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Huyghe E, Ducrot Q, Kassab D, Faix A, Hupertan V, Labrecque M. Survey on vasectomy practices in France in 2022. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102593. [PMID: 38401346 DOI: 10.1016/j.fjurol.2024.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 12/27/2023] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Prior to the publication of the recommendations of the French Association of Urology (AFU) on vasectomy, we conducted a survey to assess current practices and required training interventions in France regarding vasectomy. METHOD An invitation with a link to a 38-item questionnaire on MonkeySurvey was sent in November 2022 to the 1760 urologist members of the AFU. RESULTS A total of 352 (20%) urologists completed the survey. Among the participants, 20% reported refusing the surgery to patients aged 25 to 30 years old and 17% if they had no children, respectively. Three quarters of participants mentioned systematically performing a scrotal exam at the time of the pre-vasectomy consultation. Forty-one percent of respondents reported systematically performing vasectomy under general anesthesia. While 56% of participants mentioned performing a minimally invasive technique for exposing the vas, 70% said they were willing to learn the no-scalpel technique for this purpose. The most frequently reported occlusion techniques combine excision of a vas segment and ligation of both ends of the divided vas. Only 26% reported performing fascial interposition and 4% using the "open end" technique. A post-vasectomy semen analysis showing less than 100,000 non-motile sperm per millilitre makes only 38% of respondents recommending stopping other contraceptive methods. Half of the respondents considered that current reimbursement fee structure for the procedure restrains the development of this clinical activity. CONCLUSION Our survey suggests that vasectomy practice and services in France do not meet the international standards. We identified the clinical and organizational changes needed to improve practices and access to vasectomy services in France. LEVEL OF EVIDENCE Grade 3.
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Affiliation(s)
- Eric 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 Toulouse 3, université de Montpellier, Montpellier, France.
| | - Quentin Ducrot
- 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
| | - Diana Kassab
- Association française d'urologie, rue Viète, 75017 Paris, France
| | | | | | - Michel Labrecque
- Département de médecine familiale et de médecine d'urgence, Université Laval, Québec, Canada
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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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Dings SJM, van Stralen KJ, Struben VMD, Noordzij MA. Pain and anxiety during vasectomies while distracting patients with video glasses or virtual reality glasses. BJU Int 2021; 128:561-567. [PMID: 33387391 DOI: 10.1111/bju.15332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine whether it is possible to reduce the amount of pain and anxiety experienced during a vasectomy by use of two-dimensional (2D) video glasses or virtual reality (VR) glasses during the vasectomy. PATIENTS AND METHODS A non-randomised controlled trial was performed between October 2017 and March 2018. A total of 176 patients were planned for a vasectomy in an outpatient setting and 141 of these patients were divided sequentially into three groups: Control, 2D video glasses and VR glasses. Follow-up lasted 7 days. One patient was lost to follow-up. The main outcomes were pain (visual analogue scale [VAS] score 0-10) and anxiety ((VAS score 0-10), and State-Trait Anxiety Inventory for Adults [STAI-AD] score 20-80) during the vasectomy. Data were compared using analysis of variance or chi-square measurements. RESULTS No significant differences in pain were found (VAS score of 2 in all groups). The odds ratio (OR) and (95% confidence interval [CI]) in the 2D video glasses group was 1.15 (0.92-1.48) and in the VR group was 0.98 (0.76-1.26). Patients in the VR group experienced significantly more anxiety during the procedure (OR 1.40, 95% CI 1.07-1.85). Also, patients without prior hospitalisation reported significantly more pain than patients with one or more hospitalisations (OR 1.35, 95% CI 1.11-1.65). CONCLUSIONS The VR and 2D video glasses did not reduce pain or stress during the vasectomy. In the VR group, the anxiety levels during the procedure were even higher.
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Affiliation(s)
- Sam J M Dings
- Urology, Spaarne Gasthuis Hoofddorp, Hoofddorp, the Netherlands
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Miller S, Couture S, James G, Plourde S, Rioux J, Labrecque M. Unilateral absence of vas deferens: prevalence among 23.013 men seeking vasectomy. Int Braz J Urol 2017; 42:1010-1017. [PMID: 27509370 PMCID: PMC5066900 DOI: 10.1590/s1677-5538.ibju.2015.0717] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/14/2016] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Sarah Miller
- The Institute for Family Health and Montefiore Medical Center's Department of Social and Family Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sophie Couture
- Research Centre of the CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Quebec City, Canada
| | - Gareth James
- Danetre Medical Practice, Daventry, United Kingdom
| | - Simon Plourde
- Clinique médicale Pierre-Bertrand, Quebec City, Canada
| | - Jacky Rioux
- Research Centre of the CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Quebec City, Canada
| | - Michel Labrecque
- Research Centre of the CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Quebec City, Canada.,Clinique médicale Pierre-Bertrand, Quebec City, Canada
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Mini-incision vasectomy reversal using no-scalpel vasectomy principles: efficacy and postoperative pain compared with traditional approaches to vasectomy reversal. Urology 2010; 77:602-6. [PMID: 21185588 DOI: 10.1016/j.urology.2010.09.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 09/25/2010] [Accepted: 09/25/2010] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the efficacy and postoperative morbidity of a mini-incision vasectomy reversal (MIVR) using no-scalpel vasectomy principles compared with traditional incisional approaches to vasectomy reversal (VR). METHODS Of 164 patients undergoing consecutive VR, 139 underwent bilateral vasovasostomy (55% bilateral MIVR, 24% mixed MIVR/traditional incision VR, and 21% bilateral traditional incision VR). The MIVRs were performed using a subcentimeter incision after the vas deferens was captured and delivered through the skin using the no-scalpel vasectomy principles and instruments. Semen analyses were obtained at 3-month intervals postoperatively until pregnancy was achieved. Motile sperm in the ejaculate after VR defined patency. Pain and functional recovery after surgery were evaluated using a previously validated 10-point pain scale adapted to VR. The no-scalpel vasectomy patients served as controls for the postoperative pain assessments. RESULTS The median follow-up was 11.6 months. The patency rate was 96%, 100%, and 91% for the MIVR, mixed MIVR/traditional incision, and bilateral traditional incision VR, respectively (P = .4). The semen parameters did not significantly differ among the VR approaches. The pain severity during the first 48 hours after surgery was significantly less (P < .05) for the patients who had undergone bilateral MIVR than for the patients who had undergone traditional incision VR and did not significantly differ from that of the men who had undergone no-scalpel vasectomy. The patients returned to normal activities an average of 2 days earlier after MIVR than after traditional incision VR. CONCLUSIONS The results of our study have shown that MIVR does not compromise patency outcomes or semen parameters compared with more traditional approaches to VR and results in less pain during the early period of recovery after surgery and quicker functional recovery.
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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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