Vasectomy

Vasectomy is a common method of sterilisation. However, it is less popular than tubal ligation world-wide. It is also a frequent cause of litigation relating to its complications. This article reviews the early and late risks associated with the procedure. Data collection was done using the internet to search Medline for obtaining evidence-based medicine reviews. Cross-references were obtained from key articles. Websites of government bodies and medical associations were searched for guidelines relating to vasectomy. Early complications include haematoma, wound and genito-urinary infections, and traumatic fistulae. Vasectomy failure occurs in 0-2% of patients. Late recanalisation causes failure in 0.2% of vasectomies. Significant chronic orchalgia may occur in up to 15% of men after vasectomy, and may require epididyectomy or vasectomy reversal. Antisperm antibodies develop in a significant proportion of men post-vasectomy, but do not increase the risk of immune-complex or atheroscl...

Just over 20% of white women in America will never bear children, the highest percentage in modern history.  Only half of this group-10% of women without children- are considered infertile.  Many women in the fertile but childless group are voluntarily so:  the self-proclaimed childfree.

Yet despite the growing acceptability in remaining a childfree adult, doctors are resistant to sterilizing women without children. Access to sterilization is usually repeatedly denied, often with tactics of humiliation, hoop jumping, or second-guessing the legitimacy of the patient’s desire for sterilization, despite the legal status of voluntary sterilization for any competent person over the age of 21- regardless of parity.     

This paper will examine the many reasons why a woman who does not have children would want to continue in her childfree lifestyle, evaluate the accessibility of sterilization for women who are childfree by examining the reported reasons for denial of sterilization- both from the woman’s and the physicians’ perspective, and assess the legal status of voluntary sterilization for nonparous women. The paper will conclude that sterilization for childfree women is an ethical, legal option and that willing doctors should follow recommended guidelines for counseling women who desire sterilization, and urge hesitant doctors to reconsider their oppositions to voluntary sterilization for childfree women and provide the contraception of preference to women.

To examine prospectively the relationship between vasectomy and prostate cancer. Cohort study. Health professionals (dentists, veterinarians, osteopaths, optometrists, pharmacists, and podiastrists) in the United States. There were 10,055 male members of the Health Professionals Follow-up Study, aged 40 to 75 years, who had had a vasectomy, and 37,800 members who had not had a vasectomy at the time of study entry in 1986. These participants had provided detailed information on various life-style variables including diet. Diagnosis of prostate cancer. Between 1986 and 1990, 300 new cases of prostate cancer were diagnosed in participants who were initially free of diagnosed cancer. Vasectomy was associated with an elevated risk of prostate cancer (age-adjusted relative risk, 1.66; 95% confidence interval, 1.25 to 2.21; P = .0004). This elevated risk persisted after excluding 21 stage A1 cases (age-adjusted relative risk, 1.56; 95% confidence interval, 1.15 to 2.11; P = .004). Among men who had their vasectomy at least 22 years in the past (before 1965), the risk of prostate cancer was even higher (relative risk, 1.85; 95% confidence interval, 1.26 to 2.72; P = .002). This elevated risk among men with vasectomy did not appear to be caused by detection bias and persisted when we controlled for diet, level of physical activity, smoking, alcohol consumption, educational level, body mass index, and geographical area of residence. These results support evidence from other epidemiologic studies that vasectomy increases risk of prostate cancer. The consistency of results among various epidemiologic studies, the increase of risk over time following vasectomy, the apparent lack of confounding or bias, and the existence of physiological changes in the prostate following vasectomy suggest that the association may be causal.

CONTEXT The European Association of Urology presents its guidelines for vasectomy. Vasectomy is highly effective, but problems can arise that are related to insufficient preoperative patient information, the surgical procedure, and postoperative follow-up. OBJECTIVE These guidelines aim to provide information and recommendations for physicians who perform vasectomies and to promote the provision of adequate information to the patient before the operation to prevent unrealistic expectations and legal procedures. EVIDENCE ACQUISITION An extensive review of the literature was carried out using Medline, Embase, and the Cochrane Database of Systematic Reviews from 1980 to 2010. The focus was on randomised controlled trials (RCTs) and meta-analyses of RCTs (level 1 evidence) and on well-designed studies without randomisation (level 2 and 3 evidence). A total of 113 unique records were identified for consideration. Non-English language publications were excluded as well as studies publishe...

Objective
To investigate the association between the presence of sperm in the vasal fluid during vasectomy reversal (VR) and postoperative patency.

Methods
We performed a systematic review and meta-analysis of the English-language literature reporting on the association between the presence of sperm in the intraoperative vasal fluid (ie, whole or parts vs none) and patency (ie, patent or not) after microsurgical vasovasostomy for men with obstructive azoospermia due to vasectomy. Odds ratios (OR) and 95% confidence intervals were calculated to quantify the strength of the association reported by each study. Meta-analysis was performed using a random-effects model.

Results
Four case series and 2 retrospective cohort studies of a total of 1293 eligible patients were identified. The mean age at VR was 37.8 years, and the mean obstructive interval was 7.1 years. The unadjusted OR of postoperative patency was 4.1 times higher (95% confidence interval, 2.3-7.3) given the presence of intravasal sperm or sperm parts as opposed to their absence at the time of VR (Q = 3.4; df = 5; P = .6; I(2) = 22%). The pooled OR should be interpreted with caution as only the 2 retrospective cohort studies reported meaningful data on this association. Because of inconsistent reporting, analysis of other vasal fluid characteristics (eg, consistency) and outcomes (eg, pregnancy) was not possible.

Conclusions
The presence of whole sperm or sperm parts in the vasal fluid during VR is positively associated with postoperative patency. Our review highlights the poor methodological quality of existing evidence and underscores the need for more thorough follow up and higher standards of reporting in future studies.

... London : BMA 1994: 14. 6 Public Health (Infectious Diseases) Act 1984. Great Britain, 1984. 7 The Abortion Act 1968 (SI 1968 no 390 as amended) Great Britain. ... Evans WD, Rajan KT. Does vasectomy predispose to osteoporosis Br J Urol 1997; 79: 599–601. ... S, White C et al. ...

1). To determine the likelihood of sterilization reversal and of subsequent sterilization after sterilization reversal among men and women and 2). to examine the likelihood of pregnancy after sterilization (contraceptive failure) and of pregnancy after sterilization reversal. Payment data from the Quebec provincial health insurance system were obtained for each person undergoing vasectomy or female sterilization from January 1, 1980 to December 31, 1999 and linked through a unique identifying number for each person. Using standard techniques of survival analysis, we computed the cumulative probability of experiencing each of six events. Among women, 0.9% (of 311960) experienced a pregnancy after sterilization, 1.8% (of 321929) obtained a reversal after sterilization, 61% (of 4369) achieved a pregnancy after sterilization reversal and 48% achieved a delivery; 23% (of 4677) obtained a subsequent sterilization after reversal. Among men, 2.4% (of 310827) obtained a reversal after vasect...

Objective: To study the demographic profile of vasectomy clients and the psychosocial factors motivating them to be sterilized. Method and sample: One hundred fifty clients attending Reproductive Health Services Center (RHSC) Vasectomy Unit Sir Ganga Ram Hospital, Lahore were interviewed using a specifically constructed interview form. The form was developed on the basis of items generated through Focused Group Discussions (FGDs) with vasectomy clients. The investigators themselves conducted the interviews at Department of Psychiatry, Sir Ganga Ram Hospital, Lahore. Results: Mean age of the sample was 36.13 years. Out of the total sample 62 % were illiterate. Majority of clients were employed temporarily as laborers (i.e. 52.7%) and unskilled workers (i.e.15%). Eighty nine percent of the clients were earning less than Rs. 4000/- per month. Financial reasons were the main motivating factor to go for vasectomy. About 63 % of clients reported that they had never tried any other contrac...

The vas deferens is a site which can be exploited for male contraception without undue side effects. The only effective technique available for male contraception is vasectomy, being practiced world wide, despite that it is a permanent surgical procedure and its successful reversal is not assured. Although no-scalpel vasectomy minimizes surgical procedures, the fate of its reversal is akin to that of vasectomy. Several occlusive and non-occlusive vasal procedures which claim to be reversible without surgical intervention, possess more disadvantages than advantages. Vas occlusion with plug, 'Shug' or medical grade silicone rubber, although claimed to produce reversible azoospermia without affecting spermatogenesis, requires skilled microsurgery for their implantation and later removal. RISUG, a non-sclerotic polymer styrene maleic anhydride (SMA), could be more advantageous than vasectomy and other vas occlusive procedures in that it could be a totally non-invasive procedure ...

The study aimed to evaluate reversal of short- and long-term vas occlusion with reversible inhibition of sperm under guidance (RISUG) using dimethyl sulfoxide (DMSO) and sodium bicarbonate (NaHCO 3 ) in male rabbits (Oryctolagus cuniculus). Animals were divided into seven groups containing five animals each. Fortnightly, semen analysis revealed that sperm concentration and output steadily declined after vas occlusion and complete azoospermia was attained at 30-60 days postinjection. Spermatozoa reappeared at 60-75 days of reversal and normozoospermia was noticed between 135 days and 150 days in the reversal groups. All spermatozoa were found nonmotile prior to azoospermia and a gradual recovery in sperm motility was observed between 105 days and 135 days of reversal. A significant decline in viability of sperms was noticed during vas occlusion up to 30-60 days which recovered at 60-75 days postreversal and normalized by 75-105 days in the reversal groups. A significant enhancement i...