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At least 19 recordsLinked to original sources

PubMed2002

Vasectomy and the risk of prostate cancer: a meta-analysis examining vasectomy status, age at vasectomy, and time since vasectomy.

The aim of this study was to conduct a quantitative review of prostate cancer studies to pool relative risk (RR) estimates on the association between prostate cancer and vasectomy, in an attempt to determine whether there is an association, and if so, its magnitude. Random-effects models were examined along with a linear model for time since vasectomy. The pooled RR estimate was 1.37 (95% CI=1.15-1.62) based on five cohort studies and 17 case-control studies. The RR estimate varied by study design with the lowest risk for population-based case-control studies. No difference was seen in risk by age at vasectomy. A linear trend based on the 16 studies reporting time since vasectomy suggested an 10% increase for each additional 10 y or a RR of 1.32 (95% CI=1.17-1.50) for 30 y since vasectomy. When null effects were assumed for the six studies not reporting information, the linear RR for the 22 studies was 1.07 (1.03-1.11) and 1.23 (1.11-1.37) for 10 and 30 y since vasectomy, respectively. These results suggest that men with a prior vasectomy may be at an increased risk of prostate cancer, however, the increase may not be causal since potential bias cannot be discounted. The overall association was small and therefore could be explained by bias. The latency effect shown here for time since vasectomy should be examined further.

Age Factors↗

PubMed2002

[Vasectomy. A prospective, randomized trial of vasectomy with bilateral incision versus the Li vasectomy].

INTRODUCTION: Studies have shown that the Li vasectomy can match the effectiveness of and reduce the duration of operation and rate of complications compared to standard vasectomy with bilateral incision. MATERIALS AND METHODS: A prospective, randomised trial was conducted to compare the Li vasectomy with the standard vasectomy with bilateral incision. Data regarding effectiveness, time of operation, the patient's pain and discomfort, and peroperative and postoperative complications were recorded. Overall, 99 patients were entered in the trial, 51 with vasectomy with bilateral incision, 48 with the Li vasectomy. RESULTS: No significant difference was found between the two methods with regard to effectiveness, time of operation, the patient's pain and discomfort, and peroperative and postoperative complications. Overall, vasectomy was inadequate in 5%, haematoma was found in 13%, infection in 9%, and scrotal pain or painful ejaculation in 9%. DISCUSSION: The Li vasectomy can be learned and practiced under routine conditions by residents in training with the same effectiveness and the same rate of complications as standard vasectomy with bilateral incision. The total morbidity was at the same level as in previous Danish studies, but higher than in the international studies with the Li vasectomy.

Adult↗

PubMed2000

Vasectomy reversal for the post-vasectomy pain syndrome: a clinical and histological evaluation.

PURPOSE: The cause of the post-vasectomy pain syndrome is unclear. Some postulated etiologies include epididymal congestion, tender sperm granuloma and/or nerve entrapment at the vasectomy site. To our knowledge nerve proliferation has not been evaluated previously as a cause of pain. Vasectomy reversal is reportedly successful for relieving pain in some patients. We report our experience and correlate histological findings in resected vasal segments with outcome to explain the mechanism of pain in these patients. MATERIALS AND METHODS: We retrospectively reviewed the records of 13 men who underwent vasectomy reversal for the post-vasectomy pain syndrome. We compared blinded histological evaluations of the vasal ends excised at vasectomy reversal in these patients with those of pain-free controls who underwent vasectomy reversal to reestablish fertility. Controls were matched to patients for the interval since vasectomy. Histological features were graded according to the degree of severity of vasitis nodosum, chronic inflammation and nerve proliferation. RESULTS: Mean time to pain onset after vasectomy was 2 years. Presenting symptoms included testicular pain in 9 cases, epididymal pain in 2, pain at ejaculation in 4 and pain during intercourse in 8. Physical examination demonstrated tender epididymides in 6 men, full epididymides in 6, a tender vasectomy site in 4 and a palpable nodule in 4. No patient had testicular tenderness on palpation. Unilateral and bilateral vasovasostomy was performed in 3 and 10 of the 13 patients, respectively. Postoperatively 9 of the 13 men (69%) became completely pain-free. Mean followup was 1.5 years. We observed no differences in vasectomy site histological features in patients with the post-vasectomy pain syndrome and matched controls, and no difference in histological findings in patients with the post-vasectomy pain syndrome who did and did not become pain-free postoperatively. CONCLUSIONS: No histological features aid in identifying a cause of pain or provide prognostic value for subsequent pain relief. Vasectomy reversal appeared to be beneficial for relieving pain in the majority of select patients with the post-vasectomy pain syndrome.

Adult↗

PubMed1997

Vasectomy reversal for treatment of the post-vasectomy pain syndrome.

PURPOSE: The post-vasectomy pain syndrome is a rare but troublesome complication of vasectomy. We report our experience with 32 patients who underwent vasectomy reversal for relief of the post-vasectomy pain syndrome. MATERIALS AND METHODS: The records of 32 patients undergoing vasovasostomy or epididymovasostomy for the post-vasectomy pain syndrome were evaluated for characteristics of symptoms, previous therapy, interval from vasectomy, success of surgery and duration of relief. RESULTS: Of 32 men who underwent vasectomy reversal for the post-vasectomy pain syndrome between 1980 and 1994, 24 had relief of symptoms after the initial procedure. Of 8 men with recurrent pain 6 underwent a second reversal procedure, and 3 of them subsequently had relief of symptoms. Overall, 27 of 32 men had resolution of pain. CONCLUSIONS: In our experience vasectomy reversal has a high rate of success for relief of the post-vasectomy pain syndrome. It does not preclude other forms of surgical therapy and it should be considered in the treatment of the post-vasectomy pain syndrome.

Adult↗

PubMed2002

Vasectomy reversal performed 15 years or more after vasectomy: correlation of pregnancy outcome with partner age and with pregnancy results of in vitro fertilization with intracytoplasmic sperm injection.

OBJECTIVE: To document a contemporary series of vasectomy reversals performed in men 15 years or more after vasectomy and to correlate the results with spousal age and results of ICSI for obstructive azoospermia. SETTING: University referral center for male infertility. DESIGN: Retrospective analysis of a single surgeon's experience compared with reported ICSI results. PARTICIPANT(S): One hundred seventy-three men who had vasectomy reversal 15 years or more after vasectomy. INTERVENTION(S): Reversal of vasectomy by vasovasostomy or epididymovasostomy. MAIN OUTCOME MEASURE(S): Correlation of pregnancy results after vasectomy reversal with spousal age and published ICSI results. RESULT(S): Pregnancy rates for the intervals of 15-19 years, 20-25 years, and >25 years after vasectomy were 49%, 39%, and 25%, respectively. For spousal age <30 years, 30--35 years, 36-40 years, and >40 years, pregnancy rates were 64%, 49%, 32%, and 28%, respectively. The overall pregnancy rate was 43%, which is similar to the pregnancy rate of 40% for ICSI in obstructive azoospermia. Sixty-two percent of the men required a unilateral or bilateral epididymovasostomy. CONCLUSION(S): Spousal age is an important predictive factor after vasectomy reversal among men who have reversal 15 years or more after vasectomy. Pregnancy rates after vasectomy reversal compare favorably with those obtained with ICSI.

Adult↗

PubMed1990

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.

Constriction↗

PubMed2003

Percutaneous vasectomy: a simple modification eliminates the steep learning curve of no-scalpel vasectomy.

PURPOSE: We report a simplified method to avoid the most difficult step of no-scalpel vasectomy, while maintaining its minimally invasive advantages. MATERIALS AND METHODS: Using the no-scalpel vasectomy instruments in percutaneous fashion we perform vasectomy in the office setting without fixation of the vas to skin using the ring clamp. The sharp no-scalpel hemostat punctures the skin. The vas is then grasped with the ringed instrument instead of piercing the vas and performing the supination maneuver, as described for no-scalpel vasectomy. RESULTS: Percutaneous vasectomy was performed in 573 men by a single surgeon. In the 35 consecutive cases recently reviewed average operative time was 9.3 minutes with an additional 67 seconds added when a resident performed the procedure on 1 side in 15 cases. As determined by the knuckle of vas pulled through a puncture, average incisional length was 8.4 mm. Patients reported complete recovery in an average of 8.9 days. No major complications occurred. A single case of recanalization (0.17%) was successfully corrected by repeat percutaneous vasectomy. CONCLUSIONS: Percutaneous vasectomy is a minimally invasive option for permanent male sterilization that avoids the difficult aspects of no-scalpel vasectomy.

Ambulatory Surgical Procedures↗

PubMedDate not supplied

Ultrastructural features of the vas deferens from patients undergoing vasectomy and vasectomy reversal.

Despite more than 30 million vasectomies, the ultrastructural features of the epithelium of the vas deferens (VD) of healthy fertile men, as well as the effects of vasectomy at both proximal (testicular) and distal (abdominal) regions of the VD relative to the initial site of incision, have yet to be fully elucidated. In the present study, the VD from 22 fertile men undergoing vasectomy and 7 vasectomized men undergoing vasectomy reversal were examined by light and transmission electron microscopy. In fertile men, aside from cellular organelles involved in endocytosis and merocrine secretion, the epithelial principal cells showed protrusions of their apical cytoplasm between adjacent microvilli, referred to as "apical blebs." The latter contained solely numerous ribosomes/polysomes and few endoplasmic reticulum (ER) cisternae, unlike the presence of lysosomes, lipofuscin granules, mitochondria, and the Golgi apparatus in the apical principal cell cytoplasm, suggesting the segregation of organelles within blebs. Many apical blebs presented a bulbous extremity with a thin stalklike attachment connecting them to the apical principal cell surface, while others appeared to be isolated and well removed from it, suggesting that blebs are capable of detaching and being liberated into the lumen. We hypothesize that apical blebs represent a type of secretion, referred to as "apocrine secretion." In men undergoing vasectomy reversal, the VD proximal (testicular) to the vasectomy site showed a reduction in the size of principal cells and their microvilli and in the number of apical blebs. In contrast, the lumen of the VD distal (abdominal) to the vasectomy site was virtually abolished, with the epithelium reduced to a flattened layer of cells showing a paucity of organelles and no apical blebs, suggesting that these cells become undifferentiated in the absence of seminal fluids. Taken together, these data may explain, in part, the decreased pregnancy rate noted after vasectomy reversal despite a patent anastomosis.

Adult↗

PubMed1976

Vasectomy and vasovasostomy. I. Timing of histologic changes in immature and mature dog testis after vasectomy.

The effects of vasectomy on the development and maintenance of spermatogenesis was studied using immature and mature dog testes. Bilateral vasectomy in immature dogs delayed the development of advanced spermatocytes, spermatids, and spermatozoa for about 3 months postsurgery. Spermatogenesis appeared to be recovered to control levels by 4 months postvasectomy. Spermatogenesis in mature dogs was also altered after bilateral vasectomy. Decreased numbers of advanced spermatocytes as well as maturation arrest was observed by 3 weeks postvasectomy. Seminiferous tubule cell layers quickly decreased to one to three layers as the lumina became occluded with sloughed cells by 3 to 6 weeks postvasectomy. Recovery in terms of the numbers of spermatocytes, spermatids, and spermatozoa was evident by 13 weeks postvasectomy, although occasional dog testes did not recover and appeared to be more sensitive to vasectomy-induced damage. It thus appears that vasectomy temporarily inhibits both the development and maintenance of spermatogenesis in immature as well as mature dog testes. Spermatogenesis does recover but may be maintained at somewhat lower levels after vasectomy. Changes are rapid in onset and take several weeks to be reversed. Some dog testes appear to be more sensitive to the damage and it may be irreversible in these testes.

Animals↗

PubMed2003

[Vasectomy today: a review of 1,275 vasectomies in 10 years].

We report on a large series of 1,275 patients who underwent outpatient vasectomy performed by a single urological surgeon within a 10-year period. In addition, the results of a prospective questionnaire-based study on 217 patients regarding their opinions and motivation, and the financial aspects of the vasectomy are discussed. The mean age was 37.0+/-5.9 years. A total of 98.4% of the patients had an uneventful postoperative course. The average duration of sick leave was 2.2+/-0.21 days. During the study period, the length of sick leave dropped significantly from 2.63 (1990/91) to 1.1 days (1998/99; P=0.001). Efficacy was documented with azoospermia rates of 96.6% and 98.5% in patients who presented for two and three sperm examinations, respectively. A vast majority of patients (94.6%) felt that the procedure should be covered by their health insurance, although 88.1% stated they would also pay by themselves. A minority of patients (0.7%: 9/1,275) subsequently considered vasectomy reversal. The wish to reverse the vasectomy was significantly associated with a younger patient age. In conclusion, outpatient vasectomy provides a safe and reliable form of contraception at low cost. Overall satisfaction in appropriately counselled patients is very high. Based on these findings, further attempts to propagate vasectomy as a timely form of contraception are medically and socioeconomically recommended.

Adolescent↗

PubMed1997

A cross-sectional study of vasectomy, time since vasectomy and prostate cancer.

Past studies of the association of vasectomy and prostate cancer have reported inconsistent results. Our objective was to investigate whether vasectomy and time since vasectomy are associated with a higher risk of prostate cancer. We conducted a cross-sectional study on unduplicated records of >95 000 participants in a longitudinal study (1993-1995) of prostate cancer screening conducted during Prostate Cancer Awareness Week. Vasectomy was reported by 28%, and there were 2530 biopsies. (chi)(2) tests and logistic regression analyses were used and found that vasectomy and an increased length of time since vasectomy are not associated with a higher risk of prostate cancer.

Journal Article↗

PubMed1983

Immunoglobulin in seminal fluid of fertile, infertile, vasectomy and vasectomy reversal patients.

We measured the concentrations of IgG, IgA, and IgM, in the seminal fluid of 16 fertile men, 77 men of infertile marriages, 21 men who had undergone vasectomy reversal and 5 men who had undergone vasectomy only. The lower limits of sensitivity of the assay was 0.04 mg./dl. IgG (mean concentration 3.29 mg./dl., range 0.48 to 15.41 mg./dl.) and IgA (mean concentration 1.11 mg./dl., range 0.05 to 19.11 mg./dl.) were measureable in all specimens, but IgM (range 0.04 to 0.76 mg./dl.) was measureable in only 20 per cent. Intrasubject variability of IgG and IgA concentrations expressed as the coefficients of variation of serial determinations ranged from 18 to 40 per cent and 29 to 52 per cent, respectively. Discrepancies between the presence or absence of measurable IgM in serial determinations were unusual. The mean concentrations of seminal fluid IgG and IgA in the fertile group were not significantly different from the other patient groups. However, IgM was measurable in only 13 per cent of specimens from the fertile patients but in 62 per cent of specimens from the vasectomy reversal patients (p = 0.003). This suggests disruption of the blood-genital tract barrier following vasectomy and continuing after vasectomy reversal.

Adult↗

PubMed1994

Vasectomy and vasectomy reversal.

Vasectomy remains the safest method of birth control and there is much to commend it in the setting of a stable family relationship. However, some aspects of this operation have been wrongly presented in an attempt to widen its popularity and increase public acceptance. A simple procedure it may be but it is not totally free of complications; sometimes the operation has to be repeated and rarely it may reverse spontaneously even after the most stringent precautions. The family planning officer who counsels a prospective candidate and the surgeon who undertakes the procedure must ensure that these facts are understood by the patient with crystal clarity and that this fact is duly recorded on a signed and witnessed permission slip. Any organization which includes vasectomy in its programme of family planning should include advice and referral for vasectomy reversal in exactly the same way that the pill may be stopped or a coil can be removed. Fertility can be successfully restored by vasovasostomy in 50% of men who wish to have their vasectomies reversed, which often is due to a change in circumstances beyond their direct control.

Aftercare↗

PubMed1977

Comparison of allergic aspermatogenesis with that induced by vasectomy. II. In vitro studies of cell-mediated immunity to sperm after vasectomy in man and guinea-pig.

Transformation of peripheral blood leucocytes was shown to be a valid assay for cell-mediated immunity to sperm in male guinea-pigs immunized with homologous epididymal sperm (ES) in FCA. A heat-treated extract of ES (BES) was used for culture. Possible developement of cell-mediated immunity to sperm after vasectomy was investigated in patients and guinea-pigs, by culture of blood leucocytes before and at intervals after operation. Patients' leucocytes were cultured with a heat-treated extract of human seminal sperm (BHS); guinea-pigs' leucocytes were cultured with BES. These cultures showed no evidence of specific stimulation of leucocytes by sperm extract, up to 1 year after vasectomy in patients, or up to 6 months in guinea-pigs. Similarly, no evidence of delayed hypersensitivity could be demonstrated by skin tests with BES in animals vasectomized 1 year previously. We consider that this study establishes that cell-mediated immunity to sperm does not develop in either man or guinea-pigs, up to 1 year after conventional vasectomy.

Animals↗

PubMed1979

Epididymal extravasation following vasectomy as a cause for failure of vasectomy reversal.

Twenty-eight men undergoing vasectomy reversal who were found to have no sperm in the proximal vas fluid on one or both sides underwent microscopic epididymal exploration. In 33 of 39 cases so explored, normal sperm were found in the epididymal fluid of the corpus, despite absence of sperm in the vas fluid. Epididymal histology distal to this site revealed extensive interstitial sperm granulomas resulting from rupture of the epididymal duct. Testicular biopsy revealed normal spermatogenesis. Secondary epididymal obstructions were noted when there was copious fluid in the vas deferens proximal to the vasectomy site as well as when there was scanty fluid. It is concluded that persistent azoospermia after an accurate microscopic vasovasostomy results from the secondary epididymal obstruction induced by rupture of the epididymal duct related to the pressure increase after vasectomy.

Adult↗

PubMed2001

Irrigation of the distal vas deferens during vasectomy: does it accelerate the post-vasectomy sperm-free rate?

A prospective, non-randomized, partially blinded, controlled trial was conducted to evaluate the efficacy of irrigation with normal saline solution (NSS) during no-scalpel vasectomy (NSV) compared with NSV alone in 62 men. In the NSS irrigation group, an Angiocath 24-gauge needle was inserted into the distal vas lumen, and 20 mL NSS solution was used to irrigate the vas manually on both sides. Post-operative follow-up included urine samples collected immediately and semen samples for sperm count at 2, 6 and 12 weeks post-vasectomy. The difference in the number of spermatozoa appearing in the post-vasectomy urine samples and the mean urine sperm count in both groups were significantly different ( p < 0.0001 and p < 0.01, respectively). The numbers of post-operative ejaculations, the mean sperm concentration, and the number of patients who achieved sterility (defined as no motile spermatozoa in the ejaculate) in both groups at 2, 6 and 12 weeks were similar ( p > 0.05). It is concluded that although irrigation of the distal vas with NSS was successful in removing a large number of spermatozoa from the tract, this procedure did not significantly accelerate the rate of achieving absence of motile spermatozoa in the ejaculate.

Adult↗

PubMed1988

Vasectomy and health: cardiovascular and other diseases following vasectomy in Sichuan province, People's Republic of China.

The long-term sequelae of vasectomy were studied in a retrospective cohort study of 4596 vasectomized and 4340 nonvasectomized farmers from eight rural communes in Sichuan, People's Republic of China. The mean duration since the operation was 14.5 years with a range of 10 to 25 years. At the time of evaluation the vasectomized men were generally healthier than the non-vasectomized for a wide range of health indicators including clinical signs of cardiovascular disease, resting ECG changes, positive ECG changes following a maximal stress test, or fundus abnormalities. The lack of association between vasectomy and cardiovascular disease noted in Europe and the USA is supported by the present study conducted in a population with a low prevalence of cardiovascular disease and risk factors.

Adult↗

PubMed1994

The post-vasectomy length of the testicular vasal remnant: a predictor of surgical outcome in microscopic vasectomy reversal.

To identify another preoperative predictor of surgical outcome in vasal reconstruction, we prospectively measured the post-vasectomy length of the testicular vas deferens from the cauda of the epididymis to the site of the vasectomy in 26 patients undergoing vasal reconstruction. Intraoperatively, the vasal fluid was microscopically inspected and classified as whole sperm present or whole sperm absent. The length of the testicular vasal remnant was correlated with the intraoperative status of the vasal fluid. A testicular vasal remnant length greater than 2.7 cm. predicted the presence of fluid with whole sperm present in 30 of 32 testicles (94%). A testicular vasal length of less than 2.7 cm. predicted the presence of fluid without whole sperm in 17 of 20 testicles (85%). The length of the testicular vasal remnant can be measured preoperatively and knowledge of this length may be used to advise patients regarding the likelihood of successful vasal reconstruction.

Humans↗