Vasectomy

Interpositional substitution of free vas deferens segment autografts in rat: feasibility and potential implications

Background

Insufficient vas length for performing a tension-free vasovasostomy is a problem occasionally encountered by microsurgeons. Herein we evaluated utilization of a non-vascularized vas deferens autograft in a rat model.

Methods

Segments of isolated vas deferens, 2.5 cm in length, were used as bilateral autografts in 15 rats. Each autograft was implanted between the two transected ends of vas deferens using end-to-end anastomosis. Fertility, sperm motility, and graft survival was evaluated and compared with the control group.

Results

At the end of the 3 months, 9/15 (60%) rats were able to breed successfully and 24 (80%) vas grafts were patent and viable. Large granulomata developed at the proximal anastomosis sites in 6 (20%) autografts that failed. Unilateral minimal fluid leakage was observed in 6 (20%) of the proximal (testicular end) anastomosis sites in those rats that were able to breed. Histological evaluations demonstrated that graft survival was associated with mild to severe changes in the structure of the vas autograft. On semen analysis 76% of the sperms in the experimental group had forward motility compared to 78% in the control group (p > 0.05).

Conclusions

Vas autograft can successfully be performed in a rat model with ultimate breeding capability.

Male contraception: Past, present and future

Male contraception research has yielded a number of promising leads over the past 50 years. Yet, little is known by the public due to lack of institutional support and funding. This is unfortunate since, apart from condom and vasectomy, there are many male methods which may be safer, more effective and easier to use. This paper explores male contraception which has been used in the past and the present and discusses some of its potential developments.

A combination of check tug and fascial interposition with no-scalpel vasectomy

The prospective study was carried out to evaluate the success rates of combining a check tug and fascial interposition while performing a no-scalpel vasectomy. A total of 2150 male acceptors visiting the family welfare clinic of Lok Nayak Hospital, Delhi, from July 1992 to June 1995 and opting for a no-scalpel vasectomy, underwent a combination of check tug and fascial interposition during the procedure. These men were followed-up for failure rates as shown by semen analysis, 3 months and at least 20 ejaculations following the procedure. All the clients showed a negative sperm count during the subsequent follow-up, less than two non-motile sperms per high power field being taken as a negative count (n = 5) and there were no reported pregnancies. A check tug ensures that the same vas deferens is not ligated twice, particularly as the approach is a midline one. The fascial interposition prevents spontaneous recanalisation of the cut vas. Thus the combination of the two would further increase the reliability of the procedure.

Safety and effectiveness of vasectomy

OBJECTIVE

To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy.

DESIGN

A systematic MEDLINE review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998.

MAIN OUTCOME MEASURE(S)

Early failure rates are <1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%-6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.

CONCLUSION(S)

Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.

Lethal Fournier's gangrene following vasectomy

A case is presented of a healthy young man who had Fournier's gangrene after standard bilateral vasectomy. Despite maximal treatment, including extensive necrectomy and broad-spectrum antibiotics, this complication was lethal. To our knowledge a lethal complication of vasectomy has not been reported in the literature.