Trends in vasectomy and sexually transmitted diseases in Chile: findings from robust national databases.

A controversy about the increase or decline of vasectomy is emerging; however, the evidence is still scarce in Latin America. This ecological study analyzed the vasectomy and sexual transmitted diseases (STD) trends over a period of 10 years in Chile and determined if there is any relationship between them. We conducted a mixed ecological study using secondary and representative data on the number of vasectomies and STD cases from 2008 to 2017. Vasectomy rates were calculated for age-specific groups of men aged 20-59 years, and specific STD (HIV, chlamydia, gonorrhea, trichomoniasis, and syphilis) for the same period. Multivariate negative binomial regression models were fitted to evaluate rate trends and relationships. The mean vasectomy age was 40.3 years, with no significant differences between the years of the study (p = 0.058). The overall vasectomy rate significantly increased from 2008 to 2017 (p < 0.001), with differences between age groups (p < 0.001). The most significant increase was observed in men aged 30-49 (p < 0.001). The STD rates significantly increased (p < 0.05) during the study period. A significant positive correlation was found between vasectomy and gonorrhea incidence rates (p = 0.008) and an inverse correlation was found with hepatitis B incidence rates (p = 0.002). Vasectomy trends and STD rates significantly increased from 2018 to 2017 in Chile. especially among men aged 30-49 years. The relationship between vasectomy and STD increments suggests a new risk factor for reproductive and sexual health policies to aid controlling the HIV and STD epidemic.

Vasectomy and risk of prostate cancer: A Mendelian randomization study and confounder analysis.

BACKGROUND: Previous reports have shown a potential causal impact of vasectomy on prostate cancer (PCa). The objective of this study was to investigate the association between vasectomy and PCa, while evaluating the influence of confounding factors such as prostate-specific antigen (PSA) screening and body mass index (BMI). METHODS: Mendelian randomization (MR) study using summary statistics from genome-wide associations of vasectomy (462,933 European ancestry), ever had PSA test (200,410 European ancestry), time since last PSA test (46,104 European ancestry), BMI (152,893 European males) and PCa (79,148 cases, 61,106 controls, European ancestry). This study was conducted using summary statistic data from large, previously described cohorts. Data analyses were conducted from November 2022 to June 2023. RESULTS: Genetic liability to vasectomy was not associated with PCa (OR = 0.07, 95% CI: 2.95 × 10-3 , 1.54, p = 0.09). Genetic liability to vasectomy was not associated with ever had PSA test (OR = 1.08, 95% CI: 0.49-2.39, p = 0.83) and time since last PSA test (OR = 2.49, 95% CI: 0.71-8.79, p = 0.16). After controlling for PSA test and BMI, there remains no causal relationship between vasectomy and PCa risk (OR = 5.56 × 10-4 , 95% CI: 7.29 × 10-8 , 4.24, p = 0.10). The reverse MR results showed a weak association between PCa and vasectomy patients (OR = 1.00, 95% CI: 1.0003-1.0033, p = 0.02). CONCLUSION: Based on the available evidence from MR analysis, the current findings did not support vasectomy being a risk factor for PCa. Further work is required to provide additional confirmation and validation of the potential link.

Four Different Surgical Approaches to Vasectomies in Male Texas Bobwhite Quail (Colinus virginianus texanus) and Northern Bobwhite Quail (Colinus virginianus).

Vasectomies render a male sterile and have been used for various management purposes, including conservation efforts. This report evaluated 4 different surgical approaches (external approach, internal approach with dissection, internal approach with cautery, and internal approach caudally) to perform 177 vasectomies in Texas bobwhite (Colinus virginianus texanus; n = 171) and northern bobwhite quail (Colinus virginianus; n = 6) in a field setting. Birds were not randomized into groups for the different approaches. Survival was recorded in 83% (147/177) of the birds. The most common cause of death was hemorrhage from the common iliac vein due to damage during the surgical procedure. Other causes for death included transection of the ureter, parasitism, euthanasia, and undetermined causes. The approach that had the highest survival rate (89.8%, 132/147) was the internal approach with cautery, and based on these results the authors recommend this approach for vasectomies in Texas and northern bobwhite quail.

[Male contraception]. / Contraception masculine.

CONTEXT: Contraception is a major global health issue, which is still dominated by female contraception. Developments in male contraception could help redistribute the contraceptive burden. METHODS: A literature search was carried out to review the existing options and the criteria for optimal contraception, to establish the principles of a male pre-contraception consultation, and to review the various research avenues with their advantages and disadvantages. RESULTS: The new male contraception options are detailed, whether hormonal (androgen therapy, combination of progestins and testosterone) or non-hormonal, particularly thermal, with current results and avenues for improvement. Condom use and vasectomy remain the only 2 validated options. The recent development of minimally invasive vasectomy without the need for a scalpel and of occlusion techniques has simplified the procedure, minimised the risk of complications (pain, haematomas, post-vasectomy pain syndrome) and improved efficacy. The issues of regret and the possibility of repermeabilisation are also raised. CONCLUSION: The question of male contraception will become increasingly important in consultations with urologists. The urologist will have to inform the patient, as required by law, before the vasectomy is performed, and provide the best possible advice on the technique, which will often be minimally invasive without the need for a scalpel. New reversible options should also broaden the range of options available on a routine basis, with a view to gradually moving towards contraceptive equity.

Nanomaterials Solutions for Contraception: Concerns, Advances, and Prospects.

Preventing unintentional pregnancy is one of the goals of a global public health policy to minimize effects on individuals, families, and society. Various contraceptive formulations with high effectiveness and acceptance, including intrauterine devices, hormonal patches for females, and condoms and vasectomy for males, have been developed and adopted over the last decades. However, distinct breakthroughs of contraceptive techniques have not yet been achieved, while the associated long-term adverse effects are insurmountable, such as endocrine system disorder along with hormone administration, invasive ligation, and slowly restored fertility after removal of intrauterine devices. Spurred by developments of nanomaterials and bionanotechnologies, advanced contraceptives could be fulfilled via nanomaterial solutions with much safer and more controllable and effective approaches to meet various and specific needs for women and men at different reproductive stages. Nanomedicine techniques have been extended to develop contraceptive methods, such as the targeted drug delivery and controlled release of hormone using nanocarriers for females and physical stimulation assisted vasectomy using functional nanomaterials via photothermal treatment or magnetic hyperthermia for males. Nanomaterial solutions for advanced contraceptives offer significantly improved biosafety, noninvasive administration, and controllable reversibility. This review summarizes the nanomaterial solutions to female and male contraceptives including the working mechanisms, clinical concerns, and their merits and demerits. This work also reviewed the nanomaterials that have been adopted in contraceptive applications. In addition, we further discuss safety considerations and future perspectives of nanomaterials in nanostrategy development for next-generation contraceptives. We expect that nanomaterials would potentially replace conventional materials for contraception in the near future.

[Vasectomy under local anesthesia, retrospective evaluation of patient satisfaction in CH Annecy Genevois]. / La vasectomie sous anesthésie locale, évaluation rétrospective de la satisfaction des patients au CH Annecy Genevois.

Contraceptive vasectomy is a male sterilization technique by interrupting the continuity of the vas deferens. The primary endpoint of our study was to evaluate patients' feelings of vasectomy under local anesthesia. We collected responses from 108 patients who had a vasectomy under local anesthesia at the Center Hospitalier Annecy Genevois between January 1, 2020 and April 30, 2022. The average age of patients at the time of the vasectomy was 40years old. Patients were satisfied with the level of information before vasectomy for 104 of them (96%). The level of pain felt during the intervention evaluated by Visual Analog Scale had an average of 3.4/10 (standard deviation 2.4). The degree of satisfaction during the procedure was excellent/good for 103 patients (95%). In the follow-up, we reported 10 patients (10%) with a complication (hematoma, infection or healing problem). The retrospective evaluation found 103 patients (95%) who would repeat the procedure under the same modalities and 106 patients (98%) who would recommend vasectomy under local anesthesia to a relative/friend. Vasectomy under local anesthesia is increasingly common, so it is important to assess the feelings of patients with this modality. Our study had the advantage of bringing together a large number of patients over a short period with several different operators. Overall satisfaction with the hospitalization process and the procedure was very satisfactory. The patient journey was significantly simplified with local anesthesia instead of general anesthesia. LEVEL OF EVIDENCE: 4.

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices.

OBJECTIVES: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. PATIENTS AND METHODS: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. RESULTS: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. CONCLUSION: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Trends in the Vasectomy Rate Among Privately Insured Men Aged 18-64 in the United States Between 2014 and 2021.

OBJECTIVE: To update trends in the vasectomy rate among privately insured men aged 18-64 in the United States (U.S.) between 2014 and 2021. MATERIALS AND METHODS: We used commercial health insurance claims data between 2014 and 2021 to calculate the annual vasectomy rate in men aged 18-64 in the U.S. We performed these calculations nationally and by age group, marital status, maternal age of a wife, number of children, U.S. Census Bureau region, geography, geographical region, and state. We calculated the absolute and relative changes in these rates from 2014 to 2021 to study how much and how quickly they changed. RESULTS: The vasectomy rate among privately insured men aged 18-64 in the U.S. increased by 0.11%-a 26% change-from 2014 (0.427%) to 2021 (0.537%). The absolute changes were greatest in men with 3 or more children (0.489%), with 2 children (0.295%), with a wife not of advanced maternal age (0.276%), and aged 35-44 (0.243%). The relative changes were greatest in men with no children (61%), with a wife of advanced maternal age (40.8%), who were single (40.6%), and aged 18-24 (36.7%). In every region except the Northeast, the absolute and relative changes were greater in rural geographies compared to urban geographies. CONCLUSIONS: The vasectomy rate among privately insured men aged 18-64 in the U.S. increased between 2014 and 2021. Further investigation is needed to ensure demand for vasectomies may continue to be met.

Development and Application of a Novel and Efficient Skills Assessment Tool: A Pilot Initiative to Measure Vasectomy Competency on a Smartphone.

OBJECTIVE: To develop and evaluate a mobile phone-based skills assessment tool that measures procedural competency of urology residents learning to perform a common, non-robotic urology procedure as a means of tracking current skillset and improvement over time. METHODS: The assessment tool was a Qualtrics survey accessed via a smartphone link that breaks down a vasectomy into 6 critical steps. Level of competency was measured on a scale of '1-novice' to '5-expert.' Nine residents from Post graduate year (PGY)-1 to PGY-5 were evaluated by one instructor after completing a vasectomy (86 single-side cases recorded over a 6-month period). We compared individual trainees to each other, analyzed performance (improvement) over time, and evaluated competency against cohort and program averages. RESULTS: As an example, a single resident ('Resident 2,' N = 11 cases) was compared to cohort (PGY, M = 7.5/resident) and program (all residents, M = 7.4/resident). Results indicate similar skillfulness across Step 1 (puncturing and isolation of vas and hand positioning; P > 0.1), but marginally lower competency on Step 2 (opening of vasal sheath to expose/isolate vas; vs. cohort: P = 0.076, vs. residents: P = 0.082). Significantly lower competency on Steps 3-6 (all P < 0.04) suggests targeted teaching could improve cautery technique, fascial interposition, hemostasis, and positioning of stumps. CONCLUSION: Our mobile-based skills assessment is a low cost, novel, and efficient assessment that would support current Accreditation Council for Graduate Medical Education (ACGME) goals to increase competency-based residency training. This tool is easily created and accessed, provides real-time feedback to learners, and can be used for individual and group assessment at a single timepoint or longitudinally.

Telehealth Sterilization Consultation Does Not Impact Likelihood of Vasectomy: A Retrospective Institutional Analysis.

OBJECTIVE: To evaluate if telehealth consultations would impact the likelihood of patients following through with vasectomies. METHODS: We utilized electronic medical records from the past 5 years to retrospectively evaluate male patients undergoing a sterilization consult. Telehealth consultations have been offered since March 2020 due to the COVID-19 pandemic. Patients were stratified to in-office or telehealth consultation. We then utilized billing codes to determine if patients underwent a vasectomy. Percentages of patients who subsequently underwent vasectomy were compared using Chi-square analysis. Logistic regression was performed to identify factors associated with completing vasectomy. RESULTS: There were a total of 369 patients who underwent a telehealth male sterilization consultation and 1664 patients who were seen in the office. We found that 66.9% of telehealth patients ultimately underwent a vasectomy (n.ß=.ß247) compared to 64.3% of patients who were seen via office assessment (n.ß=.ß1070) (X2 =.ß0.646, p.ß=.ß.724). Younger age was the only variable on univariate logistic regression that was associated with completing vasectomy (p.ß=.ß.002) via either an in-person or televisit, while body mass index, race, and ethnicity were not significant. CONCLUSION: Only 2/3 of the men completing a vasectomy consult receive a subsequent vasectomy. Both in-office and telehealth consultations resulted in comparable rates of vasectomy. This is the first study to report on the likelihood of following through with a surgical procedure comparing in-office vs.ßtelehealth assessment in male sexual and reproductive medicine. As vasectomy consultations continue to rise, clinicians can be reassured by the effectiveness of telehealth consultations prior to vasectomy.

Knowledge and Willingness to Accept Vasectomy as a Method of Family Planning among Married Male Workers in the University of Nigeria, Enugu Campus, Enugu State, Nigeria.

BACKGROUND: Vasectomy is a safe and effective contraceptive option available to men, yet the practice is very low. The study aimed to assess the knowledge and willingness to accept vasectomy as a method of family planning among male married workers in a university in Enugu, Nigeria. METHODS: This was a cross-sectional study conducted among 405 male married workers in a tertiary institution in Enugu, Nigeria. Samples were selected using multistage sampling technique. Data was collected using pretested structured questionnaire and analyzed using proportion, chi - square and logistic regression. Statistical significance was set at < 0.05. RESULTS: Very few of the respondents, 10.6% had good knowledge of vasectomy and about 20.7% showed willingness to accept vasectomy as a contraceptive option. Educational level (AOR = 2.441, C.I = 1.158 - 5.146), wife support (AOR = 0.201, C.I = 0.071 - 0.571) and completed family size (AOR = 0.063, P = 0.030 - 0.136) were found to be the predictors of willingness to use vasectomy as a contraceptive among male workers of University of Nigeria, Enugu. CONCLUSION: Knowledge of vasectomy and willingness to accept it as a contraceptive were found to be poor. Awareness campaign and health education on vasectomy and ensuring that family planning services are attended by couples with completed family size will improve knowledge and willingness to accept vasectomy.

CONTEXTE: La vasectomie est une option contraceptive sûre etCefficace offerte aux hommes, mais sa pratique est très faible. L'étude visait à évaluer les connaissances et la volonté d'accepter la vasectomie comme méthode de planification familiale chez les travailleurs mariés de sexe masculin dans une université d'Enugu, au Nigeria. MÉTHODES: Il s'agit d'une étude transversale menée auprès de 405 hommes mariés travaillant dans une institution tertiaire à Enugu, au Nigeria. Les échantillons ont été sélectionnés à l'aide d'une technique d'échantillonnage à plusieurs degrés. Les données ont été recueillies à l'aide d'un questionnaire structuré prétesté et analysées à l'aide de proportions, du chi carré et de la régression logistique. La signification statistique a été fixée à < 0,05. RÉSULTATS: Très peu de répondants, 10,6 %, avaient une bonne connaissance de la vasectomie et environ 20,7 % étaient prêts à accepter la vasectomie comme option contraceptive. Le niveau d'éducation (AOR = 2,441, C.I = 1,158 - 5,146), le soutien de l'épouse (AOR = 0,201, C.I = 0,071 ­ 0,571) et la taille de la famille (AOR = 0,063, P = 0,030 - 0,136) se sont avérés être les prédicteurs de la volonté d'utiliser la vasectomie comme moyen de contraception parmi les travailleurs masculins de l'Université du Nigeria, Enugu. CONCLUSION: La connaissance de la vasectomie et la volonté de l'accepter comme moyen de contraception sont faibles. Une campagne de sensibilisation et d'éducation sanitaire sur la vasectomie et l'assurance que les services de planification familiale sont fréquentés par des couples ayant une taille de famille complète amélioreront la connaissance et la volonté d'accepter la vasectomie. Mots clés: Connaissance, Volonté, Vasectomie, Planification familiale, Homme, Nigeria.

The Diversity of Vasectomy Reversal Providers and Their Web-based Advertising Habits in the United States.

OBJECTIVE: To better understand the internet advertising material published on clinician websites for the 30,000 men who undergo evaluation for vasectomy reversal (VR), which is a technically demanding procedure requiring microsurgical expertise. METHODS: Internet search trends for "vasectomy" and "vasectomy reversal" from 2004 to 2022 were assessed using Google Trends. Search engines were then queried on a state-by-state basis for physicians performing VR and the available information aggregated and analyzed using standard statistical approaches. RESULTS: VR search volume consistently represented roughly one-tenth of the search volume for vasectomy. One hundred and ninety reversal clinics were identified in 44 of 50 states with the highest number identified in the southeast region and an overall median price of $6500. Ninety percent of physicians were male and completed residencies in urology. Other specialties included obstetrics and gynecology, general surgery, family medicine and orthopedic surgery. Forty-two percent of urologists had completed infertility fellowships. Sixty percent of physicians utilized a microscope, and 4.7% of physicians explicitly stated they did not perform vasoepididymostomy even when indicated. Fifty two percent of clinics reported VR success rates as high as 100%, and 34% of clinics reported pregnancy outcomes. Twenty-five percent of clinics reported out-of-pocket VR pricing and 26% discussed possible complications. CONCLUSION: VR is a technically demanding cash-pay procedure being performed by physicians with a wide array of backgrounds and outcomes. Urologists should strive to lead by example and report their training, personal experiences, and expected outcomes to enable optimal medical decision making for each patient.

Down But Not Out: Vasectomy Is Faring Poorly Almost Everywhere-We Can Do Better To Make It A True Method Option.

INTRODUCTION: Demand for vasectomy-1 of 2 contraceptive methods for men-has been low, with deep-seated myths, misconceptions, and provider bias against it widespread. Programmatic attention and donor funding have been limited and sporadic. METHODS: We analyzed vasectomy use in 84 low- and middle-income countries (LMICs) plus the 11 high-income countries with vasectomy prevalence above 1%. These 95 countries comprise 90% of the world's population. Data come from United Nations survey compilations, population estimates, and gender inequality rankings. We also reviewed recent articles on vasectomy and analyses of chronic challenges to vasectomy service provision. RESULTS: Vasectomy use is 61% lower now than 2 decades ago. Of 922 million women using contraception worldwide, 17 million rely on vasectomy-27 million fewer than in 2001. In contrast, 219 million women use tubectomy-8 million more than in 2001. Of 84 LMICs, 7 report vasectomy prevalence above 2%. In 56 LMICs, no more than 1 in 1,000 women relies on vasectomy. Female-to-male disparities in permanent method use widened globally, from 5:1 to 13:1, and are much higher in some regions and countries (e.g., 76:1 in India). Countries with the highest vasectomy prevalence are among those with the highest gender equality and vice versa. CONCLUSION: Vasectomy use is surprisingly low globally and declining. Use remains negligible in almost all LMICs, reflecting low demand and program priority. For vasectomy to become an accessible, rights-based option, program efforts need to be holistic, ensuring an enabling environment while coordinating demand- and service-focused efforts. Vasectomy champions at all levels should be supported on a sustained basis. On the demand side, harnessing mass and social media to increase accurate knowledge and normalize vasectomy as a method and service will be particularly valuable. Evidence from Bolivia suggests relatively few trained providers and procedures could result in a country's attaining 1% vasectomy prevalence.

[Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy]. / Recommandations du Comité d'Andrologie et de Médecine Sexuelle de l'AFU concernant la prise en charge de la vasectomie.

OBJECTIVES: To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request. METHOD: The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021 identified 508 references, of which 79 were selected and analyzed with the GRADE grid. RECOMMENDATIONS: Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.

Vasectomy and ovary-sparing spay in dogs: comparison of health and behavior outcomes with gonadectomized and sexually intact dogs.

OBJECTIVE: To compare health and behavior outcomes for dogs that underwent vasectomy or ovary-sparing spay (hysterectomy) with sexually intact dogs or dogs that had undergone traditional castration or spay. SAMPLE: 6,018 dog owners responded to a web-based survey between November 3, 2021, and January 7, 2022. PROCEDURES: Participants were asked demographic questions and to provide information about 1 or more dogs (living or deceased). Options for reproductive status were as follows: sexually intact, castrated, spayed (ovariohysterectomy or ovariectomy), vasectomy, or ovary-sparing spay (hysterectomy). Participants were asked questions about orthopedic and other health problems, cancer, and problematic behavior. Logistic regression models, survival analyses, and descriptive statistics were used to assess relationships between reproductive status and outcomes. RESULTS: Owners provided valid surveys for 6,018 dogs, including 1,056 sexually intact, 1,672 castrated, and 58 vasectomized male dogs and 792 sexually intact, 2,281 spayed, and 159 female dogs that had undergone ovary-sparing spay. Longer exposure to gonadal hormones, regardless of reproductive status, was associated with reduced odds of general health problems and both problematic and nuisance behaviors. CLINICAL RELEVANCE: To our knowledge, this study provides the first data on health and behavior outcomes of vasectomy and ovary-sparing spay in dogs and is the first to compare these outcomes to sexually intact and gonadectomized dogs. It adds to accumulating data on the mixed benefits and risks of removing the gonads to prevent reproduction and emphasizes the importance of developing an informed, case-by-case assessment of each patient, taking into consideration the potential risks and benefits of spaying or neutering and alternative reproductive surgeries.