No-scalpel vasectomy at the King's birthday vasectomy festival

No-scalpel vasectomy was developed to increase acceptability of vasectomy by elimination of the fear of the incision. Although this method has been used for over 8,000,000 men, the technique is largely unknown in developed countries. During the King's birthday vasectomy festival no-scalpel vasectomy was compared with standard incisional vasectomy in 1203 patients. An average of 57 procedures per day could be done by each physician with the no-scalpel method, compared to 33 procedures with the standard method (p less than 0.001). The complication rate was 0.4/100 procedures for no-scalpel vasectomy compared with 3.1/100 for standard vasectomy (p less than 0.001). No-scalpel vasectomy is a rapid and economic alternative to standard vasectomy, with fewer complications and increased patient acceptability.

Transcervical sterilization with use of methyl 2-cyanoacrylate and a newer delivery system (the FEMCEPT device)

The increasing use of sterilization as a means of permanent contraception prompts the search for simpler, safer methods. Methyl 2-cyanoacrylate 0.6 ml was administered to the uterocornual tubal junction with the use of the FEMCEPT transcervical delivery system in 35 healthy parous women aged 30 to 44 years. Hysterosalpingography 4 months after the procedure showed bilateral tubal occlusion in 88.2% of the study participants. There were no complications in the study group, and there were no pregnancies among those who demonstrated bilateral tubal occlusion. The technique, which is safe, effective, and simple, could consideraly reduce anesthetic and operative risk in sterilization.

Learning hysteroscopy sterilization and the Ovabloc System with Hyskon

A review of the first 100 and the last 100 patients in a series of 268 patients sterilized by hysteroscopic injection of liquid silicone into the fallopian was made to evaluate the success rate as it relates to experience with the procedure. The two groups were similar in composition. While the percentage of patients sterilized increased only from 91% in the first 100 patients to 94% in the last 100 patients the numbers that were sterilized at the time of the first procedure increased by 9%. The two major reasons for repeated procedures were tip separation and tubal spasm. The former may become less of a problem with new manufacturing changes. Tubal spasm was reduced as a problem by controlling the temperature of Hyskon but it remains a difficult problem in a smaller number of patients even in the last group. Other causes for repeated procedures were primarily related to operator inexperience and investigational problems. They appear not to be a significant problem for physicians who will learn this procedure in future. This procedure is well received by patients. Hysteroscopists will find it a valuable outpatient female sterilization technique.

Chemical sterilization with an IUD

Zipper has more than adequately demonstrated that quinacrine, when placed in the uterine cavity, has a sclerosing effect on the tubal ostia, resulting in chemical sterilization of the fallopian tubes. His technique involves the use of 3 monthly instillations of 250 mg of pellets into the uterine cavity. With the hope of reducing the total dosage and making it a 1-insertion technique, quinacrine has been mixed with polyethylene oxide and place on the arms of various IUDs. It is hoped that the material is directed at the tubal ostia. Studies to date have occurred in women awaiting hysterectomy with careful pathologic examination of the intramural portion of the tube. The results thus far are most encouraging and once the best vector is identified, it is hoped that this will become an acceptable means of female sterilization.

Quinacrine hydrochloride pellets: preliminary data on a nonsurgical method of female sterilization

The efficacy of transcervical insertions of quinacrine hydrochloride pellets to produce tubal occlusion has been evaluated in a study of 139 women in Santiago, Chile. At one year, the pregnancy rate was 3.1%, an acceptable rate for a nonsurgical method of female sterilization.

An outpatient approach to female sterilization with methylcyanoacrylate

MCA is a tissue adhesive which can be delivered transcervically to the Fallopian tubes by means of the FEMCEPT device. In the patients treated with this system, both prior to hysterectomy and on an ambulatory basis, there have been no significant complications or side effects. In the most recent series of ambulatory patients treated with the REMCEPT-MCA system, the bilateral tubal closure rate was 78%.

[Male sterilization]

More than 50,000 men have received spermatic duct injections, a new method of male sterilization, in densely populated Sichuan Province since 1972. The new method is to inject 0.02 milliliters of a phenol mixture into the spermatic duct and to block the duct for 1.5 centimeters. The method takes less than 10 minutes, which involves no surgical operation. The method was devised by Li Chunqiang, a surgeon at the Chongqing No. 1 workers' hospital, who is also deputy director of the city's research institute on family planning. Examinations of the seminal fluid of 1629 men who had the injections showed that 92.04% of their sperm disappeared. The method has been shown to be 90.95% effective. This method is simple, safe and reliable, and less complicated than vasectomy. It reduced hematoma, infection and causes less damage to surrounding tissue.

Azoospermia in dogs induced by injection of sclerosing agents into the caudae of the epididymides

Injections of sclerosing agents into the caudae of the epididymides of adult and prepubertal dogs induced a long-lasting and probably irreversible azoospermia. The technique is easy to do and inexpensive, does not seem to cause undesirable side effects, and appears suitable for large-scale sterilization programs in male dogs.

[Surgical procedures for sterilization of the women: certainty--complications (author's transl)]

The time (interval, postpartum, postabortum), location (uterus, mucus membrane of the oviducts, tubes), access (transcervical, transvaginal, trans-abdominal) and the actual method of sterilization for the women (surgical, electric, thermic, mechanical) can be differentiated and combined with each other in various ways. Today the usual procedure is sterilization by partial resection of the oviducts performed laparoscopically in the interval via electrocoagulation and surgically after delivery via periumbilical minilaparotomy. Laparoscopic sterilization via electrocoagulation has a rate of failure of about 1:1,000 and the mortality rate is less than 1:10,000. The most frequent complications are: hemorrhages due to injury of the larger vessels and burns in the intestine caused by the electric current. For this reason, conventional (:unipolar") electrocoagulation should be replaced by the so-called bipolar coagulation or other newer methods which avoid these complications. On the basis of the current literature, no definitive statements can be made regarding the reliability of the newer methods (silastic ring, plastic clips, thermocoagulation). An additional, although up until now purely hypothetic, advantage of the newer methods is the possibility of reversibility. With conventional electrocoagulation, the rate of reversilbility is very low. Additional alternatives are also culdotomy and minilaparotomy in the interval with the assistance of a uterus elevator. Both ways of access may be combined with various methods of sterilization. The pros and cons of the hysterectomy as a method of sterilization are still being discussed. Occasional late sequelae of sterilization such as menstrual disorders, pain and, particularly, problems related to sexual intercourse have only recently come to light. They have not yet been adequately investigated.

Effects of a single ethanol injection into the vas deferens on the testicular function of rats

1. A new approach to rapid male sterilization has been studied by giving a single injection of 95% ethanol directly into the vas deferens. It produced an effective block in the lumen. The mating exposure test showed that the males were sterile. The sperm granulomas at the site of vas injection were confirmed. 2. Ethanol injection in the vas deferens caused an atrophy of the testes. Extensive necrosis and exfoliation of the seminiferous elements were conspicuous. 3. Decrease in testicular weight, seminiferous tubule diameter and RNA and sialic acid levels after 4 weeks of vas injection were associated with the histological evidence for severe degeneration of spermatogenic elements. The protein contents of testis, epididymides and seminal vesicles did not change. 4. Testicular cholesterol, total lipids and alkaline phosphatase activity was increased. 5. Low sialic acid levels in the testis, epididymides and seminal vesicles of vas-injected rats indicated an inhibition of androgen production, which was further reflected in reduced nuclear diameters of leydig cells.

The metabolism of 3-chloro,- 3-bromo- and 3-iodoprpan-1,2-diol in rats and mice

1. The metabolism of the 3-halopropan-1,2-diols (alpha-halohydrins) has been investigated in rats and mice. Apart from 3-chloropropan-1,2-diol (I), of which some 10% is excreted unchanged by both species, the compounds are completely degraded following intraperitoneal administration. 2. The alpha-halohydrins are detoxicated by conjugation with glutathione and produce two urinary metabolites, isolated and identified as S-(2,3-dihydroxypropyl)cysteine (VII) and the corresponding mercapturic acid N-acetyl-S-(2,3-dihydroxypropyl)cysteine (VIII). 3. When incubated with rat liver supernatant, the compounds do not conjugate with glutathione and their general chemical reactivity suggests that they react via a common intermediate proposed to be glycidol (2,3-epoxypropanol, IV). As the epoxide produces the same urinary metabolites as the alpha-halo-hydrins, and conjugates with glutathione either with or without liver supernatant to form the primary metabolite S-(2,3-dihydroxypropyl)glutathione (VI), glycidol is also proposed to be the reactive intermediate in vivo. 4. The role of epoxides in intermediary metabolism is discussed.

Chemosterilant action of trimethylphosphate in rodents

Trimethylphosphate, the simplest tri-alkyl ester of phosphoric acid, produces marked antifertility effects in experimental male rodents (Jackson and Jones, 1968). The predominant effect is the "functional" sterilizing action involving spermatids from which intact motile but incompetent sperm continue to be produced. Relatively high doses are required in the mouse (5 X 1 gm/kg orally), whereas it is effective in the rat at 1/10 of this level. Trimethylphosphate is remarkable in that it possesses no anticholinesterase activity, is freshly soluble and stable in water, is effective orally, and has a high level of tolerance. Whereas 500 mg/kg orally render male rats sterile for the ensuing 3 weeks, 5 times this amount, although tolerable, completely disorganizes spermatogenesis without damaging tubular architecture. Such treated rats remain infertile for 20-25 weeks, apparently retaining sexual activity, though a proportion appear to be more permanently sterilized. Rats treated weekly at 5 X 100 mg/kg orally for over 1 year have remained sterile but recover fertility 3-5 weeks from terminating treatment. "Side effects" so far observed are a sedative action and, towards 1 year of treatment, hind leg paresis, although 5 times this dose rate caused progressive loss in weight. Using phosphorus-32-trimethylphosphate the sole phosphorus-containing metabolite is dimethylphosphate (Jackson and Jones, 1968), which has no antifertility activity. With carbon-14-trimethylphosphate, S-methyl cysteine was identified as a urinary metabolite, indicating that trimethylphosphate is involved, at least in its detoxification process, as an alkylating agent. The antifertility action of trimethylphosphate is probably related to methyl alkylation. This would bring it into line with the methyl ester of methanesulphonic acid which also produces the "functional" type of sterility in rats and mice (Jackson, 1964). Like methyl methanesulphonate (Partington and Bateman, 1964), trimethylphosphate in substerilizing doses induces so-called dominant lethal mutations. Preliminary structure/activity studies have shown that tri-n-propyl- and tri-iso-propylphosphates do not affect the fertility of male mice (5 X 1 gm/kg orally). Both these esters together with tri-n-propyl- and tri-n-butyl-phosphates still have the capacity to alkylate, and like trimethylphosphate, the only metabolites in the rat were the di-alkylphosphates and corresponding S-alkyl cysteines. Whereas all these substances interact with cysteine in vitro, only trimethylphosphate reacts readily with glutathione. This might be pertinent to its biological activity.