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*

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

PURPOSE: Microsurgical vasovasostomy is associated with high patency and pregnancy rates, but is difficult and requires significant effort and time to learn. Therefore, we assessed a simplified loupe-assisted vasovasostomy method using a Prolene stent. MATERIALS AND METHODS: The medical records of 82 patients who underwent loupe-assisted vasovasostomy with a Prolene stent by a single surgeon between January 2004 and December 2015 were reviewed. The association between the vasal obstructive interval (VOI) and the success rate was evaluated. RESULTS: The average age at the time of vasovasostomy was 39.8 years (range, 29~57 years). The mean VOI was 6.6 years (range, 1~19 years). The mean operation time was 87.0 minutes (range, 55.0~140.0 minutes). The overall patency and natural pregnancy rates were 90.2% and 45.1%, respectively. The success rate decreased as time after vasectomy increased (odds ratio, 0.869; 95% confidence interval, 0.760~0.993; p=0.039). The cases were divided into 2 groups according to the mean VOI: group A (>7 years) and group B (≤7 years), with 31 cases (37.8%) and 51 cases (62.2%), respectively. The patency and pregnancy rates of group A were 80.6% and 51.6%, respectively, while those of group B were 96.1% and 41.2%, respectively. CONCLUSIONS: Loupe-assisted vasovasostomy using a Prolene stent is a safe and effective method.
Humans ; Medical Records ; Methods ; Polypropylenes* ; Pregnancy ; Pregnancy Rate ; Stents* ; Vasectomy* ; Vasovasostomy*

BACKGROUND2-Suture longitudinal vasoepididymostomy shows superiority to transverse technique in an animal study; to date, this has not been consistently confirmed in human body. In the present study, we evaluated the effectiveness of 2-suture transverse intussusception vasoepididymostomy and compared the rationality between transverse and longitudinal techniques.

METHODSFrom May 2007 to December 2008, we performed 2-suture transverse vasoepididymostomy in 19 consecutive patients, as described by Marmar with modification. Between March 2009 and January 2010, the internal diameter of the vas lumen and the outer diameter of the epididymal tube were measured using microruler (21 patients and 37 sides).

RESULTSThree patients lost to follow-up. At the first follow-up period (ranged from 10 to 24 months), the patency rate was 56.3% (9/16) and the natural pregnancy rate was 25% (4/16). At the second follow-up period (ranged from 46 to 63 months), the patency rate was 68.8% (11/16), the natural pregnancy rate was 37.5% (6/16), respectively, and the take-home baby rate was 31.3% (5/16). The diameter of the vas lumen and the outer diameter of the epididymal tubule were (0.512 ± 0.046) mm and (0.572 ± 0.051) mm (P < 0.001), respectively.

CONCLUSIONTransverse 2-suture intussusception vasoepididymostomy is still an effective technique in treating obstructive azoospermia.

Adult ; Azoospermia ; surgery ; Humans ; Male ; Vasectomy ; methods ; standards

OBJECTIVETo explore the clinical application of high-frequency ultrasound in the diagnosis and treatment of epididymal stasis after vasectomy.

METHODSWe retrospectively studied the sonographic characteristics of 23 cases of epididymal stasis treated by vasectomy, which were divided into a mild (n = 5), a moderate (n = 11) and a severe group (n = 7) according to the results of color Doppler flow imaging. We analyzed the significance of high-frequency ultrasonography in the treatment of epididymal stasis after vasectomy.

RESULTSHigh-frequency ultrasonography revealed 14 cases of increased bilateral epididymal volume, 6 cases of left epididymal thickening and 3 cases of right epididymal thickening, mainly the thickening of the epididymal body and tail. After conservative treatment, 18 of the epididymal stasis cases (5 mild, 11 moderate and 2 severe) were improved, and the other 5 severe cases significantly relieved and discharged from hospital following conservative treatment combined with vasectomy reversal.

CONCLUSIONPost-vasectomy epididymal stasis has typical sonographic characteristics, and high-frequency ultrasonography has an extremely important application value in the clinical classification, diagnosis and treatment of the disease.

Adult ; Aged ; Epididymis ; diagnostic imaging ; Genital Diseases, Male ; diagnostic imaging ; etiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Ultrasonography ; methods ; Vasectomy ; adverse effects

OBJECTIVETo assess the long-term effect and safety of non-occlusive intra-vas device (IVD) for male contraception in comparison with no-scalpel vasectomy (NSV).

METHODSWe conducted a follow-up investigation on 100 males who had received IVD and another 50 who had undergone NSV 6 years before. We compared the rates of sperm absence and complications between the two groups.

RESULTSFollow-up visits were successfully performed on 95 males (95%) of the IVD group and 44 (88%) of the NSV group. Pregnancy was not found in any of the cases. Spermatozoa (> or = 5 x 10(6)/ml) were not detected in 87 cases (91.58%) in the IVD group and in 44 cases (95.45%) in the NSV group, with no significant differences between the two groups (P > 0.05). The rate of postoperative complications in the IVD group (11.58%) showed no significant difference from that of the NSV group (4.55%) (P > 0.05).

CONCLUSIONIVD is as effective and safe as NSV for male contraception.

Adult ; Contraception ; methods ; Follow-Up Studies ; Humans ; Male ; Vas Deferens ; Vasectomy

We evaluated a biodegradable graft for reconstruction of rat vasa deferentia with long obstructed or missing segments. A total of 47 Sprague-Dawley rats underwent bilateral vasectomy and were divided into groups according to length of the vas deferens affected (0.5, 1, 1.5 cm). After 8 weeks, poly-(D,L-lactide) (PDLA) grafts were used to reconnect the vas deferens. Grafts and adjoining vasa deferentia were excised 8 and 12 weeks later and evaluated microscopically. At 8 weeks, microscopic changes included a robust inflammatory response around the grafts. All grafts were still intact but in the early stages of degradation. No microtubules, indicative of vas deferens recanalization, were identified. One specimen showed evidence of healing and neovascularization at the interface zone between the vas deferens and the graft. At 12 weeks, grafts were further degraded but still present. Microscopic evaluation showed decreased inflammation. Seven specimens showed neovascularization at the interface zone; two of these showed distinct epithelialized vas deferens microcanals at the graft edges. One specimen showed a microcanal spanning the entire 0.5-cm graft. A time period of 8 weeks is not ample enough for vas deferens regeneration in the setting of a biodegradable PDLA graft; however, early evidence of re-growth was seen at 12 weeks. A longer healing time should permit further biodegradation of the graft, as well as re-growth and possible eventual reconnection of the vas deferens, allowing passage of sperm. These findings suggest a potential role for biodegradable grafts in the reconstruction of vas deferens with long obstructed segments.
Absorbable Implants ; Animals ; Graft Survival ; Male ; Rats ; Rats, Sprague-Dawley ; Vas Deferens ; cytology ; surgery ; Vasectomy ; Vasovasostomy ; methods

AIMTo determine whether vasectomy away from the epididymal tail (via the inguinal canal) in rabbits can reduce the early postoperative effects on spermatogenesis.

METHODSTwenty-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.

RESULTSNeither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral sham-operated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation.

CONCLUSIONVasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.

Animals ; Male ; Rabbits ; Spermatogenesis ; Vasectomy ; methods

AIMTo study the histologic changes of the vas deferens following Nd: YAG laser irradiation.

METHODSIntravasal laser irradiation was given to (i) 52 segments of rabbit (laser dosage: 2 seconds at 40 W approximately 50 W) and 16 segments of human (3 seconds at 45 W approximately 55 W) vas deferens in vitro, (ii) 25 rabbit vasa (2 seconds approximately 2.5 seconds at 40 W approximately 45 W) in vivo and (iii) 2 human vasa (3 seconds at 55 W) in vivo. Segments of vasa were removed from the in vivo irradiated vasa deferentia 15 days approximately 180 days (rabbit) or 15 days (man) after the exposure. All vas segments were embedded in methacrylate resin. Serial sections (thickness 25 microm approximately 30 microm) were obtained and observed under a light microscope.

RESULTS(i) Laser-induced damage reached the muscularis layer in 27% and 94% of the rabbit and human vas segments in vitro, respectively. (ii) Fourteen of the 25 in vivo rabbit vasa were completely occluded by fibrous tissue and the longer the time interval after treatment, the more likely was the vas occluded. Those unoccluded vasa had either a normal histology or a mucosal damage. (iii) One in vivo human vas was almost completely occluded by the fibrous tissue but the other had a relatively large lumen packed with sperm granulomatous tissue and partial destruction of the smooth muscle layer.

CONCLUSIONLaser irradiation can induce long-term vas occlusion; for rapid occlusion, laser doses just completely destroying the mucosal layer will be advisable.

Animals ; Humans ; Laser Coagulation ; Male ; Rabbits ; Sterilization, Reproductive ; methods ; Vas Deferens ; anatomy & histology ; Vasectomy