A randomized clinical trial of the effect of intraoperative saline perfusion on postvasectomy azoospermia

Outpatient Vasectomy: Safe, Reliable, and Cost-effective

Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization. Vasectomies are typically done under local anesthesia in outpatient settings, and patients usually go home within an hour of the surgery. Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information from observational studies, with few controlled clinical trials.

Effect of ductus deferens lavage on the time to achieve azoospermia in patients undergoing vasectomy

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.

Sites of residual spermatozoa after irrigation of the distal vas deferens using normal saline solution during vasectomy in a rat model

We have previously reported that irrigation of the distal vas deferens using a normal saline solution (NSS) is successful in removing a large amount of spermatozoa from the tract. However, this technique does not completely remove all the motile spermatozoa from the ejaculate. The aim of the present study is to evaluate the location of the residual spermatozoa after distally irrigating the vas deferens. Twenty male Sprague-Dawley rats (400-450 g) constitute our study population. The animals were divided into two groups: group 1, control group (n = 10), rats that undergo only vasectomy and group 2, experimented group (n = 10), rats that undergo vasectomy and distal irrigation of the vas deferens using 3 mL of NSS. In both groups, the middle and terminal parts of the vas deferens including the seminal vesicles are removed and sent for spermatozoa count. The post-vasectomy urine samples containing spermatozoa are obtained by mid-ventral cystocentesis and the concentration is determined using a haemocytometer. More spermatozoa was found in the urine samples of the experimented group than the control (21.3 +/- 10.61 vs. 0.2 +/- 0.20 million/ml, p-value = 0.068), and lesser residual sperms reside at both the middle and the terminal parts of the vas deferens (0.5 +/- 0.31 vs. 3.0 +/- 0.00; p = 0.008 and 1.1 +/- 0.99 vs. 2.0 +/- 0.00; p = 0.036 respectively). No sperms were present in the seminal vesicles of the control group, but two of 10 rats in the experimented group had few to moderate amount of sperms in their seminal vesicles (p = 0.180). After the distal irrigation of the vas deferens using NSS, some residual sperms resided in the middle and more at the distal part of the vas with a few that escaped into the seminal vesicles.