Standard Vasectomy Research Articles

Fournier’s Gangrene after Bilateral Vasectomy-A Case Report

Fournier’s gangrene is an acute, rapidly progressing, potentially fatal necrotizing fasciitis affectingthe external genitalia, perineal or perianal regions and is caused by a mixed infection with aerobic/anaerobic bacteria, which commonly affects the men, but can also occur in women and children. The most common foci of infection are from gastrointestinal tract, genitourinary tract or less commonly from the cutaneous injuries. The common risk factors includediabetes mellitus,alcohol abuse, extremes of age, male gender, chronic steroid use, malnutrition and immunosuppression. Uncommonly, Fournier’s gangrene has been documented after vasectomy operation-a permanent technique for male partner sterilization. Here we present a case of Fournier’s gangrene in an adult male who had undergone bilateral standard vasectomy for permanent contraception and presenting after 7 days with gangrene in the scrotum requiring urgent debridement and broad-spectrum antibiotics.

A comparative study of scalpel versus no scalpel vasectomy

Background: The objective of this study was to compare the standard vasectomy method and no scalpel vasectomy and complications, effectiveness, safety and acceptability of standard vasectomy (SV) versus no-scalpel standard vasectomy (NSV).Methods: Informed man who does not want to become father of any children and who desires an inexpensive outpatient method of voluntary permanent surgical sterilization, explain to patient and his wife regarding both procedure, semen analysis done after 3 months in every patient. Results: In NSV 72% patients required 10 to 20 minutes and in SV 100% required 20 to 35 minutes operative time. NSV, out of which 28% and in SV performed 60% having perioperative pain. NSV only 8% and 40% in SV having pain during follow up. In NSV average analgesic requirement was 2-3 days while among SV average analgesic requirement was 6-8 days. NSV, average antibiotic requirement was 5 days while among SV average antibiotic requirement was 7-10 days. In NSV 8% and in SV 32% were having infection during follow up. In NSV8% having wound problem during follow-up. In SV 32% having wound problem during follow-up. NSV 0% and in SV4% having vasectomy failure.Conclusions: Compared to the standard vasectomy technique, the no-scalpel vasectomy approach to the vas resulted in less bleeding, less pain during or after the procedure, and infection, as well as a shorter operative time, no longer day’s analgesic and antibiotic requirement and a more rapid resumption of sexual activity.

LAPAROSCOPIC MOBILIZATION OF THE RETROPERITONEAL VAS DEFERENS FOR MICROSCOPIC INGUINAL VASOVASOSTOMY

The management of obstructive azoospermia arising from previous inguinal hernia repair represents an uncommon dilemma. Mobilization of an adequate length of abdominal vas to provide a tension-free anastamosis for inguinal vasovasostomy is technically difficult. We report a novel laparoscopic approach to mobilization of the inguinal vas. CASE REPORT A 41-year-old male with a history of combined vasectomy and right polypropylene mesh hernia repair was referred for vasectomy reversal. At the time of the right inguinal hernia repair right inguinal vasectomy and left scrotal vasectomy were performed. At exploration standard 2-layer microscopic vasovasostomy was performed on the left side. On the right sid ea2c m inguinal incision was made at the level of the external ring. The right vas deferens was identified just inferior and medial to the area of the hernia repair and was incised approximately 0.5 cm from the area of the hernia site. Fluid from the testicular aspect of the vas revealed motile sperm. Laparoscopic mobilization of the abdominal aspect of the right vas deferens was initiated with a 12 mm port placed at the umbilicus, the abdomen was insufflated, a 10 mm laparoscope was placed and 2, 12 mm ports were placed in the lower midline and the lateral right lower quadrant. The right vas deferens and testicular vessels were seen coursing into the hernia repair site (fig. 1). The peritoneum overlying the right vas deferens was dissected free, and the vas deferens was mobilized with its blood supply off the pelvic side wall down to the polypropylene mesh. A tunnel was created bluntly for the vas to exit through the transversalis fascia and out through the external inguinal ring. The vas deferens was then transected as it entered the polyprolyene mesh plug and pulled medial to the medial umbilical ligament. A right angle clampwas then p laced inguinally through the transversalis fascia tunnel. The clamp was visualized laparoscopically, and the vas was then transferred to the right angle clamp and pulled through the external ring (fig. 2). Approximately 5 cm vas was mobilized using this technique (55 minutes). A 2-layer inguinal microscopic vasovasostomy was performed. Postoperatively sperm concentration increased from 15 million per ml (1 month) to 42 million per ml (6 months), with increased motility from 1% (1 month) to 30% (6 months). A healthy child was born at 1.5 years postoperatively. Since combined scrotal and inguinal vasovasostomy was performed, success of the inguinal reconstruction cannot be clearly determined. DISCUSSION The success rate for inguinal vasal repair following herniorrhaphy is poorer than that in standard vasectomy reversal cases where scrotal vasovasostomy may be performed, and is likely related to the technical difficulty associated with microsurgical anastomosis in the inguinal canal or other factors related to iatrogenic vasal injury.1, 2 Buch and Woods reported that 5.83 cm additional length can be gained from retroperitoneal dissection of the vas and redirection through the external ring.3 Inguinal and retroperitoneal approaches in patients with inguinal vasal obstruction may require a large incision and extensive dissection, and result in subsequent increased morbidity especially associated with polypropylene mesh. Laparoscopic vasal mobilization theoretically maintains the efficacy of the hernia repair, mini

Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? a prospective randomized trial

Objectives. To assess the effect of irrigation of the distal vas deferens with sterile water at the time of vasectomy on sperm clearance. Is it possible to accelerate clearance and avoid the problem of lingering sperm?Methods. Two hundred men undergoing vasectomy were randomized to receive either a standard vasectomy or vasectomy plus irrigation of each vas deferens with sterile water. The interval between vasectomy and the production of two azoospermic semen samples was recorded.Results. Overall, 37 patients were excluded for failing to follow the postvasectomy protocol for semen analysis, leaving 87 in the control group and 76 who received vasal irrigation. No statistically significant differences existed between the two groups with regard to the mean time to clearance (26.4 weeks, control group versus 28.6 weeks, flush group), proportion clear at 16 weeks (29% versus 21%), or proportion with lingering sperm at 40 weeks (22% versus 26%).Conclusions. Irrigation of the vas deferens with sterile water does not accelerate the clearance of spermatozoa after vasectomy. Men wishing to undergo vasectomy must be counseled about the possibility of lingering sperm.

COMPARATIVE EVALUATION OF NO-SCALPEL VASECTOMY AND STANDARD INCISIONAL VASECTOMY

No-scalpel vasectomy employs a refined method of dissection and delivery of the vas deferens. We compared no-scalpel vasectomy with standard incisional vasectomy in 176 patients over a 33 month period. The haemorrhage rate was 1.08 per cent for no-scalpel vasectomy compared with 11.9 per cent for standard vasectomy (p < 0.005). The infection rate was 3.26 per cent for no-scalpel vasectomy as against 14.28 per cent for standard vasectomy (p < 0.01). There was a 37.5 per cent reduction in operating time and a substantial reduction in pain during and after the procedure when no-scalpel vasectomy was performed and also there was no failure of vasectomy. No-scalpel vasectomy is a satisfactory alternative to standard vasectomy with fewer complications and increased patient acceptability.

No-scalpel vasectomy at the King's birthday vasectomy festival

No-scalpel vasectomy was developed to increase acceptability of vasectomy by elimination of the fear of the incision. Although this method has been used for over 8000 000 men, the technique is largely unknown in developed countries. During the King's birthday vasectomy festival no-scalpel vasectomy was compared with standard incisional vasectomy in 1203 patients. An average of 57 procedures per day could be done by each physician with the no-scalpel method, compared to 33 procedures with the standard method (p<0·001). The complication rate was 0·4/100 procedures for no-scalpel vasectomy compared with 3·1/100 for standard vasectomy (p<0·001). No-scalpel vasectomy is a rapid and economic alternative to standard vasectomy, with fewer complications and increased patient acceptability.

Nitrofurazone: Vas Irrigation as an Adjunct in Vasectomy

Intraoperative vas irrigation with nitrofurazone utilized in a 1-mg/ml concentration can cause immediate sterility postoperatively. This irrigation procedure adds little time to the standard vasectomy and can easily be performed as an outpatient office procedure, minimizing time-consuming postoperative semen analyses. Moreover, in developing countries where postoperative vasectomy follow-up may be more difficult to obtain and may even be nonexistent, this procedure would provide an additional positive factor in an attempt to ensure sterility.

Prevalence of Circulating HL-A Lymphocytotoxic Antibodies in Men After Vasectomy

Thirty-two men undergoing vasectomy were studied for one year to determine presence of HL-A antibodies after surgery. Blood samples were taken prior to vasectomy and at three, six, nine, and 12 months following surgery. Twenty-six men showed no increase in antibody activity during the study when their sera were matched against a 25-member typed lymphocyte donor panel. Sera of two men showed a definite increase in positive reactions, six to 12 months after surgery. The sera of four men showed slight increases in reactivity between three and 12 months after vasectomy. The serum of one man showed a single positive reaction against his own lymphocytes three months after surgery, but no positive reactivity against the lymphocyte donor panel. These studies suggest that HL-A antibodies are not regularly formed as a result of standard vasectomy procedures, but that further long-term evaluation of vasectomized patients may be needed to make definite conclusions.

Control of male fertility report of a workshop

34 speakers participated in a workshop on the control of male fertility and the information they presented is summarized in this report. Possible targets for contraceptive action include: 1) the anterior pelvic ganglia with its adrenergic neurons 2) interference with a sperm-coating protein 3) use of small molecular weight compounds in the permeable epididymis and 4) enzyme inhibitors which affect sperm motility. Vasectomy is discussed including the relative lack of success in achieving pregnancy (30%) after successful restoration of the vas. The use of reversible valves and other occluding devices also has problems in restoring normal sperm count. Use of chemical methods of vas occlusion has a higher failure rate than that of standard vasectomy. No adverse effects of vasectomy on the endocrinological status of the patients have been detected. Data on antibody development in vasectomized men suggest there is large variability (20%-50%) in the number who develop sperm-immobilizing and sperm-agglutinating activity.

Nitrofurans: Sperm-immobilizing agents Their tissue toxicity and clinical application

Nitrofurantoin sodium and nitrofurazone in certain critical concentrations have the ability to cause sperm immobilization. Intraoperative vas irrigation with these solutions in 24 patients has produced sterility in the immediate postoperative period. This irrigation procedure adds little time to the standard vasectomy and can easily be performed as an in-office procedure. This minimizes time-consuming postoperative sperm analyses. Moreover, in underdeveloped countries where postoperative follow-up is more difficult to obtain, this procedure would provide an additional positive factor in an attempt to insure sterility.