Incidence of Surgical Reintervention for Benign Prostatic Hyperplasia Following Prostatic Urethral Lift, Transurethral Resection of the Prostate, and Photoselective Vaporization of the Prostate: A TriNetX Analysis.

Background: Prostatic urethral lift, or UroLift, has gained popularity as a treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Surgical reintervention rates are a reliable indicator for treatment durability. Objective: The objective of this study was to utilize TriNetX, a third-party database, to investigate the incidence of surgical reintervention following UroLift, transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) procedures for BPH from 2015 to 2018. Design setting and participants: Male patients aged 18-100 yr diagnosed with BPH were identified in the TriNetX Diamond Network database between January 2015 and December 2018. Cohorts of individuals undergoing their first UroLift procedure were built using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. TURP and PVP cohorts were built as comparison groups. The cohorts were then queried for subsequent BPH-related procedures. Outcome measurements and statistical analysis: Reprocedure rates were assessed and descriptive statistics were used. Results and limitations: The mean age at first-time UroLift was 70.1 ± 9.4 yr (n = 14 343). Cumulative reprocedure rates collected after first-time UroLift included 1 yr after UroLift (5.1%, n = 14 343) and 4 yr after UroLift (16.1%, n = 710), with an average annual increase of +3.6% per year following 1 yr after the procedure. Comparatively, TURP (n = 22 071) and PVP (n = 14 110) had 4-yr reprocedure rates of 7.5% and 7.8%, respectively, during the same timeframe. Limitations include a lack of clinical data and loss of follow-up data outside the Diamond Network. Conclusions: The reprocedure rate of UroLift at 4 yr is double the rate of TURP and PVP. In appropriately selected patients, UroLift might be a suitable option for those who desire symptomatic relief from BPH with minimal erectile and ejaculatory side effects. However, the risk of secondary surgical intervention should be considered when considering BPH treatments. Patient summary: We compared the reintervention rates of prostatic urethral lift (PUL), transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) using the TriNetX database, and have found that the highest reintervention rates were for PUL of 16% at 4 yr of follow-up, compared with about 8% for those who had TURP and PVP. Interestingly, the most common reintervention was the same operation at 1 yr. This has important implications when counseling patients about the durability of these various outlet procedures for BPH.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study.

Objective: The objective of the study was to compare the outcome of tunica albuginea urethroplasty (TAU) and buccal mucosa graft (BMG) urethroplasty for anterior urethral stricture. Methods: Thirty patients who met the inclusion criteria were randomised into two groups: TAU (Group A) and BMG urethroplasty (Group B). Surgical outcome was evaluated with pre- and post-operative work-up involving retrograde urethrogram, voiding cystourethrogram, uroflowmetry, and urethroscopy. Patients were followed up till 1 year. Results: Mean duration of surgery was statistically significant between two groups (p=0.0005). Maximum urine flow rate was comparable when compared between two groups (p=0.22) but statistically significant when compared pre- and post-operatively (p<0.001). At follow-up of 1 year, the successful outcomes were 80% in Group A and 87% in Group B. A total of five patients who had unsuccessful results required redo urethroplasty. Complications were minimal in both the groups. Conclusion: TAU provides outcomes equivalent to those of BMG urethroplasty. TAU has less operative time, easy to perform, and beneficial in patients with poor oral hygiene.

Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients.

BACKGROUND: Thulium laser enucleation of the prostate (ThuLEP) is an established treatment option for benign prostatic enlargement (BPE), but long-term outcomes have not yet been reported. OBJECTIVE: To prove the durability of ThuLEP by investigating its long-term efficacy and morbidity. DESIGN, SETTING, AND PARTICIPANTS: All patients who underwent ThuLEP at a German tertiary referral center between 2009 and 2021 were retrospectively followed up for reinterventions for persistence or regrowth of prostate adenoma (ReIP) or long-term complications (ReIC). INTERVENTION: ThuLEP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We calculated the cumulative incidence for ReIP and ReIC at 10 yr. Univariate and multivariate Cox regression models were constructed to identify predictors of ReIP and ReIC. RESULTS AND LIMITATIONS: Overall, 1097 patients underwent ThuLEP. The median overall follow-up was 6.0 yr (interquartile range [IQR] 2.4-9.2). For one-third of patients (n = 369), median follow-up of 10 yr (IQR 9.1-11.2) was available. A total of 42 patients (3.8%) underwent ReIP after a median of 2 yr (IQR 0.3-4.9). The rate of long-term ReIC was 2.6% (n = 29) and the median time to ReIC was 0.5 yr (IQR 0.3-1.7). The most frequent ReIC was urethrotomy (n = 16, 1.5%). The cumulative incidence of ReIP and ReIC at 10 yr was estimated at 5.6% and 3.4%, respectively. Enucleation weight ≥60 g was a significant predictor of ReIP (hazard ratio 1.2, p = 0.014). The retrospective study design and the lack of functional outcomes are the main limitations. CONCLUSIONS: ThuLEP is a durably effective and safe procedure with low reintervention rates within 12 yr. PATIENT SUMMARY: This study investigated long-term outcomes of thulium laser enucleation of the prostate for benign enlargement of the prostate (BPE). Low rates of repeat treatment for BPE recurrence or for other complications were observed. Our results show the safety and efficacy of this treatment over a period of 12 years.

Sperm-related antigens, antibodies, and circulating immune complexes in sera of recently vasectomized men.

Sera from 35 men were collected before and at timed intervals subsequent to vasectomy and examined for the presence of (a) antibody reactive with human spermatozoa, (b) sperm-related antigen, and (c) circulating immune complexes (CIC). Fewer than 10% of the men examined were ever positive for antisperm antibodies. However, sperm-related antigens were elevated in the sera of 18, 18, and 26% of the mean at 2 wk, 2 mo, and 4 mo postvasectomy, respectively. CIC were detected in the sera of some vasectomized men by three different assays. The CIC in patients' sera were precipitated with polyethylene glycol, dissociated, and the individual CIC components identified by an enzyme-linked immunosorbent assay. Most, but not all, of the CIC contained antigen reactive with antisperm immunoglobulin (Ig)G and some also contained complement components C3 and/or Clq. IgA was identified in some of the CIC positive for IgG and sperm antigen and two men had IgM-containing CIC. Analysis of the CIC by sucrose gradient centrifugation revealed them to be heterogeneous in size.

Pudendal nerve blocks in men undergoing urethroplasty: a case series.

The pudendal nerve block (PNB) is widely used for regional anesthesia during obstetric and anorectal procedures, but its role in urologic procedures has not been thoroughly studied. While transvaginal PNB is relatively straightforward, PNB in male patients often requires imaging guidance due to difficulty appreciating anatomic landmarks. We review the PNB and relevant sonoanatomy, and describe its analgesic efficacy in three male patients undergoing urethroplasty for urethral stricture. In this procedure, the patient was placed in lithotomy position, the ischial tuberosity was palpated, and the sacrotuberous ligament and pudendal artery were identified using ultrasound. Ropivacaine was injected medial to the pudendal artery and disappearance of muscle twitch was demonstrated. Two patients reported well-controlled pain at 24 hours postoperatively. One reported perineal pain requiring additional analgesia. All patients were discharged on postoperative day 1 without complications. Ultrasound-guided PNB provides safe and reasonably effective pain control to male patients undergoing urologic procedures.

Vasectomy: subclinical pathologic changes.

The nature of the local histopathologic changes secondary to vasectomy is described in tissue excised at vasovasostomy in 37 secondarily infertile patients. Segments of surgically removed vasa were also studied in four patients with primary infertility who underwent scrotal explorations and subsequent vasoepididymostomy. Except for infertility, all patients were asymptomatic. Three, often concurrent, inflammatory or proliferative changes were found in 50 of 76 segments of vasa deferentia. These included suture granuloma, sperm granuloma, and vasitis nodosa, the last being a ductular proliferation originating from the central vas lumen and extending into the perivasal soft tissues. Vasitis nodosa occurred in 66% of the patients, and although it was often found with a sperm granuloma, it did occur by itself and is a lesion which should be recognized.

Evaluation of blood pressure in vasectomized and nonvasectomized men.

We assessed the effect of vasectomy on blood pressure by collecting cross-sectional data on the systolic and diastolic blood pressure of 946 male volunteer blood donors; of these, 30% were vasectomized. We used analysis of multiple covariance to correct both pressures for variation in age, weight, and height. Vasectomized and nonvasectomized men did not differ significantly in mean systolic or diastolic blood pressures. However, many of these men had been vasectomized for only a short period of time. We analysed the vasectomy subsample by multiple regression to determine whether blood pressures adjusted for age, body mass index, and height changed with time since vasectomy and found a slight, but non-significant, rise in the systolic pressure with square of time since vasectomy. The data are sufficiently strong to raise concern that data from a sample of men who have been vasectomized for longer periods of time would have shown a more dramatic increase.

PIP: This study evaluates the extent to which vasectomy might affect blood pressure thus contributing to hasten the rate of atherogenesis in men. Data were collected from 946 men, of whom 30.1% had been vasectomised; variables considered were number of years since vasectomy, weight, height, body mass and age. No significant differences were found in mean systolic or distolic blood pressure between the 2 groups of men, it was noted, however, that many men had been vasectomized only for a short period of time. When the group of vasectomized men were analyzed by multiple regression to determine the relation of blood pressure, age, body mass index, and height with time since vasectomy, a slight rise in systolic pressure was found, related with time since vasectomy. Conclusions from this investigation may not be correct for the general population since the sample studied here was nontypical and was not checked for factors such as race, diet, smoking habit, or physical fitness, which may potentially affect blood pressure. However, if the data are consistent with the hypothesis that there are no effects on blood pressure attributable to vasectomy, they also are consistent with a moderate rise in the systolic blood pressure of vasectomized males; the effect seems to accelerate with time. This problem should be further investigated on a larger number of males vasectomized for a period of 15 years or more.

A comparison of eight techniques for the evaluation of the auto-immune response to spermatozoa after vasectomy.

The tray agglutination tests (TAT), gelatin agglutination test (GAT), side agglutination test (SAT), tube-slide agglutination test (TSAT), sperm immobilization test (SIT), ATP-release cytotoxicity test (ARCT), indirect immunofluorescence technique (IFT) on methanol-fixed, intact spermatozoa, and a lymphocyte transformation test (LTT) were compared using a maximum of 329 blood samples taken from 47 men before and after vasectomy. The TAT, GAT, TSAT, SIT and ARCT discriminated between the pre- and post-vasectomy samples, and the sensitivity for sperm antibodies decreased in that order. The activity in the IFT and the LTT did not change significantly after vasectomy. In the TAT the mode of agglutination varied with serum dilution; the results for the 1:4 dilution showed the best agreement with the SAT results. Almost all TAT activity was detected by a combination of GAT and TSAT. Sperm agglutinins were present in all serum samples positive in the two complement-dependent tests, SIT and ARCT. If improved in sensitivity, the ARCT, which lacks the subjective elements of microscopy, might be suitable for the screening of male sera in clinical work. For the present, we recommend the TAT.

Counseling for sterilization.

PIP: The physician's counseling role in sterilization is discussed. Changing attitudes and technologic innovations have caused the demand for sterilization to increase dramatically. It is generally accepted that oral contraception should rarely be used by women beyond their mid-30s. Physicians should explain the procedure, its risks, and fallibility to couples contemplating sterilization. Concern about litigation need be no greater than in any other elective operation if this is done properly. Counseling should include the following areas: 1) Should sterilization be performed? 2) Which partner should have it done? 3) What method should be used? 4) When should it be done?^ieng

Psychologic effects of vasectomy in voluntarily childless men.

Forty-four childless men and 51 vasectomized parents were compared as to their childhood backgrounds, marital satisfaction, social/emotional adjustment, physical and emotional problems attributed to the vasectomy, and attitudes toward vasectomy as a means of birth control. The findings suggested that for young married men, firmly committed to childlessness and in agreement with their wives regarding the necessity of the operation, vasectomy appears to be as physically and psychologically safe as in married parents for at least a two-year period. There were differences in the childfree men and fathers in styles of adjustment, with the childfree reporting themselves to be more independent, mobile, and less tied to tradition; these differences were seen as being more related to choosing a childfree life style than to the choice of vasectomy as a contraceptive method.

PIP: A comparative study was conducted to determine whether vasectomy produces different physical and/or psychological effects in childless men and fathers. Subjects were 51 married vasectomized fathers and 44 married vasectomized, voluntarily childless men matched in age, education, and time of the vasectomy. All the vasectomies were performed at the Planned Parenthood Association of Maryland vasectomy clinic between 1971 and 1975. Determinants and results of the procedure were similar for both groups. All subjects indicated concurrence of the wife. Prior contraceptive methods used and practice levels were similar, with both groups using condoms at a higher rate than for the general population. Both groups reported a 5-10% short- or long-term complication rate. The childfree men reported themselves more independent and mobile and less tradition-bound than the fathers; these differences are attributed to their childlessness and not to the choice of vasectomy. The study findings show vasectomy to be physically and psychologically safe in both childless men and fathers.

Vasectomy with transurethral resection of prostate.

A retrospective study was made of 200 patients undergoing transurethral prostatectomy. Half of these patients received bilateral vasectomies. The vasectomized patients had a 5-percent incidence of epididymitis as compared with a 2-percent incidence in the nonvasectomized patients. Vasectomy failed to provide adequate protection against postoperative epididymitis and cannot be recommended as a routine procedure with a transurethral prostatectomy.

PIP: Transurethral prostatectomy was performed on 200 patients from the Lettermen Army Medical Center. The patients were divided into 2 groups: group 1 (N=100) consisted of those who had bilateral vasectomies immediately before transurethral resection, while group 2 consisted of those who did not have vasectomy and had no prior history of vasectomy or epididymitis (defined as tenderness, swelling, and/or induration of the epididymitis with or without fever). The 2 groups were followed up from 3 months to 6 years. Group 1 exhibited a 5% incidence of epididymitis compared with group 2's 2% incidence. A significant difference observed between the 2 groups was the duration of hospital stay: group 1 averaged 16 days while group 2 averaged 13.25 hospital days. Although prolonged hospital stay has been associated with risk of iatrogenic wound infections, it is not known whether it is a factor in postprostatectomy epididymitis. One possible explanation for the mechanism of epididymitis is the reflux of infected urine into the vas deferens; this is the rationale for performing vasectomy to prevent epididymitis. Incidence of postprostatectomy epididymitis can be reduced by using better equipment and optics (for more accurate resectioning), early treatment of prostatism, and shorter hospital stay. The findings of this study suggest that vasectomy does not reduce incidence of epididymitis and hence cannot be used as a routine procedure with a transurethral prostatectomy.

Vasectomy failure using an open-ended technique.

PIP: An open-ended vasectomy technique that involved purposeful creation of a sperm granuloma on the testicular side of the vas was used in 4 patients as a possible contribution to easier reversal, since animal and human studies suggest that such a granuloma prevents pressure-induced epididymal damage and favors maintenance of normal spermatogenesis. The 4 vasectomies were performed at an outpatient clinic using local anesthesia. Through transverse high scrotal incisions, .5 cm segments of vas were removed, and the abdominal side lumina were cauterized to a depth of .5 cm. The testicular side was neither cauterized nor ligated. No complications occurred in any patient, and all wounds healed normally. Examination of semen specimens 15 ejaculations after vasectomy revealed azoospermia in 2 men and active motile sperm in 2 others. Repeat semen analyses on the 2 men up to 5 months after vasectomy revealed persistence of motile spermatozoa. Repeat vasectomies were preformed, at which time sperm granulomas .5 cm in diameter were excised, and both vas lumina were cauterized, resulting in azoospermia on later semen analysis. The failure rate of 50% with the open-ended technique is clearly unacceptable. Cauterizing or removing a longer length of vas and transposition of the open testicular end to a separate fascial plane might reduce failure rates to acceptable levels, but until this is proven in large-scale studies, vasectomy should be presented as a permanent operation.^ieng

Is the low fertility rate after vasovasostomy caused by nerve resection during vasectomy?

Cross-sections of human spermatic cords and vasectomy specimens were prepared and the number and cross-sectional area of nerves were determined. On average, about one-half of all nerves in the near neighborhood of the vas deferens were resected during vasectomy. The total cross-sectional area of the nerves along the vasectomy specimens amounted to about one-half of the total area in the spermatic cord samples. The data support the hypothesis that removing nerves to the vas deferens during vasectomy could result in poor functional results after vasovasostomy, i.e., that powerful contraction of the proximal vas deferens and epididymis could be lacking.

PIP: The possibility that an aspect inherent in the surgical technique of vasectomy is responsible for the low rate of fertility after vasovasostomy was investigated by studying the localization of nerves in the neighborhood of the vas deferens in the spermatic cord and by determining whether and to what extent nerves are resected during vasectomy. In addition, the roles of nerves in vasectomy and vasovasostomy were investigated. Spermatic cords were dissected in cross-sections from 17 cadavers; specimens from vasectomies (vas deferens) were provided by a urology dept. (n=45). In the spermatic cord material, an arbitrary radius around the vas was studied for nerve characterization, and there was no obvious prevailing localization of nerves, but they were found in the whole circumferential adventitia of the vas deferens. In the vasectomy specimens, the adventitial tissue of the vas was missing; in most cases the larger areas of the vas were bare of adventitial tissue, and the vessels and nerves found were located on 1 or 2 sides of the vas. Quantitatively, the mean number of nerves per cross-section was about 1/2 of the number in spermatic cords; the total area of nerves resected on average during vasectomy amounted to nearly 50% of all nerves found near the vas in spermatic cords. This nerve resection could result in poor functional results after reversal of sterilization because the powerful contractions of the proximal vas deferens would be lacking.

Vasectomy: etiology of infectious complications.

Semen was cultured prior to vasectomy for voluntary sterilization. Postvasectomy infectious complications occurred only in patients with positive preoperative semen cultures. The offending pathogen was the same organism found in the semen culture. This evidence for an endogenous cause of postoperative vasectomy infections suggests that a semen culture and antimicrobial sensitivity be obtained prior to vasectomy. In this manner the correct antimicrobial agent can be instituted as an aid to rapid resolution of a postvasectomy infection.

PIP: Semen from 134 fertile prevasectomy patients was obtained and cultured to determine any relationship between prevasectomy culture and development of postvasectomy infection. Significant bacterial growth was found in the semen of 5 of 134 patients. Postvasectomy complications occurred in 6 patients (4.5%), and 3 of these were infectious complications (bacterial epididymitis and superficial wound infection). The infectious complications were associated with enterococci in the wound (n=1), escherichia coli in urine (n=1), and proteus mirabilis in urine (n=1). The same offending pathogen was found in semen culture. Only those patients with prevasectomy positive cultures encountered infectious complications postvasectomy; therefore, endogenous genital tract infection prevascetomy is associated with postvasectomy infection. Semen cultures prevasectomy are recommended so that appropriate antimicrobial therapy may be instituted at sterilization.

Vasectomy: efficacy of placing the cut vas in different fascial planes.

The inadvertent failure to achieve sterility in 8 to 40 vasectomy procedures afforded a rare opportunity to study the efficacy of placing the two cut ends of the vasa in different fascial planes. Interposition of the fascia was performed in 12 patients and was not performed in 28 others, with no significant difference in the failure rates of the two groups. Histologic examination of vasal tissue from one patient in each group revealed that a sperm granuloma can erode fascia and the wall of the vas.

PIP: In a series of 40 vasectomy patients, the procedures were performed through double vertical scrotal incisions. The vasa were separated from their sheaths and transected, but no part of the vas was removed. In 12 of the procedures, interposition of the fascia was performed and in the other 28, it was not. It has been felt that this interposition procedure created an impenetrable wall of fascia, preventing spontaneous anastomosis. The failure rate in this particular series was 21.4% for the patients in whom fascia was not interposed between the 2 cut ends of the vas; the failure rate for the 12 in whom fascia was interposed was 16.7%. There is no statistical difference in the failure rates for the 2 procedures. Thus, the interposition procedure does not seem to reduce the possibility of failure. Histologic examination of vasal tissue was made in 2 cases at the time of repeat vasectomy. 1 of these patients had undergone each of the 2 procedures. Microscopic pictures of the 2 cases are presented. The histologic examination showed that sperm granulomas can erode the fascia and the wall of the vas.

A review of 357 bilateral vasectomies for male sterilization.

A series of 357 bilateral vasectomies for male sterilization performed over a period of 18 months was reviewed to assess the safety of the surgical procedure, the onset of sterility, and the acceptability of the procedure. The surgical procedure proved to be safe with few complications, the patients became sterile after approximately 82 days, and the acceptability was very good. A group of 34 patients (10.8%) had a delay in the onset of aspermia. This is discussed in relation to the findings of other investigators.

PIP: A series of 357 bilateral vasectomies for male sterilization performed over a period of 18 months was reviewed to assess the safety of the surgical procedure, the onset of sterility, and the acceptability of the procedure. Before the procedure a preoperative interview of the applicant and his wife was done. 315 of the patients were suitable for follow-up. One group of men produced negative semen samples within 180 days and the second delivered the sample only after 180 days. The operation proved to be very safe with minor complications in less than 1% and epididymitis in 1.5%., hematoma in 0.2%, and scrotal abscesses in 0.4%. Psychosexually, all patients were satisfied with the procedure and would recommend it to friends. 281 patients, or 89.2% became sterile within a reasonable period of about 82 days and most resumed sexual intercourse 2-14 days after the intervention with a frequency of 2-3 times per week. No patients presented any symptoms of spermatic granuloma.

Seminal plasma concentration of glycerylphosphorylcholine before and after vasectomy and vas reanastomosis.

The concentration of glycerylphosphorylcholine (GPC) was determined in semen obtained from normal fertile, vasectomized, and vas-reanastomosed subjects. Concentrations of GPC were markedly lower in the semen of vasectomized men. GPC levels observed in vas-reanastomosed subjects were similar to those found in normal fertile men. Vasectomy may not affect GPC synthesis significantly.

PIP: Glycerlphosphorylcholine (GPC), an organic component of major consequence in human seminal plasma, was assayed in 3 population groups for comparison: normal fertile men, vasectomized men, and vas reanastomosed men. Subjects were matched for socioeonomic status and age. Long-term effects of vasectomy were apparent: the levels of GPC were significantly lower (P .001) in the vasectomized subjects. When these subjects were divided into various post vasectomy periods and were compared with each other, no significant difference was seen in the level of GPC. Vas reanastomosed seminal fluid showed similar levels of GPC as the levels among normal fertile subjects, even though no sperm were seen in the 1st ejaculate from the reanastomosed men. GPC levels, therefore, may be useful in the evaluation of the surgical success of reversible procedures for male sterilization.

The endocrine effects of vasectomy: a prospective five-year study.

A prospective study of plasma luteinizing hormone (LH) and testosterone in 54 men for 5 years following vasectomy revealed no significant continuing alteration in either testosterone or LH. Plasma LH levels 1 year after operation were higher than preoperative levels but did not increase further. Stimulation studies (4 years postvasectomy) using human chorionic gonadotropin confirmed acceptable Leydig cell functional reserve.

Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia.

The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.

PIP: In an Ottawa study, 410 patients consented to open-ended vasectomy, and in a St. Louis study, 23 patients underwent open-ended vasectomy, in which the abdominal end is cauterized but the lumen on the testicular side is not ligated, clipped, or cauterized. In the Ottawa series, 3% of the patients developed no sperm granuloma and 97% did develop sperm granuloma. The Concept unit was used on 148 patients with a 4% failure rate; however, the Hemoclip application was used on 262 patients with only a 0.4% failure rate. In the St. Louis series, all 23 patients developed sperm granulomas with l case of recanalization. In 9 patients referred to St. Louis for chronic and persistent postvasectomy orchialgia with pain localized in the epididymis, the pain was relieved by vasovasostomy. Evidence indicated that heat cautery was not as efficient a method of sealing the vas as the Hemoclips due to the high failure rate.

The bipolar needle for vasectomy. I. Experience with the first 1000 cases.

A battery-powered, bipolar electrocoagulator has been specifically developed for sealing the cut ends of the divided vas at vasectomy. With a minimum of electric power, the electrocoagulator destroys only the mucosa and one or two muscle cell layers of the vas, which leads to optimal fibrosis of the cut ends. This instrument has been used in more than 1000 vasectomies without a known failure and with a minimum of complications. An analysis of these cases is reported with emphasis upon the method's success in sealing the vas.

PIP: Experience with the bipolar needle in the 1st 1000 cases is reported. All vasa were electrocoagulated with the battery-powered, bipolar electrocoagulator under local anesthesia in the office. This instrument requires a minimum of electric power and destroys only the mucosa and 1 or 2 muscle cell layers. The patients ranged in ages between 20 and 68 (82.5% were between the ages of 20 and 40). The number of living children whom these men had fathered ranged from 0 to 9 (53.2% had 2 children and 9.4% had 4 or more). The analysis confirms the statement that the electrocoagulation, fascial interposition technique has never failed in the author's hands. When the results are compared with ligation and monopolar techniques, the figures cited for wound infection, hematomas, and congestive epididymitis are so similar that they prove the only difference is in the type of cautery used. The low incidence of granulomas (.4%) indicated that the bipolar needle is an effective instrument for sealing the cut vas without ligatures, clips, or other devices.