Vasectomy: irrigation with euflavine

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.

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

BACKGROUND

We wanted to determine whether a saline flush during vasectomy would reduce the time needed to reach azoospermia.

METHODS

During vasectomy men were randomly assigned to flush the prostatic end of the vas deferens with 10 mL of normal saline (intervention group, n = 50), while the remaining men (n = 56) served as controls. Sperm counts were performed on the immediate postprocedure urine specimen and on semen samples at 1, 6, and 12 weeks after vasectomy.

RESULTS

The postprocedure urine specimens from the intervention and control groups contained 29.2 x 106 and 0.004 x 106 sperm, respectively (P < .001). Total sperm counts in the ejaculate for intervention and control groups at 1, 6, and 12 weeks were (in millions of sperm): 14.1 and 13.8, 0.4 and 8.0, and 0.0 and 0.011, respectively (P > .05 at all time points). There was no difference in the rate at which the men in the 2 groups achieved azoospermia.

CONCLUSIONS

Vasal perfusion with saline during vasectomy was effective in removing sperm from the distal vas; however, perfusion did not increase the rate at which men achieve azoospermia.

The effect of perioperative distal vasal lavage on subsequent semen analysis after vasectomy: a prospective randomized controlled trial

OBJECTIVE

To determine the effect of perioperative distal vasal lavage with 50 mL of normal saline on subsequent time to azoospermia after vasectomy.

PATIENTS AND METHODS

Seventy-two patients were prospectively enrolled and randomized to undergo vasectomy with or without vasal lavage. Infertility rates at 8, 10 and 12 weeks were compared for both groups and for those undergoing the procedure under local or general anaesthesia. Patient compliance for returning postoperative semen for analysis was also assessed.

RESULTS

There was no statistically significant difference in infertility rates at 8, 10 or 12 weeks after vasectomy with or without vasal lavage. Vasectomies performed under local and general anaesthesia had comparable rates of infertility at 12 weeks after surgery. Compliance in providing semen for analysis was poor.

CONCLUSION

The routine adoption of distal vasal lavage during vasectomy for contraception cannot be recommended. As compliance in providing semen for analysis was poor, the clinician has a responsibility to remind the patient of the consequences of such action.

Irrigation of the distal vas deferens during vasectomy: does it accelerate the post-vasectomy sperm-free rate?

A prospective, non-randomized, partially blinded, controlled trial was conducted to evaluate the efficacy of irrigation with normal saline solution (NSS) during no-scalpel vasectomy (NSV) compared with NSV alone in 62 men. In the NSS irrigation group, an Angiocath 24-gauge needle was inserted into the distal vas lumen, and 20 mL NSS solution was used to irrigate the vas manually on both sides. Post-operative follow-up included urine samples collected immediately and semen samples for sperm count at 2, 6 and 12 weeks post-vasectomy. The difference in the number of spermatozoa appearing in the post-vasectomy urine samples and the mean urine sperm count in both groups were significantly different ( p < 0.0001 and p < 0.01, respectively). The numbers of post-operative ejaculations, the mean sperm concentration, and the number of patients who achieved sterility (defined as no motile spermatozoa in the ejaculate) in both groups at 2, 6 and 12 weeks were similar ( p > 0.05). It is concluded that although irrigation of the distal vas with NSS was successful in removing a large number of spermatozoa from the tract, this procedure did not significantly accelerate the rate of achieving absence of motile spermatozoa in the ejaculate.

Flushing of distal vas during vasectomy: current status and review of literature

Vas irrigation during vasectomy, to effect immediate sterility or to shorten the interval between vasectomy and sterility, has received increasing attention in recent years. A review of the literature on vas irrigation is presented. Topics discussed include the effectiveness of various irrigants and irrigation methods, method and technical failures, and evidence of increased risks of recanalization, inflammation, tissue damage, and infection. Stored sperm and their location after vasectomy are explored. Suggested mechanisms for the action of irrigants are reviewed, and another mechanism is proposed. Variations in study results and our incomplete understanding of vas and seminal vesicle physiology during ejaculation (compounded by individual variations) require more investigation before large clinical trials are initiated.