INTRODUCTION

Vasectomy is a simple and reliable method of permanent contraception in men causing obstructive azoospermia. As many as 50 million men worldwide have relied on vasectomy for family planning. However, it is estimated that around 6% of these men who underwent vasectomy will ultimately seek vasectomy reversal for various reasons. Vasectomy reversal is the most cost effective option for couples desiring children after vasectomy and is the most challenging microsurgical procedures. This study presents local experience, outcomes and complications of microsurgical reconstruction of the male ductal system in the Philippines setting.

This is a retrospective study of 157 post-vasectomy patients who underwent microsurgical vasectomy reversal by a single surgeon from January 2001 to March 2024. Outcomes such as patency and pregnancy rates were documented and analyzed.

One hundred and fifty seven (157) underwent microsurgical vasectomy reversal. One hundred five (105) patients underwent bilateral microsurgical vasovasostomy. Forty eight (48) patients underwent combined microsurgical vasovasostomy and vasoepididymostomy. Three patients underwent bilateral vasoepididymostomy and one crossed microsurgical vasoepididymostomy (left to right). Four patients had no child, 87 patients had 1 child, 34 patients had 2 children, 29 had 3 children and 3 patients had 4 children prior to vasectomy. Age of wife was between 20 to 32 years old. Mean interval from vasectomy was 9 years. Vas deferens was patent in 120 (76%) of patients. Clinical pregnancy with successful delivery was achieved in 99 (63%) patients. There were only three who had postoperative hematoma (0.02%) and one developed surgical site infection (0.001%).

Microsurgical vasectomy reversal is an excellent option in men post vasectomy to achieve natural clinical pregnancy with minimal complications. The study confirms the effectiveness of male infertility microsurgery for vasectomized men who wish to father children.

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.
Humans ; Male ; Vasectomy/instrumentation* ; Cautery/methods* ; Adult ; Middle Aged ; Treatment Outcome ; Semen Analysis ; Quebec

OBJECTIVE: To explore the clinical effects of sterilization of vas deferens by irrigation in clinic. METHODS: Eighty-six male patients with voluntary sterilization were divided into control group (usual vasectomy, n=50) and observation group (sterilization of vas deferens by irrigation, n=36). The age, testicular volume, preoperative average concentration of spern, serum testosterone level, recovery duration evaluated by Artificial Obstruction Azoospermia (AOA) and degree of satisfaction were compared between the two groups of patients. RESULTS: There were significant differences in recovery duration, degree of satisfaction between the two groups (P<0.05). And there was no significant difference in age （［32.0±5.5］years vs ［31.0±6.3］years）, testicular volume （［16.0±4.8］mL vs ［17.0±4.4］mL）, preoperative average concentration of sperm (［39.6±20.2］ ×106/mL vs ［40.2±22.6］ ×106/mL) and levels of blood testosterone （［4.3±0.8］ng/mL vs ［4.4±0.8］ ng/mL）. There was significant difference in patency rate between the two sides of testicular ducts（91.7% vs 83.3%, P<0.05）. CONCLUSION The method of sterilization of vas deferens by irrigation is worth popularizing in clinic.
Humans ; Male ; Vas Deferens/surgery* ; Adult ; Therapeutic Irrigation ; Vasectomy/methods* ; Young Adult ; Sterilization, Reproductive/methods*

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.
Male ; Pregnancy ; Humans ; Female ; Adult ; Vasovasostomy ; Retrospective Studies ; Vas Deferens/surgery* ; Vasectomy ; China/epidemiology*

Azoospermia/surgery* ; Humans ; Male ; Vas Deferens ; Vasectomy

INTRODUCTION: This study explored attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students, and determined the association between their demographic characteristics, and attitudes and acceptance. METHODS: A cross-sectional survey was conducted among clinical-year medical students from a Malaysian private medical college using a self-administered questionnaire. RESULTS: There were 330 participants with a female preponderance and a mean age of 22.0 ± 1.1 years. The largest proportion of respondents were from Year 3. The vast majority were ethnically Malay (91.8%) and followed Islam (92.4%). Overall, 60.9% of participants had a positive attitude towards vasectomy and 76.0% showed good acceptance. Gender, academic year, ethnicity and religion variables were not associated with attitudes and acceptance (p > 0.05). A significantly higher proportion of male respondents thought that vasectomy was religiously forbidden and would give a bad impression. A significantly higher proportion of Year 5 students agreed to the statement 'I would recommend vasectomy to relatives, friends and people close to me' compared to Year 3 and 4 students. CONCLUSION Students' perception of vasectomy as a contraceptive method was encouraging. Our results suggest that their knowledge improved as medical training progressed, and attitudes evolved for the better irrespective of their traditional, cultural and religious beliefs - highlighting the importance of providing students with evidence-based learning about male sterilisation, which is more cost-effective and is associated with lower morbidity than female sterilisation. A qualitative study involving students from different ethnicities and religions would provide a better understanding of this subject.
Adult ; Attitude of Health Personnel ; Contraception ; methods ; psychology ; Cross-Sectional Studies ; Female ; Humans ; Malaysia ; Male ; Religion and Medicine ; Schools, Medical ; Students, Medical ; psychology ; Surveys and Questionnaires ; Vasectomy ; psychology ; Young Adult

Urologists perform the majority of vasectomies in the United States; however, family medicine physicians (FMPs) perform up to 35%. We hypothesized that differences exist in practice patterns and outcomes between urologists and FMPs. Patients 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.
Adult ; Humans ; Male ; Physicians, Family/statistics & numerical data* ; Practice Patterns, Physicians'/statistics & numerical data* ; Retrospective Studies ; Urologists/statistics & numerical data* ; Vasectomy/statistics & numerical data* ; Wisconsin

Cosmetic lateral canthoplasty has become popular among Asians in the last few decades, but few techniques have withstood the test of time to be accepted as both effective and noninvasive, with minimal complications. Novel techniques have been developed, but are not free from complications. Moreover, these methods often have limited indications and may require a rather long learning curve to master. Herein, the authors present their experiences performing a simple lateral canthoplasty procedure in 61 patients using a slightly modified V-Y advancement flap, previously known as the Uchida method.
Asian Continental Ancestry Group ; Blepharoplasty ; Cosmetic Techniques ; Humans ; Learning Curve ; Sterilization, Tubal

Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations:• Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy.• Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve.• Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended.• Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.
Endocrinology ; Fallopian Tubes ; Female ; Genital Diseases, Female ; Gynecology* ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Obstetrics* ; Ovarian Neoplasms ; Ovarian Reserve ; Prophylactic Surgical Procedures ; Reproductive Medicine ; Salpingectomy* ; Sterilization

OBJECTIVE: Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures. METHODS: This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement. RESULTS: In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal +“other” cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; P<0.01); uterus-conserving surgeries were also typically performed significantly earlier than hysterectomy (P<0.01). CONCLUSION: This investigation is the first to characterize specific gynecological operations after Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon.
Cohort Studies ; Contraception ; Device Removal ; Fallopian Tubes ; Female ; Humans ; Hysterectomy ; Reoperation ; Sterilization* ; Sterilization, Tubal