Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in f...Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.展开更多
We aimed to assess the occlusive effectiveness of open-ended vasectomy with mucosal cautery and fascial interposition and to determine the factors associated with occlusion failure.We studied all vasectomies performed...We aimed to assess the occlusive effectiveness of open-ended vasectomy with mucosal cautery and fascial interposition and to determine the factors associated with occlusion failure.We studied all vasectomies performed between September 1,2020,and August 31,2021,by four vasectomy surgeons from Quebec City,Quebec,Canada.Sociodemographic and clinical characteristics were extracted from the electronic medical records.Occlusive effectiveness was assessed in all men with at least one postvasectomy semen analysis(PVSA).The effectiveness criteria were adapted from those of the American Urological Association(AUA)vasectomy guideline.Among the 4000 eligible vasectomies,2242(56.1%)were followed by at least one PVSA,with 99(4.4%)requiring more than one PVSA.Occlusive effectiveness was achieved in 2233 vasectomies(99.6%;95%confidence interval[CI]:99.3%-99.8%),with 2199(98.1%)and 34(1.5%)classified as confirmed and probable success,respectively.The final status of the three vasectomies(0.1%)was indeterminate.Occlusive failure was observed in six vasectomies(0.3%;95%CI:0.1%-0.6%).The four surgeons had a similar risk of failure.The only significant factor associated with failure was the difficulty in performing the vas occlusion reported by the surgeon(7.4%[2/27]vs 0.2%[4/2212];relative risk=41.0;95%CI:7.8-214.2).The high occlusive effectiveness observed in our study validates AUA recommendations,supporting the use of this technique.Difficulty in occlusion of the vas deferens,as reported by surgeons,was the only factor associated with vasectomy failure.This finding highlights the need for PVSA in such cases.展开更多
Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or...Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.展开更多
Since 1985, the no-scalpel vasectomy technique has been widely used outside China. The prevalence of this tech-nique has helped to increase the acceptability of male sterilization in many parts of the world. More than...Since 1985, the no-scalpel vasectomy technique has been widely used outside China. The prevalence of this tech-nique has helped to increase the acceptability of male sterilization in many parts of the world. More than 5000 physi-cians in twenty-five developing countries have been trained in the no-scalpel vasectomy technique. In the United Statesin 1995, nearly one third of vasectomies employed the no-scalpel technique, and in the whole Northern American re-gion, a total of 1100 doctors have been made familiar with the technique. Doctors believe that there are several advan-tages of the no-scalpel technique, including no incision, no stitches, faster procedure, faster recovery, less chance ofbleeding, less discomfort and high efficacy. The key steps of the technique include fixation of the vas and infiltrationanaesthesia of the spermatic cord, as well as grasping, delivering and isolating the vas. No-scalpel technique providesa good approach to expose the vas, in conjunction with which, different vas-end occlusion methods may be used.(Asian J Androl 2000; 2: 21 - 24)展开更多
Eighty-four hamsters were vasectomized on both sides,Another group of 76 hamsters was used as the control group.The animal experiment demonstrated that the epididymal function was damaged on the basis of the micropunc...Eighty-four hamsters were vasectomized on both sides,Another group of 76 hamsters was used as the control group.The animal experiment demonstrated that the epididymal function was damaged on the basis of the micropuncture and microanalysis of the epididymal plasma.Histologic examination revealed the dilatation of the lumen,infiltration of chronic inflammatory cells in the interstitium and sperm granuloma.Thirty-nine patients with postvasectomy epididymal stasis were treated with microwave radiation and 10 cases with epididymectomy.The B and C ultrasonography and MRI were used for diagnosis.Histologic examination suggested that chronic obstruction of vasectomy mode(both-side electric coagulation or keeping proximal open)may lead to formation of the new dynamic equilibrium, therefore benefiting the spermatogenesis of testis.Others with acute obstruction of the vas(bilateral ligation) may cause epididymal stasis.展开更多
Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-nine normal male Japanese white ...Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-nine normal male Japanese white rabbits （aged 4- 6 months） were subjected to unilateral close-ended （conventional） or open-ended （the cut end of the juxta-epididymal vas deferens not ligated） vasectomy via the inguinal canal. Ten days and 3 months after operation, testes, epididymides and vasa deferentia were removed and methacrylate resin-embedded sections prepared. The histology of the testis, epididymis and vas deferens was examined under light microscope, and the volume and diameter of the seminiferous tubules were quantitatively studied using stereological methods. Results： Neither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral shamoperated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation. Conclusion： Vasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.展开更多
Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwen...Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.展开更多
By utilizing the rabbit model, previous studies have found good evidence indicating that vasectomy-induced spermatogenic damage is pressure-mediated： the damage occurs when the occluded reproductive tract is unable t...By utilizing the rabbit model, previous studies have found good evidence indicating that vasectomy-induced spermatogenic damage is pressure-mediated： the damage occurs when the occluded reproductive tract is unable to accommodate additional spermatozoa produced by the testis. More studies with the more commonly used rat model have shown, however, controversial results on whether and why the damage occurs. In this study, 12 mature male Sprague-Dawley rats were subjected to unilateral vasectomy： double ligation （without severing） of the vas deferens exposed via a small inguinal incision; 37 days after the operation, the testes, epididymides, vasa deferentia （juxta-epididymal segments）, and sperm granulomas （at the vasectomy site） were removed to obtain methacrylate resin-embedded sections and morphometric studies carried out with light microscopy. Marked spermatogenic damage with spermatids and spermatocytes depleted in the seminiferous epithelium in 43% of the seminiferous tubule profiles was demonstrated in 5 of the 12 testes on the vasectomized side, and the damage was associated with smaller or absent sperm granulomas; in the other 7 testes with essentially normal spermatogenesis, there was an increase （by 111% on average） in the volume of the tubule lumen, associated with larger granulomas or granulomas containing more spermatozoa. There was an overall increase （by 66%） in the thickness of the rete testis in the 12 testes; the epididymis or vas deferens showed no distension. It seems therefore that the spermatogenic damage induced by vasectomy in rats is pressure-mediated as well, and that variation in the damage depends mainly on the postoperative development of the sperm granuloma.展开更多
Spermatogenic damage may occur after vasectomy, and the damage is pressure mediated, occurring when the occluded reproductive tract is unable to accommodate additional sperm produced by the testis. This study aimed to...Spermatogenic damage may occur after vasectomy, and the damage is pressure mediated, occurring when the occluded reproductive tract is unable to accommodate additional sperm produced by the testis. This study aimed to determine the long-term effect of vasectomy on spermatogenesis in humans and clarify how the balance between sperm production in the testis and sperm storage in or removal from the tract might be maintained. During inguinal hernia repair, an open biopsy was performed to obtain testicular tissue blocks from 51 Chinese men （aged ≥ 50 years）, of whom 25 （control group） had not undergone vasectomy and 26 （vasectomized group） had undergone bilateral vasectomy 22-42 years before. Methacrylate resin-embedded testicular sections were made, and morphometric studies were performed using light microscopy. In addition, sizes of the testis and epididymis were estimated with ultrasonography. The testicular tissue blocks obtained from one control and seven vasectomized men consisted almost completely of connective tissue. In the other 43 men, significant differences were not found between the two groups in the testicular or epididymal size, qualitative histology or quantitative parameters including the mean diameter or volume fraction of the seminiferous tubules. In conclusion, sperm production and sperm storage/removal reached a static equilibrium after vasectomy, likely due to spermatogenic degeneration or less sperm production as a result of aging or due to vasectomy-induced testicular （interstitial） fibrosis. Thus, complications that might occur in association with overproduction of sperm and distension of the tract would disappear or be relieved with time.展开更多
HSP110 functions to protect cells, tissues, and organs from noxious conditions. Vasectomy induces apoptosis in the testis; however, little is known about the reason leading to this outcome. The aim of the present stud...HSP110 functions to protect cells, tissues, and organs from noxious conditions. Vasectomy induces apoptosis in the testis; however, little is known about the reason leading to this outcome. The aim of the present study was to evaluate the expression and function of HSP110 in mouse testis after vasectomy. Following bilateral vasectomy, we used fluorescent Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） to detect apoptosis, Western blotting and immunohistochemistry to examine HSP110 expression and localization. Serum antisperm antibody （AsAb） and testosterone were measured by Enzyme-linked immunosorbent assay （ELISA） and radioimmunoassay, respectively. Expression of endoplasmic reticulum stress （ERS） sensors and downstream signaling components was measured by Reverse Transcription-Polymerase Chain Reaction （RT-PCR）, and the phosphorylation of elF2a and JNK was detected by Western blotting. Vasectomy induced morphologic changes, increased apoptosis in the testis, increased serum AsAb, and decreased testosterone levels. After vasectomy, ORP150 mRNA level was increased first and then decreased, Bcl-2 was decreased, and the expression of HSPA41, GRP78, GADD153, PERK, ATF6, IRE-l, XBP-ls, Bax, Bak, and caspases and the phosphorylation of elF2a and JNK were increased. We present that an ER stress-mediated pathway is activated and involved in apoptosis in the testis after vasectomy. HSPA41 and ORP150 may play important roles in maintaining the normal structure and function of testis.展开更多
Curettage of the epithelium of the vas deferens might be a safe and effective method of male sterilization. We conducted a pilot study of vasectomy by epithelial curettage with a novel microcurette called the Vas-X in...Curettage of the epithelium of the vas deferens might be a safe and effective method of male sterilization. We conducted a pilot study of vasectomy by epithelial curettage with a novel microcurette called the Vas-X in 12 normal men requesting elective sterilization. Seminal fluid analysis was obtained monthly after the procedure for 6 months. Pain was assessed by questionnaire. Three months after the procedure, all men attained sperm concentrations of less than 0.2 million sperm per mL, and seven were azoospermic. Post-procedural pain was minimal. Nine men ultimately achieved and maintained azoospermia; however, 4 to 6 months after the procedure, sperm concentrations increased in three of the 12 subjects, necessitating repeat vasectomy. Microscopic examination of the vas deferens from these failures revealed re-canalization. Vasectomy by epithelial curettage can result in effective sterilization; however, 1/4 of the subjects were not effectively sterilized by the procedure due to re-canalization of the vas deferens. Epithelial curettage will require further refinement to determine if it is a viable form of vasectomy.展开更多
Aim: To investigate the morphological changes of spermatozoa in the proximal vas deferens after vasectomy.Methods: Proximal vas deferens fluids were collected from 79 fertile men (group A) and 64 vasectomized men (gro...Aim: To investigate the morphological changes of spermatozoa in the proximal vas deferens after vasectomy.Methods: Proximal vas deferens fluids were collected from 79 fertile men (group A) and 64 vasectomized men (groupB) during the operations of vasectomy or vasovasostomy. Sperm morphology in the proximal vas deferens wasanalyzed after staining with the modified Papanicolaou method. Results: The percentage of spermatozoa with anormal oval head from group B (50.7 % ± 21.7 % ) was significantly lower than that of group A (75.2 % ±11.1%). The data in group A was similar to those of normal semen and therefore represents the physiologicalcondition of the proximal vas deferens sperm of fertile men. There were no significant differences in the percentages ofnormal oval heads in group B with the time since vasectomy. Conclusion: After vasectomy, the spermatozoa in theproximal vas deferens and epididymis were continuously degenerating and being replenished by spermatozoa comingfrom testis. The obvious morphological degeneration occurred in the sperm tail and spermatozoa with a small oval headand amorphous heads were increased.展开更多
Aim: To study the effect of vaseetomy on histological appearance of the testis. Methods: Parkes strain mice wereused as the animal model; they were bilaterally vasectomized (Vx) or sham-operated (So) and killed at int...Aim: To study the effect of vaseetomy on histological appearance of the testis. Methods: Parkes strain mice wereused as the animal model; they were bilaterally vasectomized (Vx) or sham-operated (So) and killed at intervals of 4,6, 9, and 12 months after the operation. Testes were excised from 5 Vx and 5 So mice at each interval and processed for histological examination. Results: Testes of So mice showed normal histological features. By contrast, marked al-terations were observed in the seminiferou tubules in testes of Vx mice, except in those killed 4 months after the opera-tion. The seminiferous epithelium in the tubules was only 2-3 layers thick and showed much depletion of germ cells;in severe cases, the epithelium consisted of only a thin layer of Sertoli cells, spermatogonia and a few spermatocytes.Exfoliation of germ cells, occurrence of multinucleated giant cells and vacuolated appearance of the epithelium were ofcommon features in the tubules. Furthermore, lumen of the rete testis in Vx mice was greatly dilated and showed accu-mulation of sermatozoa with immature germ cells; in mice vasectomized for 6-12 months, several macrophages in-gesting spermatozoa were ofte observed in the lumen of the rete testis. Spermatic granuloma was also somettimes no-ticed in corpus or in cauda regions of the epididymis in mice vasectomized for 6-12 months. Conclusion: We sug-gest that consequences of vasectomy should be thoroughly understood in order to make this method rather more popularas a reversible method of male contraception.展开更多
Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. T...Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.展开更多
Aim: To evaluate the early and late long-term effects of vasectomy on the serum and prostatic fluid trace elements.Methods: In 37 vasectomized and 25 non-vasectomized (control) men, the Zn, Cd and Cu levels in the ser...Aim: To evaluate the early and late long-term effects of vasectomy on the serum and prostatic fluid trace elements.Methods: In 37 vasectomized and 25 non-vasectomized (control) men, the Zn, Cd and Cu levels in the serum andprostatic fluid were measured by means of inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Re-suits: No significant difference was found in the prostatic Zn, Cd and Cu levels between the vasectomized and controlgroup. The Zn level in the semm were significantly lower in the vasectomized men than in the controls (11.04 and 13.54 umol/L, respectively; P < 0.05), while the serum Cd and Cu levels were not significantly different between thetwo groups. Conclusion: Vasectomy may decrease the serum, but not the prostatic Zn levels. Its pathophysiologicalsignificance is worthy of further investigation.展开更多
Urologists perform the majority of vasectomies in the United States;however,family medicine physicians(FMPs)perform up to 35%.We hypothesized that d iff ere nces exist in practice patterns and outcomes between urologi...Urologists perform the majority of vasectomies in the United States;however,family medicine physicians(FMPs)perform up to 35%.We hypothesized that d iff ere nces exist in practice patterns and outcomes between urologists and FMPs.Patie nts who underwent a vasectomy from 2010 to 2016 were identified.Postvasectomy semen analysis(PVSA)practices were compared between urologists and FMPs,before and after release of the 2012 AUA vasectomy guidelines.From 2010 to 2016,FMPs performed 1435(35.1%)of all vasectomies.PVSA follow-up rates were similar between the two groups(63.4%vs 64.8%,P=0.18).Of the patients with follow-up,the median number of PVSAs obtained was 1(range 1-6)in both groups(P=0.22).Following the release of guidelines,fewer urologists obtained multiple PVSAs(69.8%vs 28.9%pre-and post-2012,P<0.01).FMPs had a significant but lesser change in the use of multiple PVSAs(47.5%vs 38.4%,P<0.01).Both groups made appropriate changes in the timing of the first PVSA,but FMPs continued to obtain PVSAs before 8 weeks(15.0%vs 6.5%,P<0.01).FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks,the earliest recommended by the AUA guidelines(4.1%vs 1.3%,P<0.01).Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012.In summary,FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation,suggesting less penetration of AUA guidelines to nonurology specialties.Furthermore,FMPs had more positive results on PVSAs obtained within the recommended window.展开更多
To date,there is little information about the demography of vasectomy reversal(VR)patients or the factors currently influencing VR effectiveness in China,especially after the universal two-child policy was released in...To date,there is little information about the demography of vasectomy reversal(VR)patients or the factors currently influencing VR effectiveness in China,especially after the universal two-child policy was released in 2015.In this research,demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China.Meanwhile,a telephone survey of the patients was conducted to collect follow-up information.Eventually,448 VR cases from the past 13 years were included.The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate.Appropriately statistical methods were used,and all of the protocols were approved by the Ethics Committees of the institutes in this research.The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented.Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate.A follow-up survey showed that the general postoperative pregnancy rate was 27.2%.For female partners over the age of 35 years,the postoperative pregnancy rate showed a more severe decline,but only 35.5%of them had been given a fertility examination before their husbands’VR surgery.Our work revealed that more patients in China have been demanding VR in recent years.High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR.Clinical andrologists should perform a preoperative fertility evaluation of the patients’female partners.展开更多
The effects of vasectomy on the reproductive organs in various species are controversial. This study investigated the morphological change and apoptosis of the testis, epididymis, and vas deferens in beagle dogs 12 mo...The effects of vasectomy on the reproductive organs in various species are controversial. This study investigated the morphological change and apoptosis of the testis, epididymis, and vas deferens in beagle dogs 12 months after vasectomy. The male beagles were divided into two groups: vasectomized and sham-operated groups (n=5 in each). Histopathological, ultrastructural, and TUNEL evaluation of the changes in the testis, epididymis, and ductus deferens of each animal were conducted 12 months after surgery. The mean lumen diameter, cellular thickness, mean interstitial distance, and lumen area fraction of each seminiferous tubule and ductus epididymis were measured by stereological analysis. The results showed that, compared with the sham-operated group, the seminiferous tubular epithelial cells of the testes in the vasectomized group were disorderly arranged and scattered. Significant atrophy and apoptosis were found in the endothelial cells, and a range of ultrastructural variations were observed in the cells of testes, epididymis, and vas deferens in vasectomized group. It was concluded that complete obstruction of the vas deferens as a traditional contraception method is not absolutely safe in terms of the reversal of fertility in the long run. Techniques of relieving the inner pressure in the vas deferens while maintaining the efficacy of male contraception need to be explored.展开更多
Objective:Evaluate the influence of fellowship training,resident participation,reconstruction type,and patient factors on outcomes after vasectomy reversals in a high volume,open access system.Methods:Retrospective re...Objective:Evaluate the influence of fellowship training,resident participation,reconstruction type,and patient factors on outcomes after vasectomy reversals in a high volume,open access system.Methods:Retrospective review of all vasectomy reversals performed at a single institution from January 1,2002 to December 31,2016 was conducted.Patient and spouse demographics,patient tobacco use and comorbidities,surgeon training and case volume,resident participation,reconstruction type,and postoperative patency were collected and analyzed.Results:Five hundred and twenty-six vasectomy reversals were performed during the study period.Follow-up was available in 80.6%of the cohort and overall patency,regardless of reconstruction type was 88.7%.The mean time to reversal was 7.87 years(range of 0-34 years).The majority of cases included resident participation.Case volume was high with faculty and residents logging a mean of 37.0 and 38.7(median 18 and 37)cases respectively.Bilateral vasovasostomy was the most common reconstruction type(83%)and demonstrated a significantly better patency rate(89%)than all other reconstructions(p=0.0008).Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training,resident participation or postgraduate year.Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency(p=0.0023 and p=0.043,respectively).Conclusions:Surgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility.Patency was better for bilateral vasovasostomies.Patency was not negatively impacted by tobacco use,comorbidities,resident participation,or post-graduate year.展开更多
Objective To calculate couple-year of protection （CYP） by conversion coefficient （F） of tubectomy and vasectomy in urban and rural regions of Iran. Methods A total of 103 450 married women aged 10-49 years in 2005...Objective To calculate couple-year of protection （CYP） by conversion coefficient （F） of tubectomy and vasectomy in urban and rural regions of Iran. Methods A total of 103 450 married women aged 10-49 years in 2005 across urban and rural regions of lran were sampled by multi stage cluster sampling. The data were collected by household survey and direct interview and analyzed by STATA8.0 software and survey analysis commands. Results Mean age of the women at the time of tubectomy estimated 31.9 years and conversion coefficient of tubectomy was 17.1 ±0.1. Mean age of women at the time of her husband vasectomy estimated 31.48 years and its conversion coefficient was 17. 5 ± 0. 1. Cluster analysis defined different regions of Iran on the basis of evaluated conversion coefficients of tubectomy and vasectomy which both of them presented seven clusters. Literacy of women and total coverage of family planning in a region had a direct relationship with this conversion coefficient （P〈0.05）. Conclusion The variations observed in the conversion coefficients and their dissimilarity among different regions of Iran may be due to a variety of fundamental factors of which literacy and culture are of important factors.展开更多
文摘Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.
基金supported by a grant from the Research Ceater of the Quebec City University Hospital Center,Laval University(No.85466).
文摘We aimed to assess the occlusive effectiveness of open-ended vasectomy with mucosal cautery and fascial interposition and to determine the factors associated with occlusion failure.We studied all vasectomies performed between September 1,2020,and August 31,2021,by four vasectomy surgeons from Quebec City,Quebec,Canada.Sociodemographic and clinical characteristics were extracted from the electronic medical records.Occlusive effectiveness was assessed in all men with at least one postvasectomy semen analysis(PVSA).The effectiveness criteria were adapted from those of the American Urological Association(AUA)vasectomy guideline.Among the 4000 eligible vasectomies,2242(56.1%)were followed by at least one PVSA,with 99(4.4%)requiring more than one PVSA.Occlusive effectiveness was achieved in 2233 vasectomies(99.6%;95%confidence interval[CI]:99.3%-99.8%),with 2199(98.1%)and 34(1.5%)classified as confirmed and probable success,respectively.The final status of the three vasectomies(0.1%)was indeterminate.Occlusive failure was observed in six vasectomies(0.3%;95%CI:0.1%-0.6%).The four surgeons had a similar risk of failure.The only significant factor associated with failure was the difficulty in performing the vas occlusion reported by the surgeon(7.4%[2/27]vs 0.2%[4/2212];relative risk=41.0;95%CI:7.8-214.2).The high occlusive effectiveness observed in our study validates AUA recommendations,supporting the use of this technique.Difficulty in occlusion of the vas deferens,as reported by surgeons,was the only factor associated with vasectomy failure.This finding highlights the need for PVSA in such cases.
文摘Post-vasectomy pain syndrome remains one of the more challenging urological problems to manage. This can be a frustrating process for both the patient and clinician as there is no well-recognized diagnostic regimen or reliable effective treatment. Many of these patients will end up seeing physicians across many disciplines, further frustrating them. The etiology of post-vasectomy pain syndrome is not clearly delineated. Postulations include damage to the scrotal and spermatic cord nerve structures via inflammatory effects of the immune system, back pressure effects in the obstructed vas and epididymis, vascular stasis, nerve impingement, or perineural fibrosis. Post-vasectomy pain syndrome is defined as at least 3 months of chronic or intermittent scrotal content pain. This article reviews the current understanding of post-vasectomy pain syndrome, theories behind its pathophysiology, evaluation pathways, and treatment options.
文摘Since 1985, the no-scalpel vasectomy technique has been widely used outside China. The prevalence of this tech-nique has helped to increase the acceptability of male sterilization in many parts of the world. More than 5000 physi-cians in twenty-five developing countries have been trained in the no-scalpel vasectomy technique. In the United Statesin 1995, nearly one third of vasectomies employed the no-scalpel technique, and in the whole Northern American re-gion, a total of 1100 doctors have been made familiar with the technique. Doctors believe that there are several advan-tages of the no-scalpel technique, including no incision, no stitches, faster procedure, faster recovery, less chance ofbleeding, less discomfort and high efficacy. The key steps of the technique include fixation of the vas and infiltrationanaesthesia of the spermatic cord, as well as grasping, delivering and isolating the vas. No-scalpel technique providesa good approach to expose the vas, in conjunction with which, different vas-end occlusion methods may be used.(Asian J Androl 2000; 2: 21 - 24)
文摘Eighty-four hamsters were vasectomized on both sides,Another group of 76 hamsters was used as the control group.The animal experiment demonstrated that the epididymal function was damaged on the basis of the micropuncture and microanalysis of the epididymal plasma.Histologic examination revealed the dilatation of the lumen,infiltration of chronic inflammatory cells in the interstitium and sperm granuloma.Thirty-nine patients with postvasectomy epididymal stasis were treated with microwave radiation and 10 cases with epididymectomy.The B and C ultrasonography and MRI were used for diagnosis.Histologic examination suggested that chronic obstruction of vasectomy mode(both-side electric coagulation or keeping proximal open)may lead to formation of the new dynamic equilibrium, therefore benefiting the spermatogenesis of testis.Others with acute obstruction of the vas(bilateral ligation) may cause epididymal stasis.
文摘Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-nine normal male Japanese white rabbits （aged 4- 6 months） were subjected to unilateral close-ended （conventional） or open-ended （the cut end of the juxta-epididymal vas deferens not ligated） vasectomy via the inguinal canal. Ten days and 3 months after operation, testes, epididymides and vasa deferentia were removed and methacrylate resin-embedded sections prepared. The histology of the testis, epididymis and vas deferens was examined under light microscope, and the volume and diameter of the seminiferous tubules were quantitatively studied using stereological methods. Results： Neither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral shamoperated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation. Conclusion： Vasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.
文摘Vasectomy reversal （VR） has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR （RAVR） or microsurgical VR （MVR） by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates （89% vs 92%）, 6 weeks post-VR mean sperm concentrations （28 million m1-1 vs 26 million m1-1） or total motile counts （29 million vs 30 million）, or mean operative times （141 min vs 150 min）. There was a statistically significant difference in anastomosis time （64 min vs 74 min）, however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes.
文摘By utilizing the rabbit model, previous studies have found good evidence indicating that vasectomy-induced spermatogenic damage is pressure-mediated： the damage occurs when the occluded reproductive tract is unable to accommodate additional spermatozoa produced by the testis. More studies with the more commonly used rat model have shown, however, controversial results on whether and why the damage occurs. In this study, 12 mature male Sprague-Dawley rats were subjected to unilateral vasectomy： double ligation （without severing） of the vas deferens exposed via a small inguinal incision; 37 days after the operation, the testes, epididymides, vasa deferentia （juxta-epididymal segments）, and sperm granulomas （at the vasectomy site） were removed to obtain methacrylate resin-embedded sections and morphometric studies carried out with light microscopy. Marked spermatogenic damage with spermatids and spermatocytes depleted in the seminiferous epithelium in 43% of the seminiferous tubule profiles was demonstrated in 5 of the 12 testes on the vasectomized side, and the damage was associated with smaller or absent sperm granulomas; in the other 7 testes with essentially normal spermatogenesis, there was an increase （by 111% on average） in the volume of the tubule lumen, associated with larger granulomas or granulomas containing more spermatozoa. There was an overall increase （by 66%） in the thickness of the rete testis in the 12 testes; the epididymis or vas deferens showed no distension. It seems therefore that the spermatogenic damage induced by vasectomy in rats is pressure-mediated as well, and that variation in the damage depends mainly on the postoperative development of the sperm granuloma.
文摘Spermatogenic damage may occur after vasectomy, and the damage is pressure mediated, occurring when the occluded reproductive tract is unable to accommodate additional sperm produced by the testis. This study aimed to determine the long-term effect of vasectomy on spermatogenesis in humans and clarify how the balance between sperm production in the testis and sperm storage in or removal from the tract might be maintained. During inguinal hernia repair, an open biopsy was performed to obtain testicular tissue blocks from 51 Chinese men （aged ≥ 50 years）, of whom 25 （control group） had not undergone vasectomy and 26 （vasectomized group） had undergone bilateral vasectomy 22-42 years before. Methacrylate resin-embedded testicular sections were made, and morphometric studies were performed using light microscopy. In addition, sizes of the testis and epididymis were estimated with ultrasonography. The testicular tissue blocks obtained from one control and seven vasectomized men consisted almost completely of connective tissue. In the other 43 men, significant differences were not found between the two groups in the testicular or epididymal size, qualitative histology or quantitative parameters including the mean diameter or volume fraction of the seminiferous tubules. In conclusion, sperm production and sperm storage/removal reached a static equilibrium after vasectomy, likely due to spermatogenic degeneration or less sperm production as a result of aging or due to vasectomy-induced testicular （interstitial） fibrosis. Thus, complications that might occur in association with overproduction of sperm and distension of the tract would disappear or be relieved with time.
文摘HSP110 functions to protect cells, tissues, and organs from noxious conditions. Vasectomy induces apoptosis in the testis; however, little is known about the reason leading to this outcome. The aim of the present study was to evaluate the expression and function of HSP110 in mouse testis after vasectomy. Following bilateral vasectomy, we used fluorescent Terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） to detect apoptosis, Western blotting and immunohistochemistry to examine HSP110 expression and localization. Serum antisperm antibody （AsAb） and testosterone were measured by Enzyme-linked immunosorbent assay （ELISA） and radioimmunoassay, respectively. Expression of endoplasmic reticulum stress （ERS） sensors and downstream signaling components was measured by Reverse Transcription-Polymerase Chain Reaction （RT-PCR）, and the phosphorylation of elF2a and JNK was detected by Western blotting. Vasectomy induced morphologic changes, increased apoptosis in the testis, increased serum AsAb, and decreased testosterone levels. After vasectomy, ORP150 mRNA level was increased first and then decreased, Bcl-2 was decreased, and the expression of HSPA41, GRP78, GADD153, PERK, ATF6, IRE-l, XBP-ls, Bax, Bak, and caspases and the phosphorylation of elF2a and JNK were increased. We present that an ER stress-mediated pathway is activated and involved in apoptosis in the testis after vasectomy. HSPA41 and ORP150 may play important roles in maintaining the normal structure and function of testis.
文摘Curettage of the epithelium of the vas deferens might be a safe and effective method of male sterilization. We conducted a pilot study of vasectomy by epithelial curettage with a novel microcurette called the Vas-X in 12 normal men requesting elective sterilization. Seminal fluid analysis was obtained monthly after the procedure for 6 months. Pain was assessed by questionnaire. Three months after the procedure, all men attained sperm concentrations of less than 0.2 million sperm per mL, and seven were azoospermic. Post-procedural pain was minimal. Nine men ultimately achieved and maintained azoospermia; however, 4 to 6 months after the procedure, sperm concentrations increased in three of the 12 subjects, necessitating repeat vasectomy. Microscopic examination of the vas deferens from these failures revealed re-canalization. Vasectomy by epithelial curettage can result in effective sterilization; however, 1/4 of the subjects were not effectively sterilized by the procedure due to re-canalization of the vas deferens. Epithelial curettage will require further refinement to determine if it is a viable form of vasectomy.
基金The project was supported by the State Family Planning Committee.
文摘Aim: To investigate the morphological changes of spermatozoa in the proximal vas deferens after vasectomy.Methods: Proximal vas deferens fluids were collected from 79 fertile men (group A) and 64 vasectomized men (groupB) during the operations of vasectomy or vasovasostomy. Sperm morphology in the proximal vas deferens wasanalyzed after staining with the modified Papanicolaou method. Results: The percentage of spermatozoa with anormal oval head from group B (50.7 % ± 21.7 % ) was significantly lower than that of group A (75.2 % ±11.1%). The data in group A was similar to those of normal semen and therefore represents the physiologicalcondition of the proximal vas deferens sperm of fertile men. There were no significant differences in the percentages ofnormal oval heads in group B with the time since vasectomy. Conclusion: After vasectomy, the spermatozoa in theproximal vas deferens and epididymis were continuously degenerating and being replenished by spermatozoa comingfrom testis. The obvious morphological degeneration occurred in the sperm tail and spermatozoa with a small oval headand amorphous heads were increased.
文摘Aim: To study the effect of vaseetomy on histological appearance of the testis. Methods: Parkes strain mice wereused as the animal model; they were bilaterally vasectomized (Vx) or sham-operated (So) and killed at intervals of 4,6, 9, and 12 months after the operation. Testes were excised from 5 Vx and 5 So mice at each interval and processed for histological examination. Results: Testes of So mice showed normal histological features. By contrast, marked al-terations were observed in the seminiferou tubules in testes of Vx mice, except in those killed 4 months after the opera-tion. The seminiferous epithelium in the tubules was only 2-3 layers thick and showed much depletion of germ cells;in severe cases, the epithelium consisted of only a thin layer of Sertoli cells, spermatogonia and a few spermatocytes.Exfoliation of germ cells, occurrence of multinucleated giant cells and vacuolated appearance of the epithelium were ofcommon features in the tubules. Furthermore, lumen of the rete testis in Vx mice was greatly dilated and showed accu-mulation of sermatozoa with immature germ cells; in mice vasectomized for 6-12 months, several macrophages in-gesting spermatozoa were ofte observed in the lumen of the rete testis. Spermatic granuloma was also somettimes no-ticed in corpus or in cauda regions of the epididymis in mice vasectomized for 6-12 months. Conclusion: We sug-gest that consequences of vasectomy should be thoroughly understood in order to make this method rather more popularas a reversible method of male contraception.
文摘Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.
文摘Aim: To evaluate the early and late long-term effects of vasectomy on the serum and prostatic fluid trace elements.Methods: In 37 vasectomized and 25 non-vasectomized (control) men, the Zn, Cd and Cu levels in the serum andprostatic fluid were measured by means of inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Re-suits: No significant difference was found in the prostatic Zn, Cd and Cu levels between the vasectomized and controlgroup. The Zn level in the semm were significantly lower in the vasectomized men than in the controls (11.04 and 13.54 umol/L, respectively; P < 0.05), while the serum Cd and Cu levels were not significantly different between thetwo groups. Conclusion: Vasectomy may decrease the serum, but not the prostatic Zn levels. Its pathophysiologicalsignificance is worthy of further investigation.
文摘Urologists perform the majority of vasectomies in the United States;however,family medicine physicians(FMPs)perform up to 35%.We hypothesized that d iff ere nces exist in practice patterns and outcomes between urologists and FMPs.Patie nts who underwent a vasectomy from 2010 to 2016 were identified.Postvasectomy semen analysis(PVSA)practices were compared between urologists and FMPs,before and after release of the 2012 AUA vasectomy guidelines.From 2010 to 2016,FMPs performed 1435(35.1%)of all vasectomies.PVSA follow-up rates were similar between the two groups(63.4%vs 64.8%,P=0.18).Of the patients with follow-up,the median number of PVSAs obtained was 1(range 1-6)in both groups(P=0.22).Following the release of guidelines,fewer urologists obtained multiple PVSAs(69.8%vs 28.9%pre-and post-2012,P<0.01).FMPs had a significant but lesser change in the use of multiple PVSAs(47.5%vs 38.4%,P<0.01).Both groups made appropriate changes in the timing of the first PVSA,but FMPs continued to obtain PVSAs before 8 weeks(15.0%vs 6.5%,P<0.01).FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks,the earliest recommended by the AUA guidelines(4.1%vs 1.3%,P<0.01).Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012.In summary,FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation,suggesting less penetration of AUA guidelines to nonurology specialties.Furthermore,FMPs had more positive results on PVSAs obtained within the recommended window.
基金This work was supported by the Youth Foundation of First Hospital of Shanxi Medical University(grant No.YQ1304).
文摘To date,there is little information about the demography of vasectomy reversal(VR)patients or the factors currently influencing VR effectiveness in China,especially after the universal two-child policy was released in 2015.In this research,demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China.Meanwhile,a telephone survey of the patients was conducted to collect follow-up information.Eventually,448 VR cases from the past 13 years were included.The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate.Appropriately statistical methods were used,and all of the protocols were approved by the Ethics Committees of the institutes in this research.The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented.Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate.A follow-up survey showed that the general postoperative pregnancy rate was 27.2%.For female partners over the age of 35 years,the postoperative pregnancy rate showed a more severe decline,but only 35.5%of them had been given a fertility examination before their husbands’VR surgery.Our work revealed that more patients in China have been demanding VR in recent years.High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR.Clinical andrologists should perform a preoperative fertility evaluation of the patients’female partners.
基金supported by a grant from the 11th Five-year National Technology Research and Development Program of China(No. 2006BAI03B03)
文摘The effects of vasectomy on the reproductive organs in various species are controversial. This study investigated the morphological change and apoptosis of the testis, epididymis, and vas deferens in beagle dogs 12 months after vasectomy. The male beagles were divided into two groups: vasectomized and sham-operated groups (n=5 in each). Histopathological, ultrastructural, and TUNEL evaluation of the changes in the testis, epididymis, and ductus deferens of each animal were conducted 12 months after surgery. The mean lumen diameter, cellular thickness, mean interstitial distance, and lumen area fraction of each seminiferous tubule and ductus epididymis were measured by stereological analysis. The results showed that, compared with the sham-operated group, the seminiferous tubular epithelial cells of the testes in the vasectomized group were disorderly arranged and scattered. Significant atrophy and apoptosis were found in the endothelial cells, and a range of ultrastructural variations were observed in the cells of testes, epididymis, and vas deferens in vasectomized group. It was concluded that complete obstruction of the vas deferens as a traditional contraception method is not absolutely safe in terms of the reversal of fertility in the long run. Techniques of relieving the inner pressure in the vas deferens while maintaining the efficacy of male contraception need to be explored.
文摘Objective:Evaluate the influence of fellowship training,resident participation,reconstruction type,and patient factors on outcomes after vasectomy reversals in a high volume,open access system.Methods:Retrospective review of all vasectomy reversals performed at a single institution from January 1,2002 to December 31,2016 was conducted.Patient and spouse demographics,patient tobacco use and comorbidities,surgeon training and case volume,resident participation,reconstruction type,and postoperative patency were collected and analyzed.Results:Five hundred and twenty-six vasectomy reversals were performed during the study period.Follow-up was available in 80.6%of the cohort and overall patency,regardless of reconstruction type was 88.7%.The mean time to reversal was 7.87 years(range of 0-34 years).The majority of cases included resident participation.Case volume was high with faculty and residents logging a mean of 37.0 and 38.7(median 18 and 37)cases respectively.Bilateral vasovasostomy was the most common reconstruction type(83%)and demonstrated a significantly better patency rate(89%)than all other reconstructions(p=0.0008).Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training,resident participation or postgraduate year.Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency(p=0.0023 and p=0.043,respectively).Conclusions:Surgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility.Patency was better for bilateral vasovasostomies.Patency was not negatively impacted by tobacco use,comorbidities,resident participation,or post-graduate year.
文摘Objective To calculate couple-year of protection （CYP） by conversion coefficient （F） of tubectomy and vasectomy in urban and rural regions of Iran. Methods A total of 103 450 married women aged 10-49 years in 2005 across urban and rural regions of lran were sampled by multi stage cluster sampling. The data were collected by household survey and direct interview and analyzed by STATA8.0 software and survey analysis commands. Results Mean age of the women at the time of tubectomy estimated 31.9 years and conversion coefficient of tubectomy was 17.1 ±0.1. Mean age of women at the time of her husband vasectomy estimated 31.48 years and its conversion coefficient was 17. 5 ± 0. 1. Cluster analysis defined different regions of Iran on the basis of evaluated conversion coefficients of tubectomy and vasectomy which both of them presented seven clusters. Literacy of women and total coverage of family planning in a region had a direct relationship with this conversion coefficient （P〈0.05）. Conclusion The variations observed in the conversion coefficients and their dissimilarity among different regions of Iran may be due to a variety of fundamental factors of which literacy and culture are of important factors.
