Review

Authors: Danielle Velez, Rodrigo Pagani, Mahmoud Mima...

Except for condom use, vasectomy is the only approved form of male contraception. The American Urological Association published guidelines on vasectomy in 2012, which clearly outlined patient counseling, vasectomy techniques to maximize successful occlusion, and postvasectomy care. However, there are certainly areas of further improvement to be addressed. Vasectomy is severely underutilized compared with tubal ligation for sterilization, likely due to lack of patient awareness. Although the majority of vasectomies are performed in the office with local anesthesia, some patients are still routinely prescribed narcotics for postprocedural pain, despite the well-described opioid pandemic. Finally, although patients are counseled on the necessity of a postvasectomy semen analysis to confirm sterility prior to the discontinuation of alternative contraceptives, more than 50% of men do not complete this test. Therefore, alternative strategies must be pursued to improve patient compliance.

Topics: Clinical Decision-Making; Counseling; Fertility; Humans; Male; Men's Health; Patient Satisfaction; Patient Selection; Postoperative Complications; Semen Analysis; Treatment Outcome; Vasectomy

PubMed: 33879342
DOI: 10.1016/j.fertnstert.2021.03.045

Review

Authors: John K Amory

Although female contraceptives are very effective at preventing unintended pregnancy, some women can not use them because of health conditions or side-effects, leaving some couples without effective contraceptive options. In addition, many men wish to take active responsibility for family planning. Thus, there is a great need for male contraceptives to prevent unintended pregnancies, of which 80-90 million occur annually. At present, effective male contraceptive options are condoms and vasectomy, which are not ideal for all men. Therefore, efforts are under way to develop novel male contraceptives. This paper briefly reviews the advantages and disadvantages of condoms and vasectomies and then discusses the research directed toward development of novel methods of male contraception.

Topics: Condoms; Contraception; Contraceptive Agents, Male; Family Planning Services; Female; Fertility; Humans; Male; Pregnancy; Pregnancy, Unplanned; Risk Assessment; Risk Factors; Vasectomy

PubMed: 27678037
DOI: 10.1016/j.fertnstert.2016.08.036

Authors: Robert E Brannigan

Male reproduction and male contraception form an important spectrum within men's health. In this issue's Views and Reviews, four author groups detail important new developments in vasectomy clinical practice guidelines, emerging and investigational techniques in the fields of hormonal and nonhormonal male contraception, useful paradigms for patient care when deciding between sperm extraction with in vitro fertilization and vasectomy reversal, and finally, a state-of-the-art overview of recent developments in vasectomy reversal microsurgery. These articles will provide readers with a contemporary understanding of the rapidly evolving spectrum of male reproductive and contraceptive health care.

Topics: Contraceptive Agents, Male; Contraceptive Devices, Male; Contraceptive Effectiveness; Female; Fertility; Humans; Male; Men's Health; Microsurgery; Pregnancy; Vasectomy; Vasovasostomy

PubMed: 34053509
DOI: 10.1016/j.fertnstert.2021.04.029

Review

Authors: Ninaad S Awsare, Jai Krishnan, Greg B Boustead...

INTRODUCTION

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.

PATIENTS AND METHODS

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.

DISCUSSION

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 atherosclerotic heart disease. Similarly, vasectomy does not enhance risk of testicular or prostate cancer. Vasectomy has a lower mortality as compared to tubal occlusion, but is still significantly high in non-industrialised countries because of infections.

CONCLUSIONS

Vasectomy, though safe and relatively simple, requires a high level of expertise to minimise complications. Adequate pre-operative counselling is essential to increase patient acceptability of this method of permanent contraception.

Topics: Cardiovascular Diseases; Fistula; Hematoma; Humans; Immune System Diseases; Infections; Male; Pain, Postoperative; Treatment Failure; Urogenital Neoplasms; Vasectomy

PubMed: 16263006
DOI: 10.1308/003588405X71054

Meta-Analysis

Authors: Bimal Bhindi, Christopher J D Wallis, Madhur Nayan...

IMPORTANCE

Despite 3 decades of study, there remains ongoing debate regarding whether vasectomy is associated with prostate cancer.

OBJECTIVE

To determine if vasectomy is associated with prostate cancer.

DATA SOURCES

The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched for studies indexed from database inception to March 21, 2017, without language restriction.

STUDY SELECTION

Cohort, case-control, and cross-sectional studies reporting relative effect estimates for the association between vasectomy and prostate cancer were included.

DATA EXTRACTION AND SYNTHESIS

Two investigators performed study selection independently. Data were pooled separately by study design type using random-effects models. The Newcastle-Ottawa Scale was used to assess risk of bias.

MAIN OUTCOMES AND MEASURES

The primary outcome was any diagnosis of prostate cancer. Secondary outcomes were high-grade, advanced, and fatal prostate cancer.

RESULTS

Fifty-three studies (16 cohort studies including 2 563 519 participants, 33 case-control studies including 44 536 participants, and 4 cross-sectional studies including 12 098 221 participants) were included. Of these, 7 cohort studies (44%), 26 case-control studies (79%), and all 4 cross-sectional studies were deemed to have a moderate to high risk of bias. Among studies deemed to have a low risk of bias, a weak association was found among cohort studies (7 studies; adjusted rate ratio, 1.05; 95% CI, 1.02-1.09; P < .001; I2 = 9%) and a similar but nonsignificant association was found among case-control studies (6 studies; adjusted odds ratio, 1.06; 95% CI, 0.88-1.29; P = .54; I2 = 37%). Effect estimates were further from the null when studies with a moderate to high risk of bias were included. Associations between vasectomy and high-grade prostate cancer (6 studies; adjusted rate ratio, 1.03; 95% CI, 0.89-1.21; P = .67; I2 = 55%), advanced prostate cancer (6 studies; adjusted rate ratio, 1.08; 95% CI, 0.98-1.20; P = .11; I2 = 18%), and fatal prostate cancer (5 studies; adjusted rate ratio, 1.02; 95% CI, 0.92-1.14; P = .68; I2 = 26%) were not significant (all cohort studies). Based on these data, a 0.6% (95% CI, 0.3%-1.2%) absolute increase in lifetime risk of prostate cancer associated with vasectomy and a population-attributable fraction of 0.5% (95% CI, 0.2%-0.9%) were calculated.

CONCLUSIONS AND RELEVANCE

This review found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. There was a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design. This association is unlikely to be causal and should not preclude the use of vasectomy as a long-term contraceptive option.

Topics: Epidemiologic Studies; Humans; Male; Neoplasm Grading; Neoplasm Staging; Odds Ratio; Prostatic Neoplasms; Risk Factors; Sterilization Reversal; Vasectomy

PubMed: 28715534
DOI: 10.1001/jamainternmed.2017.2791

Meta-Analysis

Authors: Fang Yang, Liang Dong, Xiaojin Zhang...

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

Meta-Analysis Review

Authors: Zhen-Lang Guo, Jing-Li Xu, Ren-Kui Lai...

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

Authors: A K Banerjee, A Simpson

Topics: Female; Fertility; Humans; Male; Pregnancy; Vasectomy; Vasovasostomy

PubMed: 1392787
DOI: 10.1136/bmj.304.6835.1130

Meta-Analysis Review

Authors: Haifeng Duan, Tuo Deng, Yiwen Chen...

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

Meta-Analysis

Authors: Li Wang, Si-Yu Chen, Shun Wan...

BACKGROUND

The relationship between vasectomy and the risk of prostate cancer (PCa) remains unclear, with observational studies reporting inconsistent results. To clarify this ambiguity, we embarked on a comprehensive investigation comprising both a meta-analysis and a Mendelian randomization (MR) study. This dual approach aimed to thoroughly examine not only the association but also the causality between undergoing a vasectomy and the subsequent risk of PCa.

METHODS

Our systematic review meticulously examined cohort studies published until January 2024, employing a random effects model for the computation of relative risks (RR) and their 95% confidence intervals (CI). For MR Analysis, we leveraged aggregated data from the IEU Open GWAS database, investigating the correlation between genetic predisposition to vasectomy and PCa. We chose single nucleotide polymorphisms (SNPs) of European descent as instrumental variables (IVs) for this analysis. The primary method for calculating the odds ratios (ORs) and their 95% CIs was inverse variance weighting (IVW). Through sensitivity analysis, we confirmed the robustness of our findings.

RESULTS

Our investigation synthesized data from 19 cohort studies, encompassing over four million participants. The combined analysis revealed a statistically significant link between vasectomy and an elevated risk of PCa across any grade (RR = 1.09; 95%CI: 1.05-1.14; P = 0.001; I² = 83.3%). This association was observed for both localized PCa (RR = 1.08; 95% CI: 1.04-1.13; P < 0.001; I² = 48.8%) and advanced PCa (RR = 1.07; 95% CI: 1.01-1.13; P = 0.016; I² = 0%). Nonetheless, the discovery cohort MR Analysis indicated no genetic causal link between vasectomy and PCa (OR = 0.067; 95%CI = 0.002-1.535; P = 0.09). A validation set in the Finnish population confirmed the robustness of the results. This conclusion remained consistent even after controlling for variables such as prostate-specific antigen (PSA) testing and body mass index (BMI), suggesting that while a statistical association exists, the genetic evidence does not support a causal relationship.

CONCLUSION

The cumulative analysis indicates a possible elevated risk of PCa in patients who have had a vasectomy. However, MR Analysis has not confirmed a direct causal link between vasectomy and PCa. This suggests that the association observed may not stem from direct causation, allowing for the continued consideration of vasectomy as a viable long-term contraceptive choice. Further research is imperative to uncover any factors that could potentially link vasectomy to an increased risk of prostate cancer, aiming to provide a more comprehensive understanding of the implications.

Topics: Humans; Prostatic Neoplasms; Mendelian Randomization Analysis; Male; Vasectomy; Polymorphism, Single Nucleotide; Cohort Studies; Genetic Predisposition to Disease; Risk Factors; Genome-Wide Association Study

PubMed: 39994603
DOI: 10.1186/s12885-025-13750-8