PVSA has no impact on compliance rates or the time between vasectomy and semen analysis when compared with "drop-in" appointments. PATIENT SUMMARY Sterility after a vasectomy is guaranteed by delivering a semen sample. Many men do not deliver this sample, and sterility cannot be guaranteed. This study found that scheduling appointments did not increase the number of men who delivered a semen sample compared with "drop-in" appointments.
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Affiliation(s)
- Frederik M. Jacobsen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Fuglesang S. Jensen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jens Sønksen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Dana A. Ohl
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - on behalf of the CopMich Collaborative
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Ortiz-Rey JA, Domínguez-de Dios J, Pérez-Schoch M, San Miguel-Fraile P, Gómez-de María C. [E-Cadherine and GATA-3 are useful in the confirmation of the vas deferens in vasectomy specimens]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 53:218-225. [PMID: 33012491 DOI: 10.1016/j.patol.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/03/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Urologists often submit the resected tissue from vasectomies for histopathological examination in order to confirm the presence of the vas deferens. Microscopy is simple and based on haematoxylin-eosin staining; however, sample artefacts can sometimes cause confusion and immunohistochemistry can be used to identify the vas deferens. MATERIALS AND METHODS We investigated the utility of immunohistochemical analysis using E-cadherin and GATA-3 to confirm the presence of vas deferens epithelium in 110 vasectomy sections with different artefacts, using monoclonal antibodies and a multimer conjugated with peroxidase based technique; 5 renal arteries and 5 renal veins were stained as negative controls. RESULTS Membrane staining was observed for E-cadherin, which was moderate (2.7%) or strong (97.3%) in the vas deferens epithelium in all cases: 35 without artefacts, 7 with denuded epithelium, 56 with compressed/distorted epithelium, 8 with detached epithelium and 4 with displaced epithelium. GATA-3 showed moderate (31%) or strong (69%) nuclear staining in all cases, including the 76 with artefacts. In the control group, arteries and veins were negative for both markers in the endothelium, but GATA-3 occasionally stained lymphocytes in the blood vessel wall. CONCLUSIONS E-cadherin membrane positivity and GATA-3 nuclear expression are useful for the identification of the vas deferens in vasectomy samples containing artefacts. Vascular endothelium is negative for both markers and any possible GATA-3 staining of the lymphocytes in the blood vessel wall should not be misinterpreted.
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Affiliation(s)
- José Antonio Ortiz-Rey
- Grupo de Investigación en Uropatología, Instituto de Investigación Sanitaria Galicia Sur, SERGAS-UVIGO, Vigo, España; Servicio de Anatomía Patológica, Hospital Álvaro Cunqueiro, Vigo, España.
| | | | | | - Pilar San Miguel-Fraile
- Grupo de Investigación en Uropatología, Instituto de Investigación Sanitaria Galicia Sur, SERGAS-UVIGO, Vigo, España; Servicio de Anatomía Patológica, Hospital Álvaro Cunqueiro, Vigo, España
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11
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Jeyendran RS, Levrant S, Puscheck E. A novel laboratory procedure to validate American Urological Association guideline on vasectomy success and to diagnose obstructive azoospermia. Andrologia 2020; 52:e13766. [PMID: 32833301 DOI: 10.1111/and.13766] [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: 04/28/2020] [Revised: 06/09/2020] [Accepted: 06/28/2020] [Indexed: 11/28/2022] Open
Abstract
The objective was to develop a laboratory procedure to validate American Urological Association (AUA) Guideline on vasectomy success when nonmotile spermatozoa are found in the post-vasectomy ejaculate. The neutral α-glucosidase (NAG) an epididymal protein assay modified to determine the activity at 30 and 90 min of incubation from 24 pre- and 47 post-vasectomy ejaculates. The difference between the two points in the relative activity was calculated and if the difference was nonsignificant will confirm vasectomy success. The mean differences in the relative NAG activity were significantly different in pre- and post-vasectomy ejaculates, respectively. The mean differences in the relative NAG activity were similar in post-vasectomy ejaculates with and without nonmotile spermatozoa. No difference in relative NAG activity in post-vasectomy ejaculates between two time points of incubation may be a reliable method to confirm occlusion of the vas deferens. It also validates the recommendation by AUA Guideline on vasectomy success in the presence of few nonmotile spermatozoa.
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Affiliation(s)
| | - Seth Levrant
- Partners in Reproductive Health, Tinley Park, IL, USA
| | - Elizabeth Puscheck
- Wayne State University School of Medicine, Detroit, MI, USA.,InVia Fertility, Hoffman Estates, IL, USA
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Bradshaw A, Ballon-Landa E, Owusu R, Hsieh TC. Poor Compliance With Postvasectomy Semen Testing: Analysis of Factors and Barriers. Urology 2020; 136:146-151. [DOI: 10.1016/j.urology.2019.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/03/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
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13
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Hendry J, Small R, Zreik A, Smyth N, Taylor J. The case for early post-vasectomy semen analysis combining small non-motile sperm and azoospermia. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818800550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Post-vasectomy semen analysis timing and criteria guidelines have evolved over time. Through analysis of our unit’s practice of post-vasectomy semen analysis from earlier sampling protocols at 8 weeks to single sampling at 12 weeks then 16 weeks, the impact on success rates and patient compliance were assessed. In addition, the use of small numbers of non-motile sperm and azoospermia combined rates as a marker of sterility were examined. Methods: All patients who underwent vasectomy in 2011 (8 and 12-week samples), 2013 (12-week samples) and 2016 (16-week samples) were included. Patients were given written and verbal instructions explaining the sample delivery protocol and samples. χ2 Testing was used to compare patient compliance and the results of post-vasectomy semen analysis with significance set at P<0.05. Results: In total 1124 vasectomies were performed, with 21% ( N=232) of patients non-compliant with submitting samples at the requested time period. Azoospermia rates increased with a longer time to post-vasectomy semen analysis from 82% to 95%, P<0.001; however, declining compliance meant the proportion of patients given clearance remained the same (70% vs. 68%, P=0.32). Rates of small non-motile sperm declined over an increasing time to post-vasectomy semen analysis. Therefore combined azoospermia and small non-motile sperm rates remained stable over an increasing sampling time (95% vs. 99%, P=0.39). Conclusion: The use of earlier post-vasectomy semen analysis is recommended as patient compliance decreases with the time from vasectomy. When azoospermia and small non-motile sperm rates are combined the rates of success of the procedure remain the same over time therefore earlier testing at 8 weeks is feasible without compromising clearance rates. Level of evidence: Not applicable for this single centre audit.
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Affiliation(s)
- Jane Hendry
- Department of Urology, Forth Valley Royal Hospital, UK
| | - Robert Small
- Department of Urology, Forth Valley Royal Hospital, UK
| | | | - Niamh Smyth
- Department of Urology, Forth Valley Royal Hospital, UK
| | - Joby Taylor
- Department of Urology, Forth Valley Royal Hospital, UK
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de Oliveira FB, Pereira VX, Oliveira FR, de Abreu LC, Daboin BEG, Norberto AR, de Alcantara Sousa LV, Tavares LFB, Glina S. Effect of ductus deferens lavage on the time to achieve azoospermia in patients undergoing vasectomy. Clinics (Sao Paulo) 2018; 73:e504. [PMID: 30304302 PMCID: PMC6152136 DOI: 10.6061/clinics/2018/e504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/01/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effect of normal saline lavage of the distal vas deferens ampulla in patients undergoing vasectomy on the time to achieve azoospermia. METHODS A prospective randomized study of 60 men divided into two groups, group lavage (GL, n=30) in which distal vas deferens ampulla lavage was performed with 10 ml of normal saline during the vasectomy, and group without lavage (GWL, n=30) in which control patients received only a vasectomy. The patients provided sperm for semen analysis at the 5th, 10th, 15th, 20th and 25th ejaculations. RESULTS Fifteen participants in GL and 16 in GWL, for a total of 31 patients, were excluded due to not completing the control spermiogram. The tests carried out at the five ejaculations showed immobile spermatozoa in 40 and 85.71%, 66.67 and 78.57%, 93.33 and 85.71%, 86.67 and 71.43%, and 93.33 and 85.71% of participants in GL and GWL, respectively. CONCLUSION Vas deferens duct lavage with 10 ml of normal saline during vasectomy did not decrease the time required to achieve postoperative azoospermia.
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Affiliation(s)
- Francisco Barros de Oliveira
- Programa de Pos-graduacao, Faculdade de Medicina do ABC (FMABC), Santo Andre, SP, BR
- *Corresponding author. E-mail:
| | - Vadelias Xavier Pereira
- Programa de Pos-graduacao, Faculdade de Medicina do ABC (FMABC), Santo Andre, SP, BR
- Programa de Pos-graduacao, Faculdade de Medicina FMUSP, Sao Paulo, SP, BR
| | | | - Luiz Carlos de Abreu
- Programa de Pos-graduacao, Faculdade de Medicina do ABC (FMABC), Santo Andre, SP, BR
- Programa de Pos-graduacao, Faculdade de Medicina FMUSP, Sao Paulo, SP, BR
| | | | - Alex Rey Norberto
- Programa de Pos-graduacao, Faculdade de Medicina do ABC (FMABC), Santo Andre, SP, BR
| | | | | | - Sidney Glina
- Programa de Pos-graduacao, Faculdade de Medicina do ABC (FMABC), Santo Andre, SP, BR
- Disciplina de Urologia, Faculdade de Medicina do ABC (FMABC), Santo Andre, SP, BR
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15
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Starmer BZ, Baird A, Lucky MA. Considerations in fertility preservation in cases of testicular trauma. BJU Int 2017; 121:466-471. [DOI: 10.1111/bju.14084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Andrew Baird
- Aintree University Hospital NHS Foundation Trust; Liverpool UK
| | - Marc A. Lucky
- Aintree University Hospital NHS Foundation Trust; Liverpool UK
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16
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Évaluation des pratiques et des coûts de la vasectomie. Expérience monocentrique française. Prog Urol 2017; 27:543-550. [DOI: 10.1016/j.purol.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/13/2017] [Accepted: 06/13/2017] [Indexed: 11/18/2022]
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17
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Esteves SC. Editorial - A missing vas deferens: practical implications for urologists performing vasectomies and managing infertile men. Int Braz J Urol 2017; 42:872-875. [PMID: 27716455 PMCID: PMC5066881 DOI: 10.1590/s1677-5538.ibju.2016.05.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, SP, Brasil
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18
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Surgery of the Male Genital System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
<p>Vasectomy is a safe and effective method of birth control. Although it is a simple elective procedure, vasectomy is associated with potential minor and major complications. The early failure rate of vasectomy (presence of motile sperm in the ejaculate at 3‒6 months post-vasectomy) is in the range of 0.3‒9% and the late failure rate is in the range of 0.04–0.08%. The no-scalpel vasectomy technique is associated with a lower risk of early postoperative complications and the use of cautery or fascial interposition will reduce the risk of contraceptive failure. As such, detailed preoperative counselling and careful assessment of the post-vasectomy ejaculate (for presence of sperm) is imperative. Failure to provide and document adequate information and counselling to patients may lead to litigation.</p><p>The focus of this guideline is the management of men presenting for vasectomy. Specifically, the topics covered include: preoperative counselling, vasectomy efficacy and complications, technical aspects of vasectomy, post-vasectomy semen testing, and interpretation-communication of post-vasectomy semen results. By performing an extensive literature review, we have generated an evidence-based consensus on the management of these men. The objective of this guideline is to help standardize the treatment of men presenting for vasectomy.</p>
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Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - John Grantmyre
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Chan
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
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20
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Lowe G. Optimizing outcomes in vasectomy: how to ensure sterility and prevent complications. Transl Androl Urol 2016; 5:176-80. [PMID: 27141443 PMCID: PMC4837312 DOI: 10.21037/tau.2016.03.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Vasectomy provides a long-term effective sterilization for men and is performed on nearly 500,000 men annually in the United States. Improvements in technique have led to a decreased failure rate and fewer complications, although significant variations in technique exist. Use of cautery occlusion with or without fascial interposition appears to have the least failures. A no-scalpel approach lowers risk of hematoma formation, infection and bleeding post-operatively. A patient can be considered sterile when azoospermia is achieved or the semen analysis shows less than 100,000 non-motile sperm per milliliter. Incorporating these principles may allow the physician to optimize outcomes in vasectomy.
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Hancock P, Woodward BJ, Muneer A, Kirkman-Brown JC. 2016 Laboratory guidelines for postvasectomy semen analysis: Association of Biomedical Andrologists, the British Andrology Society and the British Association of Urological Surgeons. J Clin Pathol 2016; 69:655-60. [DOI: 10.1136/jclinpath-2016-203731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 11/04/2022]
Abstract
Post-vasectomy semen analysis (PVSA) is the procedure used to establish whether sperm are present in the semen following a vasectomy. PVSA is presently carried out by a wide variety of individuals, ranging from doctors and nurses in general practitioner (GP) surgeries to specialist scientists in andrology laboratories, with highly variable results.Key recommendations are that: (1) PVSA should take place a minimum of 12 weeks after surgery and after a minimum of 20 ejaculations. (2) Laboratories should routinely examine samples within 4 h of production if assessing for the presence of sperm. If non-motile sperm are observed, further samples must be examined within 1 h of production. (3) Assessment of a single sample is acceptable to confirm vasectomy success if all recommendations and laboratory methodology are met and no sperm are observed. Clearance can then be given. (4) The level for special clearance should be <100 000/mL non-motile sperm. Special clearance cannot be provided if any motile sperm are observed and should only be given after assessment of two samples in full accordance with the methods contained within these guidelines. Surgeons are responsible both preoperatively and postoperatively for the counselling of patients and their partners regarding complications and the possibility of late recanalisation after clearance. These 2016 guidelines replace the 2002 British Andrology Society (BAS) laboratory guidelines and should be regarded as definitive for the UK in the provision of a quality PVSA service, accredited to ISO 15189:2012, as overseen by the United Kingdom Accreditation Service (UKAS).
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Abstract
Permanent methods of contraception are used by an estimated 220 million couples worldwide, and are often selected due to convenience, ease of use and lack of side effects. A variety of tubal occlusion techniques are available for female permanent contraception, and procedures can be performed using a transcervical or transabdominal approach. This article reviews currently available techniques for female permanent contraception and discusses considerations when helping patients choose a contraceptive method and tubal occlusion technique.
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Affiliation(s)
- Elizabeth A Micks
- Department of Obstetrics & Gynecology, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA 98195-6460, USA
| | - Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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Latham JL. Surgery of the Male Genital System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Short-term morbidity following No-Scalpel Vasectomy: an assessment of clients' perceptions by novel postcard system. Urologia 2014; 81:177-81. [PMID: 24474542 DOI: 10.5301/urologia.5000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Data on short-term (within a week) morbidity of No-Scalpel Vasectomy (NSV) is lacking. We studied clients' perceptions of early post-vasectomy morbidity by self innovated postcard pictorial questionnaire. METHODS Between March 2011 and April 2012, 821 men underwent NSV and provided pre-printed revalidated pictorial postcards depicting various grades of severity of local pain, swelling, and bleeding. Clients were asked to tick mark their problems and post them on the third day after NSV. Data were compiled and statistically analyzed. RESULTS Completed postcards were returned by 702 clients (85.5%). 25 postcards were excluded due to illegitimate filling of card. About 80.8% of clients complained of pain and minimal, moderate and severe pain was experienced by 77.69%, 18.09% and 4.20%, respectively. 16.24% of clients observed local swelling, which was minimal in 90.9%, moderate and severe in 7.27% and 1.81% of cases. 2.95% of clients noted mild bloody discharge. Most of clients managed their problems by following the instructions given in postcards; level 1 and 2 morbidity did not affect their daily activity. CONCLUSION Early morbidity after NSV is usually mild in severity and easily manageable. The postcard system is a feasible, effective, and economical way of collecting data and managing short-term post NSV problems.
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25
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Malesterilization. Contraception 2013. [DOI: 10.1017/cbo9781107323469.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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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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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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: 54] [Impact Index Per Article: 4.2] [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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Affiliation(s)
- Armand Zini
- Associate Professor, Division of Urology, McGill University, Montréal, QC
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30
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Shih G, Turok DK, Parker WJ. Vasectomy: the other (better) form of sterilization. Contraception 2010; 83:310-5. [PMID: 21397087 DOI: 10.1016/j.contraception.2010.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 11/30/2022]
Abstract
Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.
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Affiliation(s)
- Grace Shih
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
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Senanayake E, Pacey AA, Maddireddy V, Shariff U, Hastie K, Rosario DJ. A novel cost-effective approach to post-vasectomy semen analysis. BJU Int 2010; 107:1447-52. [DOI: 10.1111/j.1464-410x.2010.09637.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Singh D, Dasila NS, Vasudeva P, Dalela D, Sankhwar S, Goel A, Singh V, Singh A, Jain A, Singh BP, Ahmed N. Intraoperative Distal Vasal Flushing—Does It Improve the Rate of Early Azoospermia Following No-scalpel Vasectomy? A Prospective, Randomized, Controlled Study. Urology 2010; 76:341-4. [DOI: 10.1016/j.urology.2010.01.091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 12/26/2009] [Accepted: 01/07/2010] [Indexed: 11/15/2022]
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Michielsen D, Beerthuizen R. State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation. EUR J CONTRACEP REPR 2010; 15:136-49. [DOI: 10.3109/13625181003682714] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Woodruff DY, Horwitz G, Weigel J, Nangia AK. Fertility preservation following torsion and severe ischemic injury of a solitary testis. Fertil Steril 2010; 94:352.e4-5. [PMID: 20153856 DOI: 10.1016/j.fertnstert.2009.12.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 12/16/2009] [Accepted: 12/21/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To present a case of solitary testicular torsion and an adolescent faced with future hypogonadism and infertility. DESIGN Case report. SETTING University-affiliated teaching hospital. PATIENT(S) A 16-year-old male with solitary testicular torsion of >8 hours' duration. INTERVENTION(S) Immediate scrotal exploration, orchiopexy, and sperm cryopreservation. MAIN OUTCOME MEASURE(S) Maintenance of testosterone production and determination of preservation after detorsion of an ischemic testis. RESULT(S) Color flow Doppler ultrasound showed markedly decreased flow to solitary testis. A subjectively dead testis was seen upon scrotal exploration, with the decision to proceed with orchiopexy. Semen analysis of cryopreserved specimen 50 hours after onset of symptoms showed 1.4 mL, normal sperm concentration (89 million/mL), 67% motility, and 28% World Health Organization morphology. Normal levels of testosterone were found at 4 and 12 weeks after surgery. Testicular salvage with normal intratesticular blood flow was seen by ultrasound at 4 and 12 weeks after surgery. CONCLUSION(S) To our knowledge, this is the first reported case of testicular salvage after torsion of a solitary testicle with subsequent normal semen analysis and cryopreservation. This demonstrates the need to attempt salvage even in cases of subjectively dead testicle and the importance of offering expedient sperm cryopreservation in such cases.
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Affiliation(s)
- Daniel Y Woodruff
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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Sasaki K, Bastacky SI, Zynger DL, Parwani AV. Use of immunohistochemical markers to confirm the presence of vas deferens in vasectomy specimens. Am J Clin Pathol 2009; 132:893-8. [PMID: 19926581 DOI: 10.1309/ajcpqzx4ws8upkgg] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CD10 has recently been described as a marker that can distinguish wolffian duct derivatives from müllerian remnants but has yet to be tested in vasectomy specimens. We sought to determine if CD10 and pankeratin could corroborate the presence of vas deferens (VD). For the study, 103 consecutive vasectomy specimens were immunohistochemically analyzed for CD10, pankeratin, and CD31 expression in luminal and basal layer cells. In all cases with optimal epithelial histologic features (92/103), CD10 demonstrated intense apical membranous expression in all VD and weak basal cytoplasmic staining in about 98% of cases. Pankeratin demonstrated cytoplasmic and membranous expression in apical and basal layers in 99% of VD. In cases with suboptimal epithelial histologic features (11/103), the detection of epithelia was 100% for CD10 and pankeratin. Our data show that CD10 and pankeratin can be used to confirm the presence of VD in vasectomy specimens in which the epithelial histologic features are suboptimal.
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Kotwal S, Kotwal S, Sundaram SK, Rangaiah CS, Agrawal V, Browning AJ. Does the type of suture material used for ligation of the vas deferens affect vasectomy success? EUR J CONTRACEP REPR 2009; 13:25-30. [DOI: 10.1080/13625180801899079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Munro NP, Kotwal S, Gogoi NK, Weston PMT, Browning AJ, Harrison SCW, Biyani S, Chahal R, Sundaram SK. Fulguration of the lumen does not improve vasectomy sterilization rates. BJU Int 2009; 104:371-5. [PMID: 19239454 DOI: 10.1111/j.1464-410x.2009.08416.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the effect of adding lumen diathermy fulguration to our standard technique of vas ligation with polyglactin 910 (Vicryl(TM), Ethicon, Sommerville, NJ, USA) excision and fascial interposition, in an attempt to improve our sterilization rates. We previously reported the effect of changing suture material on vasectomy success rates; 3005 post-vasectomy semen analyses (PVSA) revealed a decrease in sterilization rates after surgery on changing from chromic catgut to polyglactin 910. PATIENTS AND METHODS We retrospectively reviewed PVSA undertaken for vasectomies performed by urological surgeons at the Mid-Yorkshire NHS Trust for 18 months from September 2005 to February 2007. RESULTS There were 592 vasectomies in all; the age distribution of patients between the groups treated with the standard and new method was similar. Overall, 166 patients (28%) failed to provide two semen samples as instructed, and so were excluded from further analyses. Sterility was achieved in 367 patients (86%); a further 28 (7%) have indeterminate analyses to date, with one of the last two PVSAs showing sperm, with the PVSA of 32 (7%) patients showing persisting sperm. For the eight surgeons reviewed the sterility rates were broadly similar. CONCLUSIONS The introduction of diathermy fulguration of the lumen has not improved vasectomy sterilization rates, with up to 14% having sperm on PVSA.
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Affiliation(s)
- Nicholas P Munro
- Mid Yorks NHS Trust, Pinderfields General Hospital, Wakefield, Leeds, UK.
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Abstract
The Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) came into being 10 years ago to provide health technology assessments specifically tailored towards new surgical techniques and technologies. It was and remains the only organisation in the world to focus on this area of research. Most funding has been provided by the Australian Government Department of Health, and assessments have helped inform the introduction of new surgical techniques into Australia. ASERNIP-S is a project of the Royal Australasian College of Surgeons. The ASERNIP-S program employs a diverse range of methods including systematic reviews, technology overviews, assessments of new and emerging surgical technologies identified by horizon scanning, and audit. Support and guidance for the program is provided by Fellows of the Royal Australasian College of Surgeons. ASERNIP-S works closely with consumers to produce health technology assessments and audits, as well as consumer information to keep patients fully informed of research. Since its inception, the ASERNIP-S program has developed a strong international profile through the production of over 60 reports on evidence-based surgery, surgical technologies and audit. The work undertaken by ASERNIP-S has evolved from assessments of the safety and efficacy of procedures to include guidance on policies and surgical training programs. ASERNIP-S needs to secure funding so that it can continue to play an integral role in the improvement of quality of care both in Australia and internationally.
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Affiliation(s)
- Guy Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide
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Steward B, Hays M, Sokal D. Diagnostic Accuracy of an Initial Azoospermic Reading Compared With Results of Post-Centrifugation Semen Analysis After Vasectomy. J Urol 2008; 180:2119-23. [DOI: 10.1016/j.juro.2008.07.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Bonika Steward
- Family Health International, Research Triangle Park, North Carolina
| | - Melissa Hays
- Family Health International, Research Triangle Park, North Carolina
| | - David Sokal
- Family Health International, Research Triangle Park, North Carolina
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Bodiwala D, Jeyarajah S, Terry TR, Griffiths TRL. The first semen analysis after vasectomy: timing and definition of success. BJU Int 2007; 99:727-8. [PMID: 17378836 DOI: 10.1111/j.1464-410x.2006.06780.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Dhaval Bodiwala
- Department of Urology, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, UK.
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Dilbaz B, Cil AP, Gultekin IB, Caliskan E, Kahyaoglu Z, Dilbaz S. Outcome of vasectomies performed at a Turkish metropolitan maternity hospital. EUR J CONTRACEP REPR 2007; 12:19-23. [PMID: 17455040 DOI: 10.1080/13625180601127341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine prospectively the outcome of vasectomies performed by two trained surgeons over a 9-month period at the Ministry of Health Ankara Etlik Maternity and Women's Health Teaching and Research Hospital Family Planning Centre. METHODS The demographic data, source of information concerning the method, sexual function before and after voluntary no-scalpel vasectomy, compliance with the post-vasectomy follow-up program of men applying for a vasectomy were analyzed. All patients were contacted by telephone and invited for follow-up visits for counseling, inquiry regarding sexual dysfunction, and performance of a semen analysis. RESULTS The patients were married men, mostly primary school graduates, with more than one child. Sources of information were health services and/or health personnel for 89% of the patients. Of the 279 men who underwent a vasectomy and who were later contacted by phone, 131 (47%) came for a follow-up assessment. There was only one post-vasectomy pregnancy (0.8%). The incidence of reported sexual problems did not change after the procedure. Vasectomy did not affect the sexual function of men in our study. CONCLUSION Compliance with follow-up after vasectomy, which is extremely important for assessment of its successful outcome, is low.
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Affiliation(s)
- Berna Dilbaz
- Ministry of Health Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Etlik, Ankara
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Levine LA, Abern MR, Lux MM. Persistent Motile Sperm After Ligation Band Vasectomy. J Urol 2006; 176:2146-8. [PMID: 17070280 DOI: 10.1016/j.juro.2006.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated the efficacy and mechanism of failure in a small case series of VasClip vasectomies. MATERIALS AND METHODS Between September 2003 and March 2004, 8 patients underwent elective vasectomy using the VasClip ligation band. Microscopic semen analysis was done a minimum of 4 weeks postoperatively and after at least 15 ejaculations. The number of sperm and motility were quantified in 15 or more high power fields. Successful vasectomy was defined as 2 consecutive postoperative unspun semen analyses containing no sperm. Patients with failed vasectomy underwent bilateral surgical removal of the vas deferens segments containing the ligation band for gross and histological analysis. RESULTS Six of 8 patients (75%) were deemed azoospermic after 2 semen analyses at a mean followup of 7 and 11 weeks postoperatively, respectively. Two of 8 patients (25%) had semen analyses containing multiple motile sperm after vasectomy. In the 2 failed cases 1 side was patent, as demonstrated by vasal cannulation and irrigation with dilute methylene blue despite a well positioned, intact and secure ligation band. Histological analysis showed extravasation and sperm granuloma on the patent side. CONCLUSIONS The VasClip was found to fail at an unexpectedly high rate. Pathological analysis suggests sperm extravasation and fistula tract formation as the mechanism. One failure resulted in an unwanted pregnancy, which demonstrates the need for patient counseling regarding postoperative followup.
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Affiliation(s)
- Laurence A Levine
- Department of Urology, Rush University Medical Center, Chicago, Illinois 60612, USA.
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Labrecque M, Hays M, Chen-Mok M, Barone MA, Sokal D. Frequency and patterns of early recanalization after vasectomy. BMC Urol 2006; 6:25. [PMID: 16984640 PMCID: PMC1586021 DOI: 10.1186/1471-2490-6-25] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 09/19/2006] [Indexed: 11/21/2022] Open
Abstract
Background Our understanding of early post-vasectomy recanalization is limited to histopathological studies. The objective of this study was to estimate the frequency and to describe semen analysis patterns of early recanalization after vasectomy. Methods Charts displaying serial post-vasectomy semen analyses were created using the semen analysis results from 826 and 389 men participating in a randomized trial of fascial interposition (FI) and an observational study of cautery, respectively. In the FI trial, participants were randomly allocated to vas occlusion by ligation and excision with or without FI. In the cautery study, sites used their usual cautery occlusion technique, two with and two without FI. Presumed early recanalization was based on the assessment of individual semen analysis charts by three independent reviewers. Discrepancies were resolved by consensus. Results Presumed early recanalization was characterized by a very low sperm concentration within two weeks after vasectomy followed by return to large numbers of sperm over the next few weeks. The overall proportion of men with presumed early recanalization was 13% (95% CI 12%–15%). The risk was highest with ligation and excision without FI (25%) and lowest for thermal cautery with FI (0%). The highest proportion of presumed early recanalization was observed among men classified as vasectomy failures. Conclusion Early recanalization, occurring within the first weeks after vasectomy, is more common than generally recognized. Its frequency depends on the occlusion technique performed.
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Affiliation(s)
- Michel Labrecque
- Evaluation Research Unit, D1-724, Centre de recherche du Centre Hospitalier Universitaire de Québec (CHUQ), Hôpital Saint-François d'Assise, 10, rue de l'Espinay, Québec, (Qc), G1L 3L5, Canada
| | - Melissa Hays
- Family Health International, 2224 East NC Highway 54, Durham, NC 27713, USA
| | - Mario Chen-Mok
- Family Health International, 2224 East NC Highway 54, Durham, NC 27713, USA
| | - Mark A Barone
- EngenderHealth, 440 Ninth Ave. New York, NY 10001, USA
| | - David Sokal
- Family Health International, 2224 East NC Highway 54, Durham, NC 27713, 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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