Vasectomy Knowledge and Interest Among U.S. Men Who Do Not Intend to Have More Children.

Vasectomy is used less often than female sterilization, and many men who do not want more children may lack accurate information about vasectomy. Between May and June 2018, we used a nationally representative online panel to survey U.S. men between 25 and 55 years of age who did not want more children about their vasectomy knowledge. We also asked about interest in undergoing the procedure if it were free or low cost and explored whether a paragraph addressing common misperceptions was associated with interest. We assessed characteristics associated with high vasectomy knowledge (≥3 accurate responses to four questions about vasectomy's effect on sexual functioning and method efficacy) and vasectomy interest, using chi-square tests and multivariable-adjusted Poisson regression. Of 620 men surveyed, 564 had complete data on the outcomes and covariates of interest. Overall, 51% of respondents demonstrated high vasectomy knowledge. Men who knew someone who had a vasectomy were more likely to have high knowledge (prevalence ratio [PR]: 1.50; 95% CI [1.22, 1.85]). One-third of the sample (35%) said they would consider getting a vasectomy. Men with high (vs. moderate/low) knowledge were more likely (PR: 1.36; 95% CI [1.04, 1.77]) to consider getting a vasectomy. Race/ethnicity, income level, and receiving the informational paragraph were not associated with vasectomy interest. Greater vasectomy knowledge affects men's interest in the procedure. Given that many U.S. men lack accurate knowledge, efforts are needed to address misinformation and increase awareness about vasectomy to ensure men have the information they need to meet or contribute to reproductive goals.

Vasectomy utilization in men aged 18-45 declined between 2002 and 2017: Results from the United States National Survey for Family Growth data.

BACKGROUND: Vasectomy remains a safe, simple, and effective contraceptive option. Conflicting data on the trend of vasectomy use among men have been described previously at various snapshots in time over the last two decades. OBJECTIVES: This paper seeks to describe the trend of vasectomy utilization in the last 15 years using a nationally representative US survey. MATERIALS AND METHODS: We analyzed data from male respondents aged 18 to 45 years of the Cycle 6 (2002), 2006-2010, 2011-2013, 2013-2015, and 2015-2017 National Survey of Family Growth (NSFG) surveys. Population estimates are calculated based on the official NSFG instructions, accounting for the complex survey design. Multivariate logistic regression models are used to study demographic and socioeconomic factors associated with vasectomy use in men. RESULTS: Baseline characteristics for men undergoing vasectomy do not differ significantly across survey years. Increased age, White race, marital status, higher education level, birthplace within the United States, higher household income, non-Catholic affiliation, and higher number of biological kids have significant positive associations with vasectomy use. After accounting for factors associated with vasectomy utilization, there was a significant temporal decline in vasectomy utilization rates in all age groups across survey years which remained in subgroup analyses of all men greater than 25, 30, and 35 years of age. DISCUSSION: This is the first population-based analysis of US data to observe a decline in vasectomy utilization over the past two decades. The decline was statistically significant after accounting for all demographic and socioeconomic factors. CONCLUSION: There is a steady decline in the prevalence of vasectomy use in men from 2002 to 2017. Given the limited contraceptive options for men and the importance of contraception and family planning in the United States, further research is needed to understand the temporal decline.

Outpatient Vasectomy: Safe, Reliable, and Cost-effective.

Vasectomy is a safe, effective, and practical option for permanent contraception in men. Vasectomy is a surgical procedure used in men to disrupt and occlude the vas deferens, which delivers sperm from the testicles. By interrupting sperm transport, this procedure provides permanent sterilization. Vasectomies are typically done under local anesthesia in outpatient settings, and patients usually go home within an hour of the surgery. Surgical techniques used for vasectomy vary widely throughout the world, with limited evidence to guide the most effective approach. Current vasectomy guidelines largely rely on information from observational studies, with few controlled clinical trials.

One size does not fit all: variations by ethnicity in demographic characteristics of men seeking fertility treatment across North America.

OBJECTIVE: To compare racial differences in male fertility history and treatment. DESIGN: Retrospective review of prospectively collected data. SETTING: North American reproductive urology centers. PATIENT(S): Males undergoing urologist fertility evaluation. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Demographic and reproductive Andrology Research Consortium data. RESULT(S): The racial breakdown of 6,462 men was: 51% White, 20% Asian/Indo-Canadian/Indo-American, 6% Black, 1% Indian/Native, <1% Native Hawaiian/Other Pacific Islander, and 21% "Other". White males sought evaluation sooner (3.5 ± 4.7 vs. 3.8 ± 4.2 years), had older partners (33.3 ± 4.9 vs. 32.9 ± 5.2 years), and more had undergone vasectomy (8.4% vs. 2.9%) vs. all other races. Black males were older (38.0 ± 8.1 vs. 36.5 ± 7.4 years), sought fertility evaluation later (4.8 ± 5.1 vs. 3.6 ± 4.4 years), fewer had undergone vasectomy (3.3% vs. 5.9%), and fewer had partners who underwent intrauterine insemination (8.2% vs. 12.6%) compared with all other races. Asian/Indo-Canadian/Indo-American patients were younger (36.1 ± 7.2 vs. 36.7 ± 7.6 years), fewer had undergone vasectomy (1.2% vs. 6.9%), and more had partners who underwent intrauterine insemination (14.2% vs. 11.9%). Indian/Native males sought evaluation later (5.1 ± 6.8 vs. 3.6 ± 4.4 years) and more had undergone vasectomy (13.4% vs. 5.7%). CONCLUSION(S): Racial differences exist for males undergoing fertility evaluation by a reproductive urologist. Better understanding of these differences in history in conjunction with societal and biologic factors can guide personalized care, as well as help to better understand and address disparities in access to fertility evaluation and treatment.

"The Back-up Vasectomy Reversal." Simultaneous Sperm Retrieval and Vasectomy Reversal in the Couple With Advanced Maternal Age: A Cost-Effectiveness Analysis.

OBJECTIVE: To determine the cost-effectiveness of different fertility options in men who have undergone vasectomy in couples with a female of advanced maternal age (AMA). The options include vasectomy reversal (VR), sperm retrieval (SR) with in vitro fertilization (IVF), and the combination of VR and SR with IVF, which is a treatment pathway that has been understudied. MATERIALS AND METHODS: Using TreeAge software, a model-based cost-utility analysis was performed estimating the cost per quality-adjusted life years (QALY) in couples with infertility due to vasectomy and advanced female age over a period of one year. The model stratified for female age (35-37, 38-40, >40) and evaluated four strategies: VR followed by natural conception (NC), SR with IVF, VR and SR followed by failed NC and then IVF, and VR and SR followed by failed IVF and then NC. QALY estimates and outcome probabilities were obtained from the literature and average patient charges were calculated from high-volume centers. RESULTS: The most cost-effective fertility strategy was to undergo VR and try for NC (cost-per-QALY: $7,150 (35-37 y), $7,203 (38-40 y), and $7,367 (>40 y)). The second most cost-effective strategy was the "back-up vasectomy reversal": undergo VR and SR, attempt IVF and switch to NC if IVF fails. CONCLUSION: In couples with a history of vasectomy and female of AMA, it is most cost-effective to undergo a VR. If the couple opts for SR for IVF, it is more cost-effective to undergo a concomitant VR than SR alone.

Access to male sexual and reproductive health services in publicly funded California clinics in 2018.

OBJECTIVES: To characterize the sexual and reproductive health (SRH) services available to men from publicly funded family planning clinics in California. STUDY DESIGN: We conducted a cross-sectional telephone survey in 2018 to compare the accessibility of SRH services for male clients at Planned Parenthood clinics in California to those visiting a random sample of 200 other publicly funded family planning clinics, selected from a California Department of Health Care Services list of 773 that had served at least 15 male clients in the prior year. A representative at each clinic answered questions about provision of 20 clinical services. We examined differences in individual service provision by clinic affiliation using χ2 tests. RESULTS: Only one-third (773/2348) of publicly funded clinics in California served more than 15 male clients each year, with rural clinics less likely than urban counties to do so. We were able to contact 62 of 107 Planned parenthood clinics and 81 of the 200 other publicly-funded family planning clinics that we attempted to reach. Most (95%) offered HIV and STI screening; 65% offered vasectomy consultation, but only 5% provided vasectomy services. Planned Parenthood clinics were more likely than other publicly funded clinics to provide condom demonstrations, emergency contraception, STI testing, HPV vaccination, penile/testicular exams, and infertility testing (p < 0.05 for all comparisons). CONCLUSIONS: Male family planning services are less frequently offered by rural clinics and by publicly funded clinics in California that are not affiliated with Planned Parenthood. IMPLICATIONS: Men's underutilization of family planning may be partially explained by a lack of access to clinical services.

Is Opioid-free Post-Vasectomy Analgesia a Pain? A Single Surgeon Experience.

OBJECTIVE: To determine the impact of transitioning from opioid to non-opioid analgesia post-vasectomy on unplanned opioid prescriptions and health encounters. METHODS: A retrospective review for patients who underwent vasectomy from October 2018 through December 2019 was performed. Beginning February 1st, 2019, patients were counseled to take scheduled acetaminophen and ibuprofen in lieu of acetaminophen with codeine, with an opioid prescription only provided upon request. Analysis was performed comparing 200 consecutive patients before and after this transition. Baseline patient characteristics, unplanned postoperative encounters for pain within 30 days of vasectomy, and associated narcotic prescriptions were compared between groups. RESULTS: 400 patients were included, consisting of 200 patients pre and 200 patients postintervention. There were no differences in socioeconomic characteristics between groups. No differences between the pre- and postintervention groups were observed in terms of generating telephone calls to clinic (9% vs 11%, P = .5), clinic visits (2.5% vs 2.5%, P = 1), or ED visits (0% vs 1%), P = .5) for the pre and postintervention cohorts, respectively. CONCLUSIONS: Patients that are not prescribed opioids after vasectomy do not generate additional phone calls, clinic, or ED visits compared to those that were routinely prescribed prior to our institutional change. We have permanently discontinued the routine use of opioids for post-vasectomy analgesia. Other physicians performing vasectomy should consider making this change as well.

Men Who Have Undergone Vasectomy are Healthier Than Non-sterilized Fertile Men: An Analysis of the Nation Survey for Family Growth.

OBJECTIVE: To evaluate the health status of men who have undergone vasectomy versus nonsterilized fertile men. METHODS: Using the National Survey for Family Growth from 2002 to 2017, univariate and multivariate analyses were performed on demographic and health data, including health status and health care utilization. RESULTS: Men who have undergone vasectomy are more likely to be older, healthier, have more children, identify as non-Hispanic white, be married, have a higher level of education, earn a higher mean household income, and were more likely to be privately insured than non-sterilized fertile men. On multivariate analysis, men who underwent vasectomy had a better health status despite being older. CONCLUSION: There are significant socioeconomic and health differences between men who elect vasectomy and non-sterilized fertile men. These differences should be considered when considering using sterilized men as a proxy for proven fertile men in epidemiological studies.

Intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019.

BACKGROUND: Vasectomy is one of the most effective and permanent male contraceptive methods, and involves cutting and ligating the vas deferens to make the semen free of sperm during ejaculation. Although it is effective, simple, and safe, it is not well known and practiced in the majority of our community. This study assessed the intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019. METHODS: A community- based cross-sectional study was conducted among 402 married men from March 05 to April 15, 2019. A simple random sampling technique was employed to select the study participants. Data was collected by face to face interview using a structured and pre-tested questionnaire. Questions concerned socio-demographic and reproductive variables and views on vasectomy. The association between variables was analyzed using a bivariable and multivariable logistic regression model. RESULT: A total of 402 participants were included with a response rate of 98.75%. The mean participant age was 37.12(SD ± 6.553) years with the age range of 20-56 years. The prevalence of intention to use vasectomy was 19.6% with 95%CI (15.6%-23.4%). Multivariable logistic regression showed that age from 30-39 years (AOR = 3.2(95% CI: 1.19-8.86)), having more than three living children (AOR = 2.5(95% CI: 1.41-4.68)), good knowledge (AOR = 3.4(95%CI: 1.88-6.40)) and positive attitude (AOR = 4.8(95% CI: 2.61-8.80)) of married men were significantly associated with intention to use vasectomy. CONCLUSION AND RECOMMENDATION: Intention to use vasectomy was comparable with findings in four regions of Ethiopia (Amhara, Oromia, SNNP, and Tigray). Age, the number of living children, knowledge, and attitude were significantly associated with the intention to use vasectomy. Improving the level of knowledge and attitude towards vasectomy is an essential strategy to scale up the intention of men to use vasectomy.

National opioid prescription patterns and patient usage after routine vasectomy.

Routine prescription of opioids after outpatient surgery is common. The main objective of this study was to determine urologist opioid prescribing patterns and patients' pain control medication regimens (opioid and anti-inflammatory) after vasectomy. We designed an anonymous seven-question electronic survey of urologists to assess vasectomy practice and post-vasectomy opioid prescriptions using the American Medical Association Physician Masterfile database. We then performed a retrospective internal telephone survey of men who had undergone vasectomy by a single surgeon (MKS). This telephone survey queried men about opioid prescription filling, opioid use and ibuprofen use. We received 136 (4.5%) electronic survey responses. 51.5% of urologists routinely prescribed opioids for post-vasectomy analgesia, despite 50.4% having 'no idea' how many patients actually used these. On internal telephone survey, 52.6% of patients who used opioids reported using ibuprofen as their primary pain medication, versus 92.6% of patients who did not use opioids (p = .004). Ibuprofen use was associated with using fewer opioid tablets (p = .003). Using ≥1 opioid tab was associated with increased odds of not using ibuprofen as the primary pain medication (OR 11.2, 95% CI 2.39-83.0, p = .005). In conclusion, integration of practice guidelines may help standardise and minimise potentially unnecessary post-vasectomy opioid prescriptions.

Religious beliefs, social pressure, and stigma: Rural women's perceptions and beliefs about vasectomy in Pwani, Tanzania.

Despite being a reliable and cost effective family planning method, vasectomy remains underutilized in many low resource settings such as East Africa. We explored rural women's perceptions and beliefs regarding barriers to vasectomy use in the low resource setting of Pwani, Tanzania. The qualitative study used in-depth semi-structured interviews to obtain data. Purposive sampling was used to recruit 20 married/cohabiting women with two or more children. Thematic analysis guided the data analysis, with qualitative data reporting informed by COREQ guidelines. Most participants were Muslim and had between two and six children. Most had completed primary-level education and were engaged in small-scale farming. We extracted three main themes with associated sub-themes:1) lack of education, which included men's education levels and inadequate knowledge and misinformation 2) religious beliefs, social pressure and stigma, which included community stigma and the belief that vasectomy was not good for men with multiple wives; and 3) promoting men's involvement in family planning which included educating men and the women's perceived role in promoting vasectomy. Participating women perceived vasectomy uptake to be affected by a lack of low knowledge (among men, women, and the community), misinformation, and various sociocultural barriers. Efforts to promote vasectomy and male involvement in reproductive health services should be directed to addressing deeply-rooted sociocultural barriers. Women may have an essential role in encouraging their partners' vasectomy uptake. In addition, engaging couples in family planning education is critical to enhance knowledge. Ideally, such community based education should be conducted in partnership with communities and healthcare providers.

Poor Compliance With Postvasectomy Semen Testing: Analysis of Factors and Barriers.

OBJECTIVE: To ensure procedure success, American Urological Association Guidelines recommend postvasectomy semen analysis (PVSA); however, current literature suggests poor compliance. We sought to measure PVSA compliance and assess barriers to completion. METHODS: A retrospective review was performed of vasectomies at San Diego Veterans Administration Hospital and UC San Diego Health between 2006 and 2018. Patients received preprocedural counseling regarding semen analysis necessity. Postprocedural management included follow-up visit within 2-4 weeks and semen analysis after 15-20 ejaculations. Demographics and periprocedural variables were collected. Telephone interviews assessed patient reported reasons for noncompliance. Multivariable analysis was performed for factors associated with semen analysis. RESULTS: 503 men, mean age 38.8 years, underwent vasectomy at San Diego Veterans Administration Hospital (n = 331) and UC San Diego (n = 172). Overall, 80% completed clinical follow-up (n = 401) and 53% completed semen analysis (n = 268). The cohorts exhibited significantly different rates of semen analysis completion (46% vs 67%, P <.001) and clinical follow-up (64% vs 85%, P = .038). No difference was observed in age, fatherhood, or marital status. On multivariable analysis, fatherhood was the only factor associated with noncompliance of semen analysis (odds ratio 0.52, 95% confidence interval 0.33-0.83). Among men interviewed, the primary barriers to semen analysis completion were distance (38%), time constraints (34%), and forgetfulness (23%). Ninety-two% reported increased likelihood of completion with home-based semen testing. CONCLUSION: Patients demonstrated poor PVSA compliance despite preprocedural counseling. Given that distance and time constraints limited compliance, incorporating home-based semen testing may improve the quality of care for men undergoing vasectomy.

Factores que inciden en la aceptabilidad de la vasectomía / Factors that influence the acceptability of vasectomy

La vasectomía es un procedimiento que genera mínimas complicaciones y ostenta una tasa de éxito del 99 %; además tiene menor costo que la esterilización femenina, por lo cual se debe tener en cuenta el rol que desempeña el hombre en el número de hijos que se proyecta tener. En esta revisión de tema se identificaron los factores que inciden en la aceptabilidad de la vasectomía. Se realizó la búsqueda de la literatura en las bases de datos de PubMed, ProQuest, BioMed Central, ScienceDirect y Clinical Key para el periodo 2008-2017. Se seleccionaron 39 artículos por haber cumplido los criterios de inclusión: (a) publicado entre el 2008 y el 2017, en inglés, español o portugués y b) reportar resultados afines al tema de interés con evidencia de calidad científica durante la aplicación de las listas de chequeo. La sistematización y análisis de la información permitió la construcción de tres categorías temáticas: Entorno cultural, Condiciones sociales y Educación e información. Sobre la temática se evidenció que los factores como las creencias, el entorno sociocultural y la educación e información que tienen los hombres y sus parejas sobre la vasectomía influyen en la decisión de realizarse o no este procedimiento. Un hallazgo novedoso fue que el sexo de la descendencia también incide en esta decisión. Se recomienda una educación masiva para aumentar el acceso y conocimiento de la vasectomía.

Vasectomy is a procedure that generates minimum complications and garners a success rate of 99 %; In addition, it is an inex-pensive procedure in comparison to female sterilization, consequently the role of men should be taken into account when considering family planning. In this review of the topic, the factors that currently affect the acceptability of vasectomy were identified. We searched PubMed, ProQuest, BioMed Central, ScienceDirect and Clinical Key databases for articles published between 2008-2017 in English, Spanish or Portuguese, and included articles that met the inclusion criteria and showed scien-tific quality during the application of checklists. A total of 39 articles were admitted into the topic review. The systematization and analysis of the information allowed the construction of three thematic categories: cultural-environment, social conditions, and education and information. In this review, it is evidenced that factors such as beliefs, socio-cultural environment, and education and information that men and their partners have about vasectomy influences the decision to undergo or avoid this procedure. The sex of the offspring was evidenced as a novel factor because the children's gender influenced the decision. Therefore, mass education to increase the access and knowledge about vasectomy is recommended

Reasons for not completing postvasectomy semen analysis.

OBJECTIVE: To identify noncompliance rates for 3-month postvasectomy semen analysis (PVSA) in men who have undergone vasectomy and to explore the self-reported reasons for not completing the 3-month PVSA. DESIGN: Retrospective chart review followed by semistructured telephone interviews. SETTING: Two family medicine clinics in Saskatoon, Sask. PARTICIPANTS: Men from the clinics who had undergone vasectomy since 2009. A total of 99 patients completed telephone interviews. METHODS: After a review of electronic medical records at 2 family medicine clinics, patients who had undergone vasectomy since 2009 were identified. Upon review of their charts, the number of patients who did not have PVSA results on file was determined. Some of these men were contacted with a predetermined telephone script to discuss reasons for noncompliance. MAIN FINDINGS: The combined noncompliance rate for the 2 clinics was high (60.5%). Three main reasons for not completing the PVSA were identified among the patient responses. These included patients feeling too busy to complete PVSA, patients feeling confident in the physician or procedure immediately after vasectomy, and patients feeling the PVSA process was too inconvenient. Our high noncompliance rates are consistent with other literature. However, the findings might also have been affected by the proportion of patients who had completed their PVSA who were not included in the telephone sample. Rates differed between the 2 clinics; the clinic with the higher compliance rate acts as an academic practice, with more time for appointments and fewer patients being referred from other physicians. CONCLUSION: Noncompliance rates for PVSA in this study were high. Three main reasons for noncompliance were identified that might help guide counseling opportunities in the future.

Vasectomía sin bisturí versus vasectomía convencional / No-scalpel vasectomy versus conventional vasectomy

CONTEXTO CLÍNICO: La vasectomía consiste en la ligadura de los conductos deferentes a nivel escrotal, con el fin de impedir el pasaje de espermatozoides provenientes del epidídimo.1 Se trata de un procedimiento quirúrgico electivo, mínimamente invasivo, muy difundido en Europa y Estados Unidos, siendo que aproximadamente el 1% de los varones de entre 20-24 años y el 20% de los varones mayores de 40 años, eligen la vasectomía como método de planificación familiar. De acuerdo a las recomendaciones de la Organización Mundial de la Salud, no existe ninguna condición médica que restrinja la posibilidad de elección de la vasectomía como método de anticoncepción, aunque sí recomienda tener precaución en presencia de: depresión, diabetes, injuria escrotal previa, edad joven, varicocele o hidrocele grande, criptorquidia; y retrasar el procedimiento hasta la resolución de infecciones locales de la piel del escroto, enfermedades de transmisión sexual activa, balanitis, epididimitis u orquitis, infecciones sistémicas, gastroenteritis, filariasis/elefantiasis (por mayor dificultad para palpar el conducto deferente), o tumor intra-escrotal.2 Así mismo, recomienda que en pacientes con síndrome de inmunodeficiencia adquirida -especialmente en presencia de enfermedades relacionadas-, desórdenes de la coagulación, y hernia inguinal, los procedimientos sean realizados en lugares que cuenten con personal experimentado y el equipo necesario para proveer anestesia general. TECNOLOGÍA: Los conductos deferentes pueden abordarse por distintos métodos. Las dos técnicas más frecuentes son la técnica convencional, en la que se utiliza un bisturí para realizar una o dos incisiones del escroto para exponer los conductos deferentes, y la comúnmente denominada "sin bisturí", que se vale de una pinza con punta delgada y afilada, que permite penetrar la piel en un único punto del escroto y acceder a los conductos deferentes sin necesidad de realizar una incisión.7,8 Este método puede requerir mayor entrenamiento y pericia médica que el procedimiento convencional. Una vez expuesto el conducto deferente, puede ocluirse por distintos procedimientos como ligadura con suturas, coagulación eléctrica o térmica, o aplicación de clips. Sin embargo, estos procedimientos de oclusión no son el objeto de este reporte, ya que se usan del mismo modo en ambos abordajes. Independientemente de las técnicas, el procedimiento es en la mayoría de los casos ambulatorio y requiere sólo anestesia local. 5,9,10 La recuperación suele ser rápida, y la mayor parte de los eventos adversos resolverán espontáneamente en aproximadamente 72hs, cuando puede reanudarse la actividad sexual en la mayoría de los pacientes. Dado que la azoospermia luego de la vasectomía, independientemente de la técnica de abordaje, no es inmediata, durante los primeros tres meses debe utilizarse otro método anticonceptivo, hasta comprobar la ausencia completa de espermatozoides en la eyaculación. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de la vasectomía sin bisturí como método de planificación familiar. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron una RS, cuatro estudios observacionales, seis GPC, y 13 informes de políticas de cobertura acerca de la vasectomia sin bisturi como método de planificación familiar. CONCLUSIONES: Evidencia de moderada calidad sugiere que la vasectomía sin bisturí es una técnica segura, y que reduce significativamente la incidencia de complicaciones a corto plazo, tales como sangrado y hematomas, infecciones y dolor escrotal, en comparación con la vasectomía convencional (mediante incisión escrotal). La efectividad del procedimiento no depende de la forma de abordaje escrotal sino del método de oclusión de los conductos deferentes, por lo que no fue evaluada en este documento. Todas las guías de práctica clínica consultadas mencionan a la vasectomía sin bisturí como una alternativa de anticoncepción quirúrgica. No se encontraron evaluaciones económicas que comparen las técnicas con y sin bisturí. En Argentina, Brasil, Uruguay, Colombia, Reino Unido y Francia se contempla la cobertura de vasectomía, aunque no se menciona específicamente a la técnica sin bisturí. La mayoría de los financiadores públicos y privados de Estados Unidos relevados no contemplan o no mencionan explícitamente la cobertura de ningún tipo de vasectomía.

Vasectomía sin bisturí versus vasectomía convencional / No-scalpel vasectomy versus conventional vasectomy

CONTEXTO CLÍNICO: La vasectomía consiste en la ligadura de los conductos deferentes a nivel escrotal, con el fin de impedir el pasaje de espermatozoides provenientes del epidídimo.1 Se trata de un procedimiento quirúrgico electivo, mínimamente invasivo, muy difundido en Europa y Estados Unidos, siendo que aproximadamente el 1% de los varones de entre 20-24 años y el 20% de los varones mayores de 40 años, eligen la vasectomía como método de planificación familiar. De acuerdo a las recomendaciones de la Organización Mundial de la Salud, no existe ninguna condición médica que restrinja la posibilidad de elección de la vasectomía como método de anticoncepción, aunque sí recomienda tener precaución en presencia de: depresión, diabetes, injuria escrotal previa, edad joven, varicocele o hidrocele grande, criptorquidia; y retrasar el procedimiento hasta la resolución de infecciones locales de la piel del escroto, enfermedades de transmisión sexual activa, balanitis, epididimitis u orquitis, infecciones sistémicas, gastroenteritis, filariasis/elefantiasis (por mayor dificultad para palpar el conducto deferente), o tumor intra-escrotal.2 Así mismo, recomenda que en pacientes con síndrome de inmunodeficiencia adquirida -especialmente en presencia de enfermedades relacionadas-, desórdenes de la coagulación, y hernia inguinal, los procedimientos sean realizados en lugares que cuenten con personal experimentado y el equipo necesario para proveer anestesia general. TECNOLOGÍA: Los conductos deferentes pueden abordarse por distintos métodos. Las dos técnicas más frecuentes son la técnica convencional, en la que se utiliza un bisturí para realizar una o dos incisiones del escroto para exponer los conductos deferentes, y la comúnmente denominada "sin bisturí", que se vale de una pinza con punta delgada y afilada, que permite penetrar la piel en un único punto del escroto y aceder a los conductos deferentes sin necesidad de realizar una incisión.7,8 Este método puede requerir mayor entrenamiento y pericia médica que el procedimiento convencional. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de la vasectomía sin bisturí como método de planificación familiar. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron una RS, cuatro estudios observacionales no comparativos, seis GPC, y 13 informes de políticas de cobertura acerca de la vasectomía sin bisturí como método de planificación familiar. CONCLUSIONES: Evidencia de moderada calidad sugiere que la vasectomía sin bisturí es una técnica segura, y que reduce significativamente la incidencia de complicaciones a corto plazo, tales como sangrado y hematomas, infecciones y dolor escrotal, en comparación con la vasectomía convencional (mediante incisión escrotal). La efectividad del procedimiento no depende de la forma de abordaje escrotal sino del método de oclusión de los conductos deferentes, por lo que no fue evaluada en este documento. Todas las guías de práctica clínica consultadas mencionan a la vasectomía sin bisturí como uma alternativa de anticoncepción quirúrgica. No se encontraron evaluaciones económicas que comparen las técnicas con y sin bisturí. En Argentina, Brasil, Uruguay, Colombia, Reino Unido y Francia se contempla la cobertura de vasectomía, aunque no se menciona específicamente a la técnica sin bisturí. La mayoría de los financiadores públicos y privados de Estados Unidos relevados no contemplan o no mencionan explícitamente la cobertura de ningún tipo de vasectomía.