Noninvasive laser vasectomy: preliminary ex vivo tissue studies.

BACKGROUND AND OBJECTIVES: Male sterilization (vasectomy) is more successful, safer, less expensive, and easier to perform than female sterilization (tubal ligation). However, female sterilization is more popular, primarily due to male fear of vasectomy complications (incision, bleeding, infection, and scrotal pain). The development of a completely noninvasive vasectomy technique may eliminate these concerns. MATERIALS AND METHODS: Ytterbium fiber laser radiation with a wavelength of 1,075 nm, average power of 11.7 W, 1-second pulse duration, 0.5 Hz pulse rate, and 3-mm-diameter spot was synchronized with cryogen cooling of the scrotal skin surface in canine tissue for a treatment time of 60 seconds. RESULTS: Vas thermal lesion dimensions measured 2.0+/-0.3 mm diameter by 3.0+/-0.9 mm length, without evidence of skin damage. The coagulated vas bursting pressure measured 295+/-72 mm Hg, significantly higher than typical vas ejaculation pressures of 136+/- 29 mm Hg. CONCLUSIONS: Noninvasive thermal coagulation and occlusion of the vas was produced in an ex vivo canine tissue model. However, chronic in vivo animal studies will be necessary to optimize the laser/cooling treatment parameters and confirm long-term vas occlusion with absence of sperm in the ejaculate, before clinical application.

Clinical efficacy of sildenafil citrate and predictors of long-term response.

PURPOSE: We assessed the long-term clinical efficacy of sildenafil citrate (SC) and predictors of satisfactory outcome. MATERIALS AND METHODS: All patients were evaluated with a self-administered questionnaire or by telephone interview before, and 3 months and 2.5 years following the initiation of SC therapy. Current SC use, other therapies and overall level of sexual satisfaction were assessed. Sexual function was measured using an abbreviated version of the International Index of Erectile Function questionnaire. RESULTS: Of the 197 men 97 (49%) were using SC at 2.5 years. Patients with a history of diabetes mellitus or prostate surgery were least likely to be satisfied with SC therapy. Men with vasculogenic etiologies for erectile dysfunction were more likely to be on SC and had better sexual function scores at 2.5 years than men with a history of prostate surgery. The 3-month International Index of Erectile Function questionnaire score was an excellent predictor of sexual satisfaction in men who continued to use SC at 2.5 years. Of the 100 men who discontinued treatment with SC 56% chose not to pursue any other treatment. CONCLUSIONS: SC remains a highly effective and durable oral agent for erectile dysfunction. Improved sexual function and sexual satisfaction were well maintained 2.5 years following the initiation of SC therapy, especially in patients with vasculogenic or psychogenic etiologies of erectile dysfunction. Patients who discontinued SC reported significantly decreased sexual function than their counterparts but under used alternative therapies to improve erectile dysfunction.