Vasectomy without complication

Unilateral absence of vas deferens: prevalence among 23.013 men seeking vasectomy

Purpose:

To determine the prevalence of unilateral absence of vas deferens (UAVD) in men with both testes seeking vasectomy.

Materials and Methods:

Computerized charts of 23,013 patients encountered between January 1994 and December 2013 in one university hospital and two community clinics of Quebec City, Canada, were searched. Pre-vasectomy consultation, operative reports and semen analysis results were reviewed to identify cases of UAVD. Cases were categorized as confirmed (unilateral vasectomy and success confirmed by semen analysis) or possible congenital UAVD further sub-categorized according to whether or not a scrotal anomaly was present.

Results:

Among 159 men identified as potentially having UAVD, chart review revealed that 47 had only one testicle, 26 had bilateral vasa, and four were misdiagnosed (post-vasectomy semen analysis [PVSA] showing motile sperm after unilateral vasectomy) leaving 82 men deemed cases of UAVD (0.36%, 95% confidence interval 0.28% to 0.43%). These were classified as confirmed (n=48, 0.21%) and possible (n=34, 0.15%; 22 without and 12 with scrotal anomalies) congenital UAVD. The misdiagnosis ratio of UAVD was low when scrotal content was otherwise normal (1:48), but higher if anomalies were present (3:12).

Conclusions:

Most surgeons who perform vasectomy will encounter cases of UAVD. In most suspected cases, it is safe and effective to proceed with unilateral vasectomy under local anesthesia while stressing the need for PVSA. Further studies or scrotal exploration may be considered in patient with prior scrotal surgery.

Persistent Motile Sperm After Ligation Band Vasectomy

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.

[Vasectomy: study of 300 interventions. Review of the national literature and of its complications]

OBJECTIVES

The aims of this paper are: 1. To study the demand and reasons why of the vasectomy in area 12 of Valencian Community. 2. To analyse the adverse effects of our series and the predictable risk factors. 3. To review the adverse effects in the national series. 4. To review the adverse effects referred to in international publications.

PATIENTS AND METHODS

A retrospective study was made of 300 patients who had submitted themselves to a vasectomy between january 1992 and december 2000. All the clinical dossiers were reviewed according to 10 pre-established variables. age, number of offspring, reasons why, pre-vasectomy anticontraceptives; date of operation, type of anaesthesia used, pathologic anatomy, semen analysis after vasectomy, adverse effects and their possible causes (risk factors). The basic statistic study was done using a data base of Microsoft Access and the interpretations of the different variables using a table of Excel.

RESULTS

The demand for contraceptive attention (vasectomy) is the 8th cause for external urological consulting and the 4th for urological local ambulatory surgery of our area. 300 operations were done during that period. The average age of the patients was 37.5 years old (ranging from 25 to 51). The number of offspring ranged from 1 to 7, with a promedia of 2.41 children/patient. The reasons why were: voluntary family planning (86%), medical illnesses of the female which contraindicated gestation (9%), genetic reasons (4.33%) and social-sanitary problems (0.66%). Contraceptive methods used by 71.63% are known: The widest-used method being IUD (49.74%) and the preservative (25.88%). 30 patients (10%) had adverse effects, 29 patients having light adverse effects. The most frequent were: 12 orchiepididymitis (4%), 5 spermatic granulomas (1.66%), 3 chronic scrotal pain (1%), 2 scrotal haematoma (0.66%) and 2 bleeding (0.66%). There was one serious complications and of all the cases mentioned above only one needed hospitalization (impetigo-sepsis) and another needed surgery due to a spermatic granuloma. There were no pregnancies or post-vasectomy court cases. 81% of the patients had been declared azoospermic within 45 to 60 days after the vasectomy in one or two consecutive semen analysis.

CONCLUSIONS

The vasectomy is a safe and simple way for male sterilization. It's the most widely done urologic operation in Spain. The technique isn't extent of adverse effects (0 to 18%) and its seriousness varies from a simple ecchymosis to Fournier's gangrene, endocarditis or sepsis. A doctor would be considered negligent if he/she didn't inform the patient about the remote possibility of a spontaneous recanalisation of the vas deferens leading to renewed fertility (failure of the vasectomy). It is imperative to give post-vasectomy information where the patient must continue using his habitual anticonceptive method until the azoospermia shown in 2 semen analysis confirm the sterility of the patient so that the urologist has no legal problem.

Vasectomy: a "seminal" analysis

Vasectomy is one of the most reliable and cost-effective permanent methods of contraception. Despite its popularity, certain issues pertaining to the procedure remain unresolved. Appropriate selection of candidates for vasectomy requires thorough counseling and screening, though a foolproof method of eliminating dissatisfaction and regret remains a mystery. Debate continues over the relative merits of the various techniques of isolating and sealing the vasal ends. Postoperative complication rates remain minimal regardless of the technique used, and no single strategy attempting to maximize patient compliance with postoperative semen analysis has enjoyed unmitigated success. Long-term consequences, other than regret, are rare. Finally, issues regarding residency training in the procedure and its impact on procedure morbidity are scarcely addressed in the literature. This study reviews the evolution of vasectomy as a contraceptive procedure and attempts to summarize current literature addressing these unresolved issues.

Voluntary vasectomy: Medico-legal aspects

In Italy, although voluntary sterilisation was decriminalised with act No. 194/78, which abrogated section 552 of the criminal code, there is no regulation as yet ratified by law. The authors refer to the trend shown by some sentences, the most important of which is No. 438 of 18.03.1987 (Court of Cassation), highlighting some aspects of physical and psychic health and “informed” consent. The surgical technique of male sterilisation and possible complications are dealt with, as well as the unresolved medico-legal aspects concerning the irreversibility of the operation or vice versa, failure of reversal. The possible judicial implications of claims for compensation for damages caused by malpractice, negligence or imprudence are also discussed. In conclusion, it is hoped that a law regulating this matter will soon be passed, while in the meantime a protocol to avoid legal liability is suggested.

Vasectomy: etiology of infectious complications

Semen was cultured prior to vasectomy for voluntary sterilization. Postvasectomy infectious complications occurred only in patients with positive preoperative semen cultures. The offending pathogen was the same organism found in the semen culture. This evidence for an endogenous cause of postoperative vasectomy infections suggests that a semen culture and antimicrobial sensitivity be obtained prior to vasectomy. In this manner the correct antimicrobial agent can be instituted as an aid to rapid resolution of a postvasectomy infection.

Unsatisfactory psychosocial results of vasectomy resulting in modification of preoperative counseling

Psychosocial problems after vasectomy resulted in a change in preoperative counseling. Psychologic instability, marital problems, sexual difficulty, and anxiety because of religion became contraindications to vasectomy. Psychosocial problems after vasectomy were then reduced. Patient age under twenty years was also a contraindication. Five hundred sixty patients in the twenty to twenty-nine age group (31 per cent of the total 1,784 vasectomise performed) had vasectomies, with psychosocial problems in only 1 patient due to the young age. This was believed not to warrant a change in the age groups having vasectomy.

Recanalization rate following methods of vasectomy using interposition of fascial sheath of vas deferens

A small but definite recanalization rate has followed the vas ligation method of partial vasectomy for sterilization. Interposition of the fascial sheath between the divided ends of the vas reduced the recanalization rate to 0. Fulguration of the lumen of the cut vas ends was used but was not the significant factor in this zero recanalization rate.