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Fertility and Sterility Jun 2015To assess whether hysteroscopic sterilization is feasible and effective in preventing pregnancy. Secondarily, to identify risk factors for failure of hysteroscopic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess whether hysteroscopic sterilization is feasible and effective in preventing pregnancy. Secondarily, to identify risk factors for failure of hysteroscopic sterilization.
DESIGN
A systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Women undergoing hysteroscopic sterilization.
INTERVENTION(S)
Hysteroscopic sterilization with a commercially available system (Ovabloc Intra Tubal Device, Essure system, or Adiana permanent contraception system).
MAIN OUTCOME MEASURE(S)
Successful placement at first attempt, confirmed correct placement, complications, incidence of pregnancy, and risk factors for placement failure in hysteroscopic sterilization.
RESULT(S)
Of the 429 citations identified, 45 articles were eligible for analyses. No randomized controlled trials (RCTs) were identified, just cohort studies. Six articles concerned Ovabloc, 37 Essure, and two Adiana sterilization. The probabilities for successful bilateral placement in a first attempt for Ovabloc, Essure, and Adiana, were, respectively, in the ranges 78%-84%, 81%-98%, and 94%. The probabilities of successful bilateral placement could not be pooled because of substantial heterogeneity. The 36 months' cumulative pregnancy rate of Adiana was 16 of 1,000. Reliable pregnancy rates after sterilization with Ovabloc or Essure method could not be calculated. For all three hysteroscopic techniques, the incidence of complications and their severity has not been studied adequately and remains unclear. We also found too little evidence to identify risk factors for placement failure.
CONCLUSION(S)
Sterilization by hysteroscopy seems feasible, but the effectiveness and risk factors for failure of sterilization remain unclear owing to the poor-quality evidence. Both currently applied hysteroscopic sterilization techniques and the coming new techniques must be evaluated properly for feasibility and effectiveness. Appropriate RCTs and observational studies with sufficient power and complete and long-term (>10 years) follow-up data on unintended pregnancies and complications are needed.
Topics: Adult; Cohort Studies; Equipment Failure Analysis; Feasibility Studies; Female; Humans; Hysteroscopy; Incidence; Internationality; Middle Aged; Pregnancy; Pregnancy Rate; Pregnancy, Unplanned; Prosthesis Design; Reoperation; Risk Factors; Silicone Elastomers; Sterilization, Tubal; Treatment Outcome; Young Adult
PubMed: 25910565
DOI: 10.1016/j.fertnstert.2015.03.009 -
Medicine Sep 2020Unintended pregnancy is popular all over the world, accounting for 40% to 50% of all pregnancies. The condition not only exerts pressure on the relationship of couples... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Unintended pregnancy is popular all over the world, accounting for 40% to 50% of all pregnancies. The condition not only exerts pressure on the relationship of couples and severely impacts the quality of life, but also imposes a heavy burden on the health of women and child. Recently, more than 220 million couples have chosen to be sterilized to obtain contraception, 47.3% of married couples select sterilization, of which vasectomy accounts for 17.1%. Vasectomy is currently the most convenient and effective method of male contraception. We will perform the systematic review and meta-analysis to assess the correlation between vasectomy and male sex dysfunction and provide evidence-based evidence for the couple METHODS:: The electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, Clinicaltrials.org., China National Knowledge Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database (CBM), VIP Science Technology Periodical Database, Chinese Clinical Trial Registry, and Cochrane Library will be retrieved before November 20, 2021. We will search English literature and Chinese literature with proper Medical Subject Heading or text key words. RevMan 5.3 and Stata 14.0 will be used for Systematic review and Meta-analysis. This protocol reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement.
CONCLUSION AND DISSEMINATION
The aim of this study was to evaluate the effect of vasectomy on the sexual function of patients after operation. The results will be published in a public issue journal to provide evidence-based medical evidence for urologists and andrologists to make clinical decisions.
REGISTRATION INFORMATION
INPLASY202080014.
Topics: Double-Blind Method; Humans; Male; Mental Health; Postoperative Complications; Randomized Controlled Trials as Topic; Research Design; Sexual Dysfunctions, Psychological; Vasectomy
PubMed: 32925772
DOI: 10.1097/MD.0000000000022149 -
Systematic Reviews Jun 2022Based on previous studies, it has been hypothesized that tube sterilization may be associated with a lower risk of breast cancer. This study aims to investigate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Based on previous studies, it has been hypothesized that tube sterilization may be associated with a lower risk of breast cancer. This study aims to investigate the relationship between tubal ligation and the risk of breast cancer through a systematic review and meta-analysis.
METHODS
In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, and Google Scholar were searched for relevant non randomized studies published up to November 2020. Then, we screened the papers to include the eligible papers in the meta-analysis. Finally, we pooled the extracted results of individual studies to estimate the summary effect size. All analyses were done using Stata software version 13 (Stata Corp, College Station, TX).
RESULTS
Four hundred sixty-four papers were retrieved from PubMed/Medline (160), Scopus (165), and Web of Science (139), and 21 papers from Google Scholar and manual search of references in selected full texts. After the removal of duplicates and screening of the papers, 11 articles (6 cohort and 5 case-control study) were included in the final analysis. The results of cohort (RR = 0.99, 95% CI = 0.97-1.0, I = 21.1%) and case control studies (OR = 0.87, 95% CI = 0.62-1.12, I = 88.9%) revealed that tubal ligation was not significantly associated with breast cancer risk.
CONCLUSION
According to our findings, tubal ligation cannot be considered as a risk factor associated with breast cancer risk.
Topics: Breast Neoplasms; Case-Control Studies; Cohort Studies; Female; Humans; Risk Factors; Sterilization, Tubal
PubMed: 35718766
DOI: 10.1186/s13643-022-02000-8 -
Medicine Aug 2017Even though several studies comparing vasectomy and cardiovascular disease (CVD) risk have been reported, most are small series with conflicting results. However, the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Even though several studies comparing vasectomy and cardiovascular disease (CVD) risk have been reported, most are small series with conflicting results. However, the extent of the risk is still uncertain. We therefore explored whether an association exists between vasectomy and CVD incidence and mortality.
METHODS
We searched PubMed, Embase, Web of Science, and Cochrane Library databases for relevant studies published before January 2017. Multivariate adjusted odds ratio (OR) and associated 95% confidence intervals (CIs) and those by subgroups were extracted and pooled using random-effects models.
RESULTS
Overall, 12 observational studies (2 cross-sectional studies, 4 case-control studies, and 6 retrospective cohort studies) comprising 299,436 participants were identified. There was no statistically significant relationship between vasectomy and CVD risk (OR: 0.90, 95% CI: 0.81-1.00). Moreover, vasectomy was not associated with CVD mortality (OR: 0.90, 95% CI: 0.81-1.00), coronary heart disease (CHD) incidence (OR: 0.94, 95% CI: 0.88-1.01), stroke incidence (OR: 0.90, 95% CI: 0.72-1.13), and myocardial infarction (MI) incidence (OR: 0.95, 95% CI: 0.88-1.02), with no significant publication bias. In subgroup analyses, the findings on the association between vasectomy and CVD risk were consistent.
CONCLUSION
Our findings suggest that vasectomy is not associated with the excess risk of CVD incidence and mortality. Nevertheless, large-volume, well-designed observational studies, with different ethnic populations, low risk of bias, and adjusted confounding factors, are awaited to confirm and update the findings of this analysis.
Topics: Cardiovascular Diseases; Coronary Disease; Cross-Sectional Studies; Humans; Incidence; Male; Myocardial Infarction; Observational Studies as Topic; Odds Ratio; Retrospective Studies; Stroke; Vasectomy
PubMed: 28834896
DOI: 10.1097/MD.0000000000007852 -
PloS One 2018A number of researchers have reported that vasectomy is a risk factor for testicular cancer. However, this conclusion is inconsistent with a number of other published... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
A number of researchers have reported that vasectomy is a risk factor for testicular cancer. However, this conclusion is inconsistent with a number of other published articles. Hence, we conducted this meta-analysis to assess whether vasectomy increases the risk of testicular cancer.
MATERIALS AND METHODS
We identified all related studies by searching the PubMed, Embase, and Cochrane Library database from January 01, 1980 to June 01, 2017. The Newcastle-Ottawa Scale (NOS) checklist was used to assess all included non-randomized studies. Summarized odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the difference in outcomes between case and control groups. Subgroup analyses were performed according to the study design and country.
RESULTS
A total of eight studies (2176 testicular cancer patients) were included in this systematic review and meta-analysis. Six articles were case-control studies, and two were cohort studies. The pooled estimate of the OR was 1.10 (95% CI: 0.93-1.30) based on the eight studies in a fixed effects model. Two subgroup analyses were performed according to the study design and country. The results were consistent with the overall findings. Publication bias was detected by Begg's test and Egger's test and p values > 0.05, respectively.
CONCLUSIONS
Our meta-analysis suggested that there was no association between vasectomy and the development of testicular cancer. More high-quality studies are warranted to further explore the association between vasectomy and risk of testicular cancer.
Topics: Case-Control Studies; Cohort Studies; Humans; Male; Neoplasms, Germ Cell and Embryonal; Risk Factors; Testicular Neoplasms; Vasectomy
PubMed: 29566037
DOI: 10.1371/journal.pone.0194606 -
Fertility and Sterility May 2000To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy. (Review)
Review
OBJECTIVE
To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy.
DESIGN
A systematic MEDLINE review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998.
MAIN OUTCOME MEASURE(S)
Early failure rates are <1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%-6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers.
CONCLUSION(S)
Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.
Topics: Adolescent; Adult; Contraindications; Counseling; Humans; MEDLINE; Male; Prostatic Neoplasms; Testicular Neoplasms; United States; Vasectomy; Vasovasostomy
PubMed: 10785217
DOI: 10.1016/s0015-0282(00)00482-9 -
BMC Cancer Oct 2019Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Studies on relationship between tubal ligation and endometrial cancer have led to contradictory findings. In several studies, however, a reduced endometrial cancer risk was suggested following tubal ligation. Therefore, a systematic review and meta-analysis was conducted to examine the relationship between tubal ligation and endometrial cancer risk.
METHODS
In this systematic review and meta-analysis, PubMed/Medline, Web of Science, Scopus, Embase, and Google Scholar were searched for relevant studies published up to May 30th, 2018. We compared endometrial cancer risk in women with and without tubal ligation in retrieved studies.
RESULTS
Two hundred nine studies were initially retrieved from the data bases. After exclusion of duplicates and studies which did not meet inclusion criteria, ten cohort and case-control studies, including 6,773,066 cases, were entered into the quantitative meta-analysis. There was 0.90% agreement between two researchers who searched and retrieved the studies. The summary OR (SOR) was reported using a random effect model. Begg's test suggested that there was no publication bias, but a considerable heterogeneity was observed (I = 95.4%, P = 0.001). We pooled the raw number of tables cells (i.e. a, b, c, and d) of eight studies. The SOR suggested that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.577, 95% CI = 0.420-0.792). Also, given the rare nature of endometrial cancer (< 5%), different effect sizes were considered as comparable measures of risk. Therefore we pooled ten studies and SOR of these studies revealed that tubal ligation was significantly associated with a lower risk of endometrial cancer (SOR = 0.696, 95% CI = 0.425-0.966). Besides that, we pooled eight studies in which adjusted effect sizes were reported and a subsequent analysis revealed that the summary estimate of adjusted odds ratio (SAOR) was significant (SAOR = 0.862, 95% CI = 0.698-1.026).
CONCLUSIONS
This study revealed a protective effect of tubal ligation on endometrial cancer risk (approximately 42% lower risk of cancer). It is recommended that studies should be designed to reveal mechanisms of this relationship.
Topics: Adolescent; Adult; Aged; Chi-Square Distribution; Endometrial Neoplasms; Female; Humans; Incidence; Middle Aged; Odds Ratio; Risk; Sterilization, Tubal; Young Adult
PubMed: 31604465
DOI: 10.1186/s12885-019-6174-3 -
The Cochrane Database of Systematic... Mar 2014Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the... (Review)
Review
BACKGROUND
Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-like instrument to puncture the skin. The no-scalpel technique aims to reduce adverse events, especially bleeding, bruising, hematoma, infection and pain and to shorten the operating time.
OBJECTIVES
The objective of this review was to compare the effectiveness, safety, and acceptability of the incisional versus no-scalpel approach to the vas.
SEARCH METHODS
In February 2014, we searched the computerized databases of CENTRAL, MEDLINE, POPLINE and LILACS. We looked for recent clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. Previous searches also included in EMBASE. For the initial review, we searched the reference lists of relevant articles and book chapters.
SELECTION CRITERIA
Randomized controlled trials and controlled clinical trials were included in this review. No language restrictions were placed on the reporting of the trials.
DATA COLLECTION AND ANALYSIS
We assessed all titles and abstracts located in the literature searches and two authors independently extracted data from the articles identified for inclusion. Outcome measures included safety, acceptability, operating time, contraceptive efficacy, and discontinuation. We calculated Peto odds ratios (OR) with 95% confidence intervals (CI) for the dichotomous variables.
MAIN RESULTS
Two randomized controlled trials evaluated the no-scalpel technique and differed in their findings. The larger trial demonstrated less perioperative bleeding (OR 0.49; 95% CI 0.27 to 0.89) and pain during surgery (OR 0.75; 95% CI 0.61 to 0.93), scrotal pain (OR 0.63; 95% 0.50 to 0.80), and incisional infection (OR 0.21; 95% CI 0.06 to 0.78) during follow up than the standard incisional group. Both studies found less hematoma with the no-scalpel technique (OR 0.23; 95% CI 0.15 to 0.36). Operations using the no-scalpel approach were faster and had a quicker resumption of sexual activity. The smaller study did not find these differences; however, the study could have failed to detect differences due to a small sample size as well as a high loss to follow up. Neither trial found differences in vasectomy effectiveness between the two approaches to the vas.
AUTHORS' CONCLUSIONS
The no-scalpel approach to the vas resulted in less bleeding, hematoma, infection, and pain as well as a shorter operation time than the traditional incision technique. No difference in effectiveness was found between the two approaches.
Topics: Hemorrhage; Humans; Intraoperative Complications; Male; Randomized Controlled Trials as Topic; Surgical Instruments; Vasectomy
PubMed: 24683021
DOI: 10.1002/14651858.CD004112.pub4 -
Fertility and Sterility Jun 2010To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal... (Review)
Review
OBJECTIVE
To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method.
DESIGN
The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008.
SETTING
The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare.
PATIENT(S)
Women over 30 years, who had been sterilized by the Essure method.
INTERVENTION(S)
Hysteroscopic tubal sterilization using Essure system.
MAIN OUTCOME MEASURE(S)
Efficacy/effectiveness, adverse events, costs.
RESULT(S)
Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed.
CONCLUSION(S)
The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.
Topics: Animals; Female; Humans; Hysteroscopy; Pain; Sterilization, Tubal
PubMed: 19409549
DOI: 10.1016/j.fertnstert.2009.02.080 -
Fertility and Sterility Feb 1998To review the literature on menstrual and hormonal changes in women who under go tubal sterilization. (Review)
Review
OBJECTIVE
To review the literature on menstrual and hormonal changes in women who under go tubal sterilization.
DESIGN
A systematic review through MEDLINE and a literature search identified more than 200 articles in the English literature from which the most relevant were selected for this review.
RESULT(S)
Many authors have investigated the sequelae of female sterilization. Increased premenstrual distress, heavier and more prolonged menstrual bleeding, and increased dysmenorrhea have been reported. However, failure to control for age, parity, obesity, previous contraceptive use, interval since sterilization, or type of sterilization may have affected study results. Most studies that have controlled for these important variables have not reported significant changes, except in women who undergo sterilization between 20 and 29 years of age.
CONCLUSION(S)
Tubal sterilization is not associated with an increased risk of menstrual dysfunction, dysmenorrhea, or increased premenstrual distress in women who undergo the procedure after age 30 years. There may be some increased risk for younger women, although they do not appear to undergo significant hormonal changes.
Topics: Age Factors; Female; Hormones; Humans; Menstrual Cycle; Menstruation Disturbances; Postoperative Complications; Sterilization, Tubal; Syndrome
PubMed: 9496325
DOI: 10.1016/s0015-0282(97)00229-x