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The World Journal of Men's Health Jul 2021Vasectomy is a simple, safe, effective, and economical method used worldwide for long-term male contraception. As a surgical operation, it has short-term and long-term... (Review)
Review
Vasectomy is a simple, safe, effective, and economical method used worldwide for long-term male contraception. As a surgical operation, it has short-term and long-term complications such as hematoma formation, infection, sterilization failure, sperm granulomas, short-term postoperative pain (nodal pain, scrotal pain, and ejaculation pain), and chronic pain syndrome. Whether it increases the risk of autoimmune disease, cardiovascular disease, testicular cancer, or prostate cancer is still controversial. Changes in plasma concentrations of luteinizing hormone, follicle-stimulating hormone, and testosterone after vasectomy have also been studied, as well as the relation between vasectomy and sexual function. Sperm quality decreases very slowly after vasectomy, and vasovasostomy and intracytoplasmic sperm injection could help a couple achieve a pregnancy if they change their minds at any point. We include a follow-up strategy and suggestions for follow-up care at the end of this review.
PubMed: 32777870
DOI: 10.5534/wjmh.200073 -
American Family Physician Jul 1999Vasectomy can be performed by means of various techniques, although each vasectomy technique requires isolation and division of the vas and operative management of the... (Review)
Review
Vasectomy can be performed by means of various techniques, although each vasectomy technique requires isolation and division of the vas and operative management of the vasal ends. Removal of at least 15 mm of vas is recommended, although division of the vas without removal of a segment is effective when this technique is combined with other techniques for handling the vasal ends, such as thermal luminal fulguration and proximal fascial interposition. Ligation of the ends without the aid of surgical clips may result in necrosis and sloughing of the ends, which may cause early failure. Leaving the testicular end of the vas open has been shown to be effective and to result in a lower incidence of epididymal congestion and sperm granuloma. The no-scalpel technique offers shorter operating time, less pain and swelling, and faster recovery.
Topics: Humans; Male; Patient Education as Topic; Teaching Materials; Vasectomy
PubMed: 10414634
DOI: No ID Found -
American Family Physician Dec 2013Vasectomy offers a safe, effective, and permanent method of male contraception, with an overall failure rate of less than 1% in pooled studies. Men older than 30 years... (Review)
Review
Vasectomy offers a safe, effective, and permanent method of male contraception, with an overall failure rate of less than 1% in pooled studies. Men older than 30 years in a stable, committed relationship appear to be the best candidates for vasectomy. The no-scalpel technique reduces operative complications, shortens operative time, and hastens resumption of sexual activity. Use of a jet injector instead of a needle to provide local anesthesia (no-needle vasectomy) may reduce pain. Bleeding and infection are short-term complications of vasectomy; long-term complications include sperm granuloma and postvasectomy pain syndrome. One postvasectomy semen analysis demonstrating azoospermia performed after three months and 20 ejaculations is sufficient to establish sterility. Vasectomy reversal is more likely to be successful if performed less than 15 years after vasectomy and in men whose female partner is younger than 40 years.
Topics: Humans; Male; Postoperative Complications; Semen Analysis; Vasectomy; Vasovasostomy
PubMed: 24364523
DOI: No ID Found -
BMJ (Clinical Research Ed.) May 1992
Topics: Female; Fertility; Humans; Male; Pregnancy; Vasectomy; Vasovasostomy
PubMed: 1392787
DOI: 10.1136/bmj.304.6835.1130 -
Spermatogenesis 2014The blood-epididymis barrier (BEB) is a critical structure for male fertility. It enables the development of a specific luminal environment that allows spermatozoa to... (Review)
Review
The blood-epididymis barrier (BEB) is a critical structure for male fertility. It enables the development of a specific luminal environment that allows spermatozoa to acquire both the ability to swim and fertilize an ovum. The presence of tight junctions and specific cellular transporters can regulate the composition of the epididymal lumen to favor proper sperm maturation. The BEB is also at the interface between the immune system and sperm. Not only does the BEB protect maturing spermatozoa from the immune system, it is also influenced by cytokines released during inflammation, which can result in the loss of barrier function. Such a loss is associated with an immune response, decreased sperm functions, and appears to be a contributing factor to post-testicular male infertility. Alterations in the BEB may be responsible for the formation of inflammatory conditions such as sperm granulomas. The present review summarizes current knowledge on the morphological, physiological and pathological components associated with the BEB, the role of immune function on the regulation of the BEB, and how disturbance of these factors can result in inflammatory lesions of the epididymis.
PubMed: 26413391
DOI: 10.4161/21565562.2014.979619 -
Andrologia Aug 2022The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy...
The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.
Topics: Cross-Sectional Studies; Granuloma; Humans; Male; Microsurgery; Semen; Spermatozoa; Vasectomy; Vasovasostomy
PubMed: 35524153
DOI: 10.1111/and.14439 -
BMJ (Clinical Research Ed.) Sep 1990
Topics: Animals; Dogs; Humans; Male; Rabbits; Seminiferous Tubules; Testicular Neoplasms; Testis; Vasectomy
PubMed: 2224212
DOI: 10.1136/bmj.301.6753.618 -
Reproductive Medicine and Biology Oct 2018In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction... (Review)
Review
BACKGROUND
In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception.
METHODS
This article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches.
MAIN FINDINGS
The reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot-assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery.
CONCLUSION
In the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.
PubMed: 30377390
DOI: 10.1002/rmb2.12207 -
Clinics (Sao Paulo, Brazil) 2013Obstructive azoospermia is a common cause of male infertility and can result from infection, congenital anomalies, or iatrogenic injury. Microsurgical vasal... (Review)
Review
Obstructive azoospermia is a common cause of male infertility and can result from infection, congenital anomalies, or iatrogenic injury. Microsurgical vasal reconstruction is a suitable treatment for many cases of obstructive azoospermia, although some couples will require sperm retrieval paired with in-vitro fertilization. The various causes of obstructive azoospermia and recommended treatments will be examined. Microsurgical vasovasostomy and vasoepididymostomy will be discussed in detail. The postoperative patency and pregnancy rates for surgical reconstruction of obstructive azoospermia and the impact of etiology, obstructive interval, sperm granuloma, age, and previous reconstruction on patency and pregnancy will be reviewed.
Topics: Azoospermia; Epididymis; Humans; Male; Microsurgery; Vas Deferens; Vasovasostomy
PubMed: 23503955
DOI: 10.6061/clinics/2013(sup01)07 -
Canadian Family Physician Medecin de... Sep 1987Vasectomy is done by a family physician at the family planning clinic of le Centre Hospitalier de l'Université Laval. The technique used combines an occlusion with...
Vasectomy is done by a family physician at the family planning clinic of le Centre Hospitalier de l'Université Laval. The technique used combines an occlusion with metal clips and an excision of one to two centimetres of the vas deferens. The post-operative complications encountered with 304 vasectomies were hematomas (4%), infections of the scotal skin (1%), orchi-epididymitis (1%) and granulomas (1%). All these problems were treated on an out-patient basis, and no consultation with specialists was required. Of 151 patients who came back for a post-vasectomy semen examination, one had a test result showing motile spermatozoa. These figures are comparable to other results published. The family physician can easily incorporate this simple and safe procedure into his practice.
PubMed: 21263976
DOI: No ID Found