Review of Vasectomy Complications and Safety Concerns

Knowledge and perceptions of men towards vasectomy among men of reproductive age in Otuke District- Uganda

OBJECTIVE

This study aimed to assess knowledge of and perceptions towards vasectomy as a family planning method among men of reproductive age in rural northern Uganda".

METHODS

A cross-sectional study involving 624 participants was conducted. Sociodemographic characteristics, use of vasectomy, number of children, and knowledge of vasectomy were assessed. Perceptions of vasectomy were measured, focusing on cultural, religious, and gender-related aspects.

RESULTS

The study revealed a predominantly adult, married, and Catholic population with low educational attainment. 2% of participants had used vasectomy as a family planning method, this indicates the right to preference in choosing vasectomy as a family planning method. Approximately half of the participants demonstrated awareness of vasectomy, and negative perceptions were recorded, with 63.5% expressing their opinions. Cultural and religious beliefs, along with concerns about promiscuity, play a significant role in shaping the perceptions. The majority believed in male dominance in family planning decisions, and a considerable portion endorsed sterilization exclusively for women.

CONCLUSION

This study highlights the low utilization and negative perceptions of vasectomy among men in rural northern Uganda, emphasizing the need for targeted interventions to address cultural and religious misconceptions and enhance education on family planning options. Public health campaigns should focus on dispelling misconceptions about vasectomy, particularly addressing cultural and spiritual concerns. Educational programs should target men and their communities, emphasizing the benefits of shared family planning decisions. Further research incorporating qualitative methods could provide a deeper understanding of the cultural aspects influencing vasectomy perceptions in this population.

Comparing vasectomy techniques, recovery and complications: tips and tricks

Vasectomies are safe and effective, achieving up to 99.7% in sterilization, with complication rates around 1-2%. As vasectomy uptake rises, physicians should stay informed about counseling, isolation and occlusion techniques, post-op recovery, and associated risks and complications. Historically, pre-vasectomy counseling has been performed in-person, but recent literature has shown that telehealth is a viable alternative, and a physical exam may not be necessitated. With regard to vas isolation and occlusion, current international guidelines support a minimally invasive approach such as no-scalpel vasectomy with mucosal cautery and fascial interposition, as they are the most effective in achieving vasectomy success and have the lowest complication rates. After a vasectomy, patients should undergo a post-vasectomy semen analysis 8-16 weeks after the procedure to ensure severe non-motile oligozoospermia (≤100,000 non-motile sperm/mL) or azoospermia. While risks and complications from vas isolation and occlusion are rare, patients should be informed about the potential for hematomas, infections, postoperative pain, and vas recanalization. In the U.S, vasectomies have increased in utilization from previous years, likely in the setting of increased access to telehealth and restricted female reproductive access. This trend raises questions about future fertility options such as vasectomy reversals and highlights the need for informed decision-making.

Complications of vasectomy: results from a prospective audit of 105 393 procedures

OBJECTIVES

To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC).

PATIENTS AND METHODS

Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis.

RESULTS

Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%).

CONCLUSIONS

Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling.

Post-Vasectomy Semen Analysis: What's All the Fuss about?

Vasectomy is a reliable male contraceptive method with a success rate exceeding 98%. Despite its efficacy, vasectomy is not foolproof, with potential early and late failures requiring careful postoperative monitoring via post-vasectomy semen analysis (PVSA). Published guidelines emphasize the necessity of conducting PVSA to ensure clinical sterility. Despite these clear guidelines, discrepancies in adherence and interpretation persist, with significant mismatches between guidelines and actual practice. Recent shifts in societal attitudes toward reproductive autonomy, spurred by significant political events and socioeconomic factors, have increased vasectomy rates, particularly among younger, childless men. This demographic change calls for enhanced PVSA compliance and clear communication about the non-immediate contraceptive effect of vasectomy. Home test kits have emerged as a convenient, though not always reliable, method for conducting PVSAs, which may require reevaluation in clinical practice. Given the variations across clinical guidelines and the challenges in achieving consistent PVSA outcomes, further research is needed to harmonize PVSA protocols across different health systems. PVSA is typically conducted between 8 and 16 weeks post-vasectomy, depending on the surgeon's preference. Success is confirmed when a fresh, uncentrifuged sample exhibits either azoospermia, rare non-motile sperm (RNMS), or fewer than 100,000 non-motile sperm per milliliter. This effort will ensure that both patients and practitioners can rely on vasectomy as a safe and effective form of contraception. Effective patient counseling and strategic follow-up are crucial when it comes to managing expectations and ensuring compliance with post-vasectomy protocols, thereby minimizing the risk of unintended pregnancies post-procedure.

Documented Paternity Despite Azoospermia Post-vasectomy

Vasectomy is a permanent and safe method of male contraception. One commonly used definition of success is azoospermia in one or two semen analyses after 20 ejaculates after three months. Failure is higher if less than 1.0 cm of vas deferens is removed or if a postsurgical infection occurs. There can be obvious social and legal consequences following a failed vasectomy and subsequent pregnancy. Paternity testing of the prospective father and child using automated DNA investigation employing amplified polymerase chain reaction (PCR) to compare short tandem repeat (STR) loci is accurate and readily available. A 32-year-old healthy male presented for elective sterilization after his wife delivered her third healthy full-term infant. The vasectomy was performed by ligation and excision as an outpatient. There were no intraoperative or postoperative complications. He had one semen analysis 48 days post-vasectomy that confirmed azoospermia. His wife conceived 119 days post-vasectomy, and he had two subsequent negative sperm counts. She delivered a full-term infant 385 days post-vasectomy. DNA paternity testing confirmed he was the father. Either the semen analysis was incorrect because of human error during the sperm count or small numbers of viable sperm were present despite reported preconception azoospermia. Human error is unlikely since all three tests were negative. This early failure probably does not represent recanalization but the transient release of sperm stored in the seminal vesicles or vas deferens. The time from vasectomy to laboratory-confirmed azoospermia varies. The time from vasectomy to functional azoospermia is not known, which is the reason for counseling about the risks of rare unexpected failures despite laboratory-confirmed azoospermia.

Male animal sterilization: history, current practices, and potential methods for replacing castration

Sterilization and castration have been synonyms for thousands of years. Making an animal sterile meant to render them incapable of producing offspring. Castration or the physical removal of the testes was discovered to be the most simple but reliable method for managing reproduction and sexual behavior in the male. Today, there continues to be global utilization of castration in domestic animals. More than six hundred million pigs are castrated every year, and surgical removal of testes in dogs and cats is a routine practice in veterinary medicine. However, modern biological research has extended the meaning of sterilization to include methods that spare testis removal and involve a variety of options, from chemical castration and immunocastration to various methods of vasectomy. This review begins with the history of sterilization, showing a direct link between its practice in man and animals. Then, it traces the evolution of concepts for inducing sterility, where research has overlapped with basic studies of reproductive hormones and the discovery of testicular toxicants, some of which serve as sterilizing agents in rodent pests. Finally, the most recent efforts to use the immune system and gene editing to block hormonal stimulation of testis function are discussed. As we respond to the crisis of animal overpopulation and strive for better animal welfare, these novel methods provide optimism for replacing surgical castration in some species.

Classical cadherins in the testis: how are they regulated?

Cadherins (CDH) are crucial intercellular adhesion molecules, contributing to morphogenesis and creating tissue barriers by regulating cells' movement, clustering and differentiation. In the testis, classical cadherins such as CDH1, CDH2 and CDH3 are critical to gonadogenesis by promoting the migration and the subsequent clustering of primordial germ cells with somatic cells. While CDH2 is present in both Sertoli and germ cells in rodents, CDH1 is primarily detected in undifferentiated spermatogonia. As for CDH3, its expression is mainly found in germ and pre-Sertoli cells in developing gonads until the establishment of the blood-testis barrier (BTB). This barrier is made of Sertoli cells forming intercellular junctional complexes. The restructuring of the BTB allows the movement of early spermatocytes toward the apical compartment as they differentiate during a process called spermatogenesis. CDH2 is among many junctional proteins participating in this process and is regulated by several pathways. While cytokines promote the disassembly of the BTB by enhancing junctional protein endocytosis for degradation, testosterone facilitates the assembly of the BTB by increasing the recycling of endocytosed junctional proteins. Mitogen-activated protein kinases (MAPKs) are also mediators of the BTB kinetics in many chemically induced damages in the testis. In addition to regulating Sertoli cell functions, follicle stimulating hormone can also regulate the expression of CDH2. In this review, we discuss the current knowledge on regulatory mechanisms of cadherin localisation and expression in the testis.

18 F-FDG PET-Positive Large Pelvic Granuloma Mimicking Malignant Bladder Tumor

ABSTRACT

An 88-year-old man was admitted to our hospital with a recurrent lower urinary tract infection. He had a history of open prostatectomy for benign prostatic hyperplasia 15 years ago and smoking. A mass arising within a bladder diverticula was suspected on the left lateral wall of the bladder on ultrasonography. Although no mass was observed in the bladder lumen on the cystoscopy, abdominal CT detected a left-sided pelvic soft tissue mass. A hypermetabolic mass was detected on 18 F-FDG PET/CT performed because of suspicion of malignancy, and it was excised. Granuloma secondary to chronic vasitis was diagnosed histopathologically.

Review of vasocutaneous fistulas and other rare complications after vasectomy

Introduction

Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy.

Material and methods

A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy.

Results

Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications.

Conclusions

Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.

A Narrative Review Discussing Vasectomy-Related Impact upon the Status of Oxidative Stress and Inflammation Biomarkers and Semen Microbiota

Background: Male contraceptive approaches besides tubal sterilization involve vasectomy and represent the method of choice among midlife men in developing countries thanks to many advantages. However, the subsidiary consequences of this intervention are insufficiently explored since the involved mechanisms may offer insight into a much more complex picture. Methods: Thus, in this manuscript, we aimed to reunite all available data by searching three separate academic database(s) (PubMed, Web of Knowledge, and Scopus) published in the past two decades by covering the interval 2000–2023 and using a predefined set of keywords and strings involving “oxidative stress” (OS), “inflammation”, and “semen microbiota” in combination with “humans”, “rats”, and “mice”. Results: By following all evidence that fits in the pre-, post-, and vasectomy reversal (VR) stages, we identified a total of n = 210 studies from which only n = 21 were finally included following two procedures of eligibility evaluation. Conclusions: The topic surrounding this intricate landscape has created debate since the current evidence is contradictory, limited, or does not exist. Starting from this consideration, we argue that further research is mandatory to decipher how a vasectomy might disturb homeostasis.

Emerging concepts in male contraception: a narrative review of novel, hormonal and non-hormonal options

Access to reliable contraception is a pillar of modern society. The burden of unintended pregnancy has fallen disproportionately on the mother throughout human history; however, recent legal developments surrounding abortion have sparked a renewed interest in male factor contraceptives beyond surgical sterilization and condoms. Modern efforts to develop reversible male birth control date back nearly a century and initially focused on altering the hypothalamic-pituitary-testes axis. These hormonal contraceptives faced multiple barriers, including systemic side effects, challenging dosing regimens, unfavorable routes of delivery, and the public stigma surrounding steroid use. Novel hormonal agents are seeking to overcome these barriers by limiting the side effects and simplifying use. Non-hormonal contraceptives are agents that target various stages of spermatogenesis; such as inhibitors of retinoic acid, Sertoli cell-germ cell interactions, sperm ion channels, and other small molecular targets. The identification of reproductive tract-specific genes associated with male infertility has led to more targeted drug development, made possible by advances in CRISPR and proteolysis targeting chimeras (PROTACs). Despite multiple human trials, no male birth control agents have garnered regulatory approval in the United States or abroad. This narrative review examines current and emerging male contraceptives, including hormonal and non-hormonal agents.

Vasectomy Regret or Lack Thereof

Background

Vasectomy is a procedure that results in permanent yet reversible sterility and remains a great contraceptive option for many. Previous research studies have highlighted frequency of vasectomy utilization, defining characteristics of individuals who opt for this method, various surgical techniques, and the risks and benefits associated with the procedure. What remains to be defined is why or why not individuals may experience post-vasectomy regret and whether the previous characteristics correlate.

Objective

The objective of this review is to synthesize information regarding reasons individuals may regret their vasectomy and seek reversal, what options exist for accomplishing the reversal, and patients' fertility prognosis post-vasovasostomy.

Methods

This review utilized a combination of secondary and tertiary data analysis across a wide scope of academic databases pertaining to the topic of interest.

Results

Typically, most males who have sought a vasectomy are satisfied with their decision, however, approximately 6% of this population seeks reversal. Key factors influencing vasectomy regret include age at the time of vasectomy, parental status, pre- and post-operative relationship status, unresolved physical and psychosexual problems, and development of chronic scrotal pain following the procedure. Few options exist for vasectomy reversal including microsurgical reconstructive vasectomy reversal (VR) and sperm extraction for in vitro fertilization. There is no guarantee that fertility will be restored in any case but a major predictive factor for success is the time interval prior to reversal.

Conclusion

Vasectomy is intended to be a permanent form of contraception; however, a minor chance remains that individuals may experience post-operative regret due to various factors. This warrants proper comprehensive counseling by the patient's provider regarding benefits and risks, procedural outcomes, opportunities for reversal, and fertility prognosis.

Ultrasound of the Normal and Abnormal Vas Deferens

ABSTRACT

The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.

Anti-adhesion agent to prevent of post-operative adhesion and fibrosis after vasectomy: a study using a rat model

Background

Post-vasectomy pain syndrome (PVPS) is difficult to treat. Direct damage to the vas deferens, inflammation, compression of nerves through fibrotic adhesions, and congestion of the epididymis are known to cause PVPS. The purpose of this study was to evaluate whether the application of anti-adhesion agents after vasectomy can reduce the degree of adhesion and fibrosis in a rat model.

Methods

In the study, 11 Sprague-Dawley rats (22 vas deferens) from each group were evaluated. In the experimental group, surgery was terminated after applying the anti-adhesion agent; this was not applied in the control group. After 14 days of vasectomy, the scrotum was dissected to evaluate the degree of gross adhesion at the vasectomy site. Histological examination of the surrounding tissues, including the vas deferens and the spermatic cord, was also performed.

Results

Adhesions were not observed in 72.73% (16/22) rats from the experimental group, in which the anti-adhesion agent was applied; in contrast, the incidence of adhesions in the control group was 100%. There was a statistically significant relationship between the distribution of grades for adhesion and anti-adhesion agent (chi-square, P<0.001). On classification of fibrosis and inflammation, application of the anti-adhesion agent was significantly associated with lower grade inflammation and fibrosis compared to that of the control group (chi-square, P=0.001). The rate of intact muscle structure was 90.91% (20/22) in the experimental group, and 36.36% (8/22) in the control group, and the application of the anti-adhesion agent demonstrated significant association with preservation of intact muscle structure (chi-square, P<0.001).

Conclusions

The application of an anti-adhesion agent after vasectomy prevented the development of adhesion, fibrosis, and inflammation reaction and further reduced structural destruction.

Reduction of oxidative stress and ornithine decarboxylase expression in a human prostate cancer cell line PC-3 by a combined treatment with α-tocopherol and naringenin

Differentiation of a human aggressive PC-3 cancer cell line was obtained, in a previous investigation, by the synergic effect of α-tocopherol (α-TOC) and naringenin (NG). This combined treatment induced apoptosis and subsequent reduction of the PC-3 cell proliferation and invasion, by a pro-differentiating action. Since one of the peculiar characteristics of NG and α-TOC is their strong antioxidant activity, this study aimed to investigate their potential effect on the activity of the main enzymes involved in the antioxidant mechanism in prostate cancer cells. NG and α-TOC administered singularly or combined in the PC-3 cell line, affected the activity of several enzymes biomarkers of the cellular antioxidant activity, as well as the concentration of total glutathione (GSH + GSSG) and thiobarbituric acid reactive substances (TBARS). The combined treatment increased the TBARS levels and superoxide dismutase (SOD) activity, while decreased the glutathione S-transferase (GST), glutathione reductase (GR), and glyoxalase I (GI) activities. The results obtained indicate that a combined treatment with these natural compounds mitigated the oxidative stress in the human PC-3 cell line. In addition, a significant reduction of both ornithine decarboxylase (ODC) expression and intracellular levels of polyamines, both well-known positive regulators of cell proliferation, accompanied the reduction of oxidative stress observed in the combined α-TOC and NG treatment. Considering the established role of polyamines in cell differentiation, the synergism with NG makes α-TOC a potential drug for further study on the differentiation therapy in prostate cancer patients.