Evaluation of one-hundred open-ended vasectomies

HOW LITTLE IS ENOUGH? THE EVIDENCE FOR POST-VASECTOMY TESTING

PURPOSE

Post-vasectomy semen analysis (PVSA) is the traditional method of confirming sterility after vasectomy. However, PVSA protocols vary in the end points accepted, and the number and timing of tests. In this systematic review we make evidence based recommendations on the appropriate PVSA protocol.

MATERIALS AND METHODS

Databases (MEDLINE, Current Contents, Cochrane Library and EMBASE) were searched up to and including March 2003. Studies were included if they dealt with post-vasectomy testing and contained data on at least 1 of the time or number of ejaculations to azoospermia, pregnancy, repeat vasectomy and histological analysis of vas specimens.

RESULTS

A total of 56 studies were included in the review. Time to achieve azoospermia was variable, although the median incidence of patients with azoospermia was consistently more than 80% after 3 months and after 20 ejaculations. A small percent of patients (14,845 or 1.4%) demonstrated persistent nonmotile sperm, although some of them eventually achieved azoospermia. The reappearance of nonmotile sperm was reported in 7 studies, occurring up to 22 months after vasectomy.

CONCLUSIONS

The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations. If the sample is positive, periodic testing can continue until azoospermia is achieved. Patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success. No evidence was located to support histological testing of the excised vas deferens.

Morphometric study of testis of Wistar rat after open-ended vasectomy

The effects on the testis of open-ended vasectomy in the Wistar rat have been assessed morphometrically and evaluated statistically at 1, 4, 12, and 24 weeks after operation, and compared to those in sham-operated controls. The open-ended technique, ie, without ligation of the epididymal end of the cut ductus deferens, allowed drainage of sperm into the spermatic cord. During the period of our study, it did not affect the structure of the testis; although the germinal epithelium, basement membrane, and the stroma and cells of the interstitial space all showed variations when compared to the control group, these were not statistically significant.

An evaluation of the no-scalpel vasectomy technique

OBJECTIVE

To evaluate the magnitude and range of complications encountered during no-scalpel vasectomy (NSV) and to identify any limiting factor or contraindication to NSV.

SUBJECTS AND METHODS

A total of 4255 men visiting a family welfare clinic of a city hospital in Delhi, India, or outpatients of the surgery department, opted for NSV; 4253 procedures were performed from September 1989 to December 1997, with two not performed because of technical difficulties. The success and complication rates were recorded.

RESULTS

The complication rates with NSV were surprisingly low; seven complications were encountered, comprising two small haematomas (0.047%), three painful nodules (0.07%), three wound infections (0.07%) and two vasal fistulae, a complication not previously described. A meticulous procedure should avoid this last complication. The mean duration of NSV was 9.5 min.

CONCLUSION

NSV is a refined and rapid technique of vasectomy with an extremely low complication rate. Being a minimally invasive procedure, it allays the fear of incision commonly encountered in men choosing vasectomy.