Biomedical subjects
P M Alderman
Publications and source records attributed to P M Alderman.
Complications in a series of 1224 vasectomies.
BACKGROUND: The assessment of a vasectomy technique should be based on the incidence of complications resulting from the procedure. Differing diagnostic criteria for defining complications and the belated occurrence of some adverse events, however, have made such appraisals difficult. The purpose of this paper is to suggest criteria for defining vasectomy-related problems and to present the results of a long-term study of 1224 vasectomies. METHODS: The records of 1224 men who had a vasectomy performed by the same technique during a 4-year period were reviewed, and documented complications were tabulated and evaluated. Patients were referred residents of the lower mainland of British Columbia, and the majority were married. The group included a wide spectrum of ages, races, and occupations. Twelve categories of potential complications were defined, of which 10 were actually encountered in the study group. Infection was defined as having had antimicrobial drugs prescribed, and regret as having returned to discuss a reversal; all other complications were diagnosed based on a documented clinical diagnosis. RESULTS: Complications had been documented in 124 cases (10.6%) and included 46 minor infections (3.8%), 2 serious infections (0.16%), 23 instances of epididymitis (1.9%), 16 cases of sperm granuloma (1.3%), and 4 minor hemorrhages (0.33%). Of 3 failures, only one (0.08%) was due to recanalization. No serious hemorrhages or late failures were seen. CONCLUSIONS: Satisfactory results were believed to be related to surgical technique and the liberal use of antimicrobial drugs. The low recanalization rate was attributed to the treatment of the ends of the vas with multiple loops of polyglycolic acid ligature.
Sterilization: Canadian choices.
Significant differences in cost and safety between vasectomy and tubal ligation have been reported. For this reason the incidence of these two procedures between 1976 and 1986 was studied to obtain information upon which future policy decisions might be based. Although tubal ligation predominated in almost every province and year its rate declined by 27.6% over the study period, whereas the rate of vasectomy increased by 39.1%. When projected to 1988 the national rates for the two procedures became nearly equal; those for Quebec had become equal by 1986. Provincial differences were most marked in eastern Canada, where neighbouring provinces had the highest and the lowest rates of sterilization in the country. Given the relative economic and surgical disadvantages of tubal ligation, policymakers may wish to consider fostering an increased acceptance of vasectomy, particularly in areas where such acceptance continues to be slow.
General and anomalous sperm disappearance characteristics found in a large vasectomy series.
There is no accepted standard for the time after vasectomy before infertility is achieved. To help address this question, the records of 5,233 vasectomy patients who had had at least 12 ejaculations and had completed semen tests were reviewed. Seventy-five percent were able to fulfill a designated criterion for success by 4 months postoperatively, nearly 90% by 6 months, and nearly 99% by 1 year. Also found were a number of individual anomalies, including five instances of transient reappearance of sperm, four late spontaneous reversals after proof of success, and one late "delayed success" after evidence of failure. Patients can be reassured by the overall efficacy of male sterilization, but physicians also may wish to be aware of the possibility of capriciously intermittent-fitful-sperm.
The lurking sperm. A review of failures in 8879 vasectomies performed by one physician.
Vasectomy techniques and failure rates vary among surgeons, and the criteria for failure are not often clearly defined. To help establish a yardstick for comparative purposes, a series of 8879 consecutive vasectomies performed with uniform technique over 24 years was reviewed. A subgroup of 5331 men who had returned for at least two postoperative semen tests--the study group--was used for follow-up analysis. Failures were defined as early or late and also were categorized as overt or technical according to the numbers, motility, or persistence of the remaining spermatozoa. There were 97 failures of all types, including 32 (0.60%) early and overt failures and 61 (1.14%) technical failures that involved the persistence of small numbers of spermatozoa, possibly of no significance. Four (0.08%) late overt failures were also seen; each of these was discovered as a result of a pregnancy, and each occurred at least four years after two azoospermic test results. Of the 97 failures, four were recognized as due to missed vasa deferentia, and the remainder were attributed to recanalization. Whether improved and reproducible failure rates can be consistently obtained by other techniques is not yet clear.
Asthma and thunderstorms.
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Vasectomy for voluntary male sterilisation.
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