No-scalpel vasectomy outside China

Since 1985, the no-scalpel vasectomy technique has been widely used outside China. The prevalence of this tech-nique has helped to increase the acceptability of male sterilization in many parts of the world. More than 5000 physi-cians in twenty-five developing countries have been trained in the no-scalpel vasectomy technique. In the United Statesin 1995, nearly one third of vasectomies employed the no-scalpel technique, and in the whole Northern American re-gion, a total of 1100 doctors have been made familiar with the technique. Doctors believe that there are several advan-tages of the no-scalpel technique, including no incision, no stitches, faster procedure, faster recovery, less chance ofbleeding, less discomfort and high efficacy. The key steps of the technique include fixation of the vas and infiltrationanaesthesia of the spermatic cord, as well as grasping, delivering and isolating the vas. No-scalpel technique providesa good approach to expose the vas, in conjunction with which, different vas-end occlusion methods may be used.(Asian J Androl 2000; 2: 21 - 24)

Effect of vasectomy via inguinal canal on spermatogenesis in rabbits

Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-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. Results： Neither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral shamoperated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation. Conclusion： Vasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.

Long-term effect of vasectomy on spermatogenesis in ,en： a morphometric study

Spermatogenic damage may occur after vasectomy, and the damage is pressure mediated, occurring when the occluded reproductive tract is unable to accommodate additional sperm produced by the testis. This study aimed to determine the long-term effect of vasectomy on spermatogenesis in humans and clarify how the balance between sperm production in the testis and sperm storage in or removal from the tract might be maintained. During inguinal hernia repair, an open biopsy was performed to obtain testicular tissue blocks from 51 Chinese men （aged ≥ 50 years）, of whom 25 （control group） had not undergone vasectomy and 26 （vasectomized group） had undergone bilateral vasectomy 22-42 years before. Methacrylate resin-embedded testicular sections were made, and morphometric studies were performed using light microscopy. In addition, sizes of the testis and epididymis were estimated with ultrasonography. The testicular tissue blocks obtained from one control and seven vasectomized men consisted almost completely of connective tissue. In the other 43 men, significant differences were not found between the two groups in the testicular or epididymal size, qualitative histology or quantitative parameters including the mean diameter or volume fraction of the seminiferous tubules. In conclusion, sperm production and sperm storage/removal reached a static equilibrium after vasectomy, likely due to spermatogenic degeneration or less sperm production as a result of aging or due to vasectomy-induced testicular （interstitial） fibrosis. Thus, complications that might occur in association with overproduction of sperm and distension of the tract would disappear or be relieved with time.

Morphological changes of spermatozoa in proximal vas deferens after vasectomy

Aim: To investigate the morphological changes of spermatozoa in the proximal vas deferens after vasectomy.Methods: Proximal vas deferens fluids were collected from 79 fertile men (group A) and 64 vasectomized men (groupB) during the operations of vasectomy or vasovasostomy. Sperm morphology in the proximal vas deferens wasanalyzed after staining with the modified Papanicolaou method. Results: The percentage of spermatozoa with anormal oval head from group B (50.7 % ± 21.7 % ) was significantly lower than that of group A (75.2 % ±11.1%). The data in group A was similar to those of normal semen and therefore represents the physiologicalcondition of the proximal vas deferens sperm of fertile men. There were no significant differences in the percentages ofnormal oval heads in group B with the time since vasectomy. Conclusion: After vasectomy, the spermatozoa in theproximal vas deferens and epididymis were continuously degenerating and being replenished by spermatozoa comingfrom testis. The obvious morphological degeneration occurred in the sperm tail and spermatozoa with a small oval headand amorphous heads were increased.

Histologic changes in the mouse testis after bilateral vasectomy

Aim: To study the effect of vaseetomy on histological appearance of the testis. Methods: Parkes strain mice wereused as the animal model; they were bilaterally vasectomized (Vx) or sham-operated (So) and killed at intervals of 4,6, 9, and 12 months after the operation. Testes were excised from 5 Vx and 5 So mice at each interval and processed for histological examination. Results: Testes of So mice showed normal histological features. By contrast, marked al-terations were observed in the seminiferou tubules in testes of Vx mice, except in those killed 4 months after the opera-tion. The seminiferous epithelium in the tubules was only 2-3 layers thick and showed much depletion of germ cells;in severe cases, the epithelium consisted of only a thin layer of Sertoli cells, spermatogonia and a few spermatocytes.Exfoliation of germ cells, occurrence of multinucleated giant cells and vacuolated appearance of the epithelium were ofcommon features in the tubules. Furthermore, lumen of the rete testis in Vx mice was greatly dilated and showed accu-mulation of sermatozoa with immature germ cells; in mice vasectomized for 6-12 months, several macrophages in-gesting spermatozoa were ofte observed in the lumen of the rete testis. Spermatic granuloma was also somettimes no-ticed in corpus or in cauda regions of the epididymis in mice vasectomized for 6-12 months. Conclusion: We sug-gest that consequences of vasectomy should be thoroughly understood in order to make this method rather more popularas a reversible method of male contraception.

Recent research on vasectomy techniques

Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.

Early and late long--term effects of vasectomy on Zn,Cd, and Cu levels in prostatic fluid and serum

Aim: To evaluate the early and late long-term effects of vasectomy on the serum and prostatic fluid trace elements.Methods: In 37 vasectomized and 25 non-vasectomized (control) men, the Zn, Cd and Cu levels in the serum andprostatic fluid were measured by means of inductively coupled plasma-atomic emission spectroscopy (ICP-AES). Re-suits: No significant difference was found in the prostatic Zn, Cd and Cu levels between the vasectomized and controlgroup. The Zn level in the semm were significantly lower in the vasectomized men than in the controls (11.04 and 13.54 umol/L, respectively; P < 0.05), while the serum Cd and Cu levels were not significantly different between thetwo groups. Conclusion: Vasectomy may decrease the serum, but not the prostatic Zn levels. Its pathophysiologicalsignificance is worthy of further investigation.

Long-term Reproductive Consequences of No-scalpel Vasectomy in Beagles

The effects of vasectomy on the reproductive organs in various species are controversial. This study investigated the morphological change and apoptosis of the testis, epididymis, and vas deferens in beagle dogs 12 months after vasectomy. The male beagles were divided into two groups: vasectomized and sham-operated groups (n=5 in each). Histopathological, ultrastructural, and TUNEL evaluation of the changes in the testis, epididymis, and ductus deferens of each animal were conducted 12 months after surgery. The mean lumen diameter, cellular thickness, mean interstitial distance, and lumen area fraction of each seminiferous tubule and ductus epididymis were measured by stereological analysis. The results showed that, compared with the sham-operated group, the seminiferous tubular epithelial cells of the testes in the vasectomized group were disorderly arranged and scattered. Significant atrophy and apoptosis were found in the endothelial cells, and a range of ultrastructural variations were observed in the cells of testes, epididymis, and vas deferens in vasectomized group. It was concluded that complete obstruction of the vas deferens as a traditional contraception method is not absolutely safe in terms of the reversal of fertility in the long run. Techniques of relieving the inner pressure in the vas deferens while maintaining the efficacy of male contraception need to be explored.

Impact of surgical volume and resident involvement on patency rates after vasectomy reversaldA 14-year experience in an open access system

Objective:Evaluate the influence of fellowship training,resident participation,reconstruction type,and patient factors on outcomes after vasectomy reversals in a high volume,open access system.Methods:Retrospective review of all vasectomy reversals performed at a single institution from January 1,2002 to December 31,2016 was conducted.Patient and spouse demographics,patient tobacco use and comorbidities,surgeon training and case volume,resident participation,reconstruction type,and postoperative patency were collected and analyzed.Results:Five hundred and twenty-six vasectomy reversals were performed during the study period.Follow-up was available in 80.6%of the cohort and overall patency,regardless of reconstruction type was 88.7%.The mean time to reversal was 7.87 years(range of 0-34 years).The majority of cases included resident participation.Case volume was high with faculty and residents logging a mean of 37.0 and 38.7(median 18 and 37)cases respectively.Bilateral vasovasostomy was the most common reconstruction type(83%)and demonstrated a significantly better patency rate(89%)than all other reconstructions(p=0.0008).Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training,resident participation or postgraduate year.Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency(p=0.0023 and p=0.043,respectively).Conclusions:Surgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility.Patency was better for bilateral vasovasostomies.Patency was not negatively impacted by tobacco use,comorbidities,resident participation,or post-graduate year.

The Observation of the Influence of Vasectomy on Some Immunological Functions in Rabbits

To study the functional changes of immunological survcillsnce after vasectomy,we hzve dynamically obscrved the influence of vasectonly on the functions of T lymphocytes and macrophages of peripheral blood from vasectomized animals as the exPerimental model. The results showed that: (1) PHA and Con-A induced mitogenesis of T lymphocytes from the rabbits vasectomized for eight months was significantly inhibited (P<0.01) and recovered in rabbits vasectoomized for 12, 18 and 22 months respectively, (2) The IL -2 secretion from peripheral blood mononuclcar cells (PBMCs) in the rabbits vasectomized for 8 months was reduced remarkably (P<0.01) and reached the normal level in the rabbits vasectomlied for 12 months; (3) A significant correlation was found betwecn Con-A induced mitogenesis of T lymphocytes and the IL-2 secrcted from PBMCs (r=0.661, P<0.01); (4) The IL- 1 secrction form periPhoal blood macrophsges induced by LPS significantly increased in the rabbits vasectonlized for S months (P<0.02) and returned to the normal level in the rabbits vasectomized for 12, 18 and 22 months respectively, (5) The levl of plasma lysozyme increased significantly in the rabbits vasectomized for 8 months (P<0.05) and returned to the normal in the rabbits vasectomized for 12 months, (6) The level of IL- 1 secreted by the macrophages and the level of plasma lysozyme were closely. Correlated (r=0.576, P<0.001). The present results may provide an expeimantal evidence for the evaluating the functional changes of immunological surveillance in vasectomized animals.

Pathological Influences of Twelve Months Vasectomy on the Reproductive Tissues in Rabbits

Objective - The effects of vasectomy on testes and related structures are disputable. The aim of this study was to determine whether the reproductive organs of rabbits were influenced after 12 months vasectomy. Study design – Bilateral vasectomy was performed on 10 male adult New Zealand Big Eared White Rabbits (another 10 rabbits set as sham operated group) and tissue samples were examined by light microscopy after 12 months treatment. The histologic alterations were observed and analyzed by stereology method. Cell apoptosis by Terminal Deoxynucleotidyl Transferase Mediated dUTP Nick End Labeling (TUNEL) assay were employed. Result - Bilateral vasectomy for 12 months affected the morphology of testis, epididymis and vas deferens tissues. Significant changes were noted in the histological stereology analysis. The apoptosis of the cells on the testis, epididymis and vas deferens increased compared with the sham operated group. Conclusion - Our findings suggest that the reproductive tissues of rabbits were influenced in a relatively longer term vasectomy.

Drawing - How Vasectomy Works: A View Inside

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Vasectomy reversal: A review of the evaluation, techniques, and outcomes

This review highlights the evaluation and treatment of men who have undergone vasectomy and desire vasectomy reversal to father children. For surgeons offering this treatment, the appropriate evaluation and treatment are crucial for acceptable outcomes. Although variations on surgical approaches have evolved over the years, one constant is the need for a high level o training and skill in microsurgical techniques.

The differenced of characteristics of contraceptive method of condom and vasectomy: A cross-sectional study among married of male in Indonesia

Background and aims:Indonesian government is regulating a family planning program to restricted fertility among reproductive aged.However,participated of married male for using contraceptive is very lowest in Indonesia.Methods:A cross-sectional study was conducted among 168 of married male(84 of condom method and 84 of vasectomy method)from April to August 2019 in Jember regency of East Java,Indonesia using purposive sampling method.A self-administered questionnaire was used to measure sociodemographic and contraceptive method of participants.Chi square test was performed to analyze the differences of characteristic of contraceptive method of condom and vasectomy among married male(P<0.05).Results:There were a significant differenced ethnic(χ^2=7.664,P-value=0.006)and access of information(χ^2=8.111,P-value=0.044)between condom and vasectomy method among married male.Conclusion:Characteristics of ethnic and access information are related with contraceptive method choosing for using condom and vasectomy among married male in Indonesia.Therefore,accessibility of contraceptive method through health education should be implemented for married male in Indonesia setting regarding their social and cultural context.

Studies on Pathogenesis and Prophylaxis and Treatment of Postvasectomy Epididymal Stasis Syndrome

Eighty-four hamsters were vasectomized on both sides,Another group of 76 hamsters was used as the control group.The animal experiment demonstrated that the epididymal function was damaged on the basis of the micropuncture and microanalysis of the epididymal plasma.Histologic examination revealed the dilatation of the lumen,infiltration of chronic inflammatory cells in the interstitium and sperm granuloma.Thirty-nine patients with postvasectomy epididymal stasis were treated with microwave radiation and 10 cases with epididymectomy.The B and C ultrasonography and MRI were used for diagnosis.Histologic examination suggested that chronic obstruction of vasectomy mode(both-side electric coagulation or keeping proximal open)may lead to formation of the new dynamic equilibrium, therefore benefiting the spermatogenesis of testis.Others with acute obstruction of the vas(bilateral ligation) may cause epididymal stasis.

What is No-Scalpel Vasectomy?

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Benefits of No-Scalpel Vasectomy Over Conventional Techniques

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Microsurgical vasovasostomy:An option for men with post vasectomy psychological distress

Vasectomy is a practical and straightforward approach to birth control.This paper presented a 31-year-old patient who desired to restore his fertility five years after being vasectomized.He met several obstacles.He developed severe psychological distress with symptoms of stress,anxiety,and aggression.He underwent microsurgical vasovasostomy,and vassal patency was confirmed by return of spermatozoa in semen samples 6 and 10 weeks after surgery,and symptoms of psychological distress disappeared.Preoperative vasectomy counseling should include information about vasectomy reversal.At the most,vasectomy reversal can be considered in selected men with psychological problems due to vasectomy.Microsurgical training should be offered to more urological surgeons,especially those who are interested in andrology.

Vasectomy reversal： a clinical update

Vasectomy is a safe and effective method of contraception used by 42-60 million men worldwide. Approximately 3%-6% of men opt for a vasectomy reversal due to the death of a child or divorce and remarriage, change in financial situation, desire for more children within the same marriage, or to alleviate the dreaded postvasectomy pain syndrome. Unlike vasectomy, vasectomy reversal is a much more technically challenging procedure that is performed only by a minority of urologists and places a larger financial strain on the patient since it is usually not covered by insurance. Interest in this procedure has increased since the operating microscope became available in the 1970s, which consequently led to improved patency and pregnancy rates following the procedure. In this clinical update, we discuss patient evaluation, variables that may influence reversal success rates, factors to consider in choosing to perform vasovasostomy versus vasoepididymostomy, and the usefulness of vasectomy reversal to alleviate postvasectomy pain syndrome. We also review the use of robotics for vasectomy reversal and other novel techniques and instrumentation that have emerged in recent years to aid in the success of this surgery.

Vasectomy reversal in China during the recent decade:insights from a multicenter retrospective investigation

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.