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.

Complications of vasectomy: results from a prospective audit of 105 393 procedures.

OBJECTIVES: To provide up-to-date complication rates for vasectomy in the UK using 15 years of data collected by the Association of Surgeons in Primary Care (ASPC). PATIENTS AND METHODS: Data were collected between 2007 and March 2022. A patient questionnaire was completed on the day of surgery and at 4 months postoperatively. Rates of early and late failure, infection, hospital admission or re-admission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations. Descriptive statistics were utilised, without formal statistical analysis. RESULTS: Over the 15-year study period, data from 105 393 vasectomies were collected, performed by >150 surgeons. In 2022, 94.4% of surgeons used one test to prove sterility. In all, 65% of patients used a postal sperm test after vasectomy to confirm sterility. Early failure rates were available for 69 500 patients. Early failure occurred in 648 patients (0.93%). Of 99 124 patients, late failure occurred in 41 (0.04%). Of 102 549 vasectomies, postoperative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%), and PVPS was reported in 139 patients (0.14%). CONCLUSIONS: Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates that can form the basis for pre-vasectomy counselling.

'If we take the engine out, how will the car go?': beliefs, understanding and access to vasectomy services in Timor-Leste.

Vasectomy is a safe, highly effective and affordable method of permanent contraception, and one of the few currently available contraceptive methods for men. Despite this, vasectomy uptake remains overall low, making up just 2% of the global contraceptive method mix. To better understand access to vasectomy in a country with negligible uptake, we conducted participatory and operational research in the Democratic Republic of Timor-Leste (Timor-Leste). We held 14 participatory group discussions with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse), and individual in-depth interviews with 24 healthcare providers (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. Community awareness and understanding about vasectomy were limited, with concerns expressed about physical and social side effects. Healthcare providers had limited experience and knowledge about vasectomy, and about male sexual and reproductive health more generally. However, our findings also indicate a small but existing demand for vasectomy services that could be grown and better met through health systems strengthening initiatives. Insights from our research have informed programmatic decision-making in Timor-Leste and can be further used to inform national health policy and practice.

[The sociological approach to vasectomized patient trajectories at the Buenos Aires University Clinical Hospital "José de San Martín"].

According to the Argentinian Ministry of Health records the number of patients requesting vasectomy increased twelve times in public hospitals in 2015-2019. The physicians and specialists account for this change in recent years, arguing, among other reasons, cultural change when male assumes active position in contraceptive methods. The article addresses vasectomized patient trajectory at the Buenos Aires University Clinical Hospital "José de San Martín". The purpose of the study was to define from sociological point of view if we are actually witnessing cultural change. While considering last ten years (2012-2022), through diachronic analysis of patient demand at the Male Fertility Laboratory (n=1136) it was found that although main motivation is fertility, minority (6%) consulting to confirm absence of sperm in the ejaculate following vasectomy increased significantly in 2022 (Pearson's chi-squared test p<0.0001). After qualitative/quantitative interviews of former patient group (n=36) two sub-populations were distinguished: childless (42%; Median age: 30 years old; range: 24-35) and those having a family (58%; Median age: 39 years old; range: 35-54). Most of them had University degree (67%) and learned about this anti-contraceptive method by the Internet. It is remarkable that 94% of them were not aware of the the Argentinian Law № 236139 of 2006 that grants their right to vasectomy. Among all patients randomly interviewed in 2022 (n=200) condom anti-contraceptive method was the best known (67%). The conclusion was made that in the meantime developed New Trend that comprises high educational level segment of population of Argentina that in the future can become the germ of Cultural Change encompassing the whole society.

Sedated masculinity: the use of anaesthesia during vasectomy in Israel.

Vasectomy is considered a permanent form of contraception for men that can help reduce reproductive inequality. Its underutilisation in the context of the threats it may pose to perceptions of traditional masculinity has been closely investigated, but the lived experience of the procedure itself has been largely overlooked. This paper examines the experience of having a vasectomy in Israel, focusing on the recommended form of anaesthesia. Drawing on 15 semi-structured interviews with Israeli men who have experienced vasectomy, we found that the choice of anaesthesia has a significant impact on the meaning and experience of vasectomy. Unlike the widespread use of local anaesthesia during vasectomy in other countries, vasectomy in Israel is performed almost exclusively under twilight sedation administered intravenously. Based on our findings, we argue that framing vasectomy as an operation that requires sedation is related to views of masculinity and reproduction. Our data suggest that vasectomy in Israel is constituted as a potentially traumatic event, and anaesthesia is employed to protect patients from feelings of embarrassment and discomfort. We conclude that the prevailing method of sedation perpetuates the silencing and marginalisation of vasectomy as a contraceptive method, and consequently, its very limited accessibility in Israel.

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.

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.

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.

[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 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.

[Surgery to improve male fertility]. / Chirurgies visant à améliorer la fertilité masculine.

BACKGROUND: At a time when increasing attention is being paid to the limitations and risks of in vitro fertilisation techniques, surgeries to improve male fertility are attracting growing interest. METHODS: Systematic review based on a Pubmed search of surgeries to improve male fertility. RESULTS: Vasovasostomy (VV) gives patency rates of 70-97% and pregnancy rates of 30-76%. Vasoepididymostomy (VE) gives patency rates of 80-84%, with pregnancy rates of 40-44%. The duration of obstruction and the age of the partner are 2 predictive parameters for the occurrence of a natural pregnancy. In cases of obstructive azoospermia due to pelvic obstruction (prostatic cyst, obstruction of the ejaculatory ducts), several surgical procedures may be proposed. Transurethral resection of the ejaculatory ducts leads to an improvement in sperm parameters in 63-83% of patients, with spontaneous pregnancy occurring in 12-31% of cases. Microsurgical cure of varicocele by the subinguinal route is a benchmark technique with recurrence rates of less than 4%. It improves live birth and pregnancy rates, both naturally and by in vitro fertilization, as well as sperm count, motility and DNA fragmentation rates. CONCLUSION: Whenever possible, the urologist should present the surgical options for improving male fertility to the ART team and to the couple, discussing the benefit/risk balance of the operation as part of a personalized approach.

[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.

Sperm degradation after vasectomy follows a sperm chromatin fragmentation-dependent mechanism causing DNA breaks in the toroid linker regions.

Vasectomy is a widely used surgical technique creating an obstructive azoospermia. Although sperm cannot be ejaculated, the testis maintains sperm production in vasectomized males. The continuous accumulation of sperm deposited in the epididymis and the vas deferens fraction necessarily need to be degraded and eliminated. While the elimination process is carried out by granulomas that form after vasectomy, the detailed mechanisms of sperm degradation are still not known. The aim was to assess whether sperm chromatin fragmentation (SCF), a mechanism that degrades the entire sperm genome at the toroid linker regions (TLRs), is activated after vasectomy in sperm cells. We vasectomized mice and evaluated the presence of TLR-specific double-strand breaks through pulsed-field gel electrophoresis and the Comet assay at 1, 2 and 3 weeks after surgery. Results for DNA damage (Olive tail moment) at single-cell level showed an increase of double-strand breaks after vasectomy for vas deferens sperm after 1, 2 and 3 weeks postvasectomy (21.78 ± 2.29; 19.71 ± 1.79 and 32.59 ± 1.81, respectively), compared to mock surgery (7.04 ± 1.03; 10.10 ± 1.29 and 8.64 ± 0.85, respectively; P < 0.001). Similar findings were obtained for cauda epididymis sperm (P < 0.001), but not for caput epididymis (P > 0.05). Pulsed-field gel electrophoresis showed the presence of double-stranded breaks between 15 and 145 kb, indicating that DNA breaks were produced mainly in the sperm TLRs. Results presented here suggest that SCF is a mechanism activated in vas deferens after vasectomy to degrade sperm DNA when they cannot be ejaculated, preventing their function.

Factors affecting the use of long term and permanent contraceptive methods: a Facebook-focused cross-sectional study.

INTRODUCTION: In the Muslim world, the use and acceptance of long-term and permanent contraceptives were limited. Our aim was to investigate those limiting factors so we can help making these methods widely available and acceptable to the society. METHODS AND DATA ANALYSIS: There were 1365 women from Facebook groups in the period 08/10/2020-8/11/2020. Participants were married women, living in Jordan. This was a cross-sectional study. Statistical Package for Social Sciences (SPSS), version 16, software was used for statistical analysis (Chicago, Illinois, USA). RESULTS: Among participants, 22.3% had never used any contraceptives. Non-hormonal IUCD was the most commonly used method. There was a statistically significant association between the use of hormonal IUCD and women's age, marriage duration, education and number of children (p < 0.0001). Tubal ligation was adopted by only 44 (3.22%) participants. 19.68% of participants declined tubal ligation merely due to religious issues. Women who completed only high school level of education underwent tubal ligation significantly more than those with university (Bachelor) and post-university (Master or PhD) degrees (p < 0.0001 and 0.026, respectively). Only 1.83% of women's partners underwent vasectomy, the majority of these vasectomies (72.0%) were done because of the need for lifelong contraception. Around 17% of women's partners had poor knowledge about vasectomy. Further, women's employment status (housewives or full-time employees) was found to be the only variable that affected acceptance of vasectomy (p = 0.0047). CONCLUSIONS: Women endured a heavy burden of contraception. Cultural and religious taboos influenced tubal ligation. Vasectomy was still very rarely adopted by men due to the lack of knowledge about the procedure. Our results raised the need for further dissemination of contraception knowledge and counselling through the primary care and maternity centers, mosques and media in official, comprehensive and integrated programs. Future research is needed in the field of permanent contraceptive methods.

Men prefer pre-vasectomy consultation by telephone: a survey of vasectomized men.

INTRODUCTION: Due to the COVID-19 pandemic teleconsultation was allowed as an insured service in the province of Quebec, Canada. We assessed the preferences of vasectomized patients for a pre-vasectomy consultation conducted in-person or by telephone. MATERIALS AND METHODS: In September 2021, we sought the participation of 214 men who had their pre-vasectomy consultation over the phone to complete an anonymous three-item survey on their preferred modality for pre-vasectomy consultation. They completed their questionnaire in the waiting room of the vasectomy clinic just after the surgical procedure. We calculated the proportion and 95% confidence interval [CI] of patients preferring each modality. We assessed the difference in preference according to the distance between hometown and vasectomy clinic (< 25 km, 25-50 km, and > 50 km) with Fisher's exact test. RESULTS: Participation rate was 98% (n = 209/214). Most patients would have preferred telephone over in-person pre-vasectomy consultation if they had been given a choice (96%; 95% CI 92% to 98%), if they had had to recommend a modality to a friend (95%; 95% CI 91% to 98%), and if they had had to do a pre-vasectomy consultation again (prefer or no preference; total 97%; 95% CI 94% to 99%). Distance between hometown and vasectomy clinic did not significantly influence their preferences (p > 0.29 for each of the three items). CONCLUSIONS: Vasectomized men preferred having pre-vasectomy consultation by telephone instead of in person. If maintained as an insured service after the COVID-19 pandemic, Canadian physicians offering vasectomy services should consider making this service available to their patients.

Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal.

The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post-VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.

Barriers to vasectomy acceptance and uptake in Nigeria: A review of the literature.

There is growing support of male involvement in reproductive health and the integration of voluntary vasectomy services into national family planning programs in lower resource contexts; yet, the prevalence of women of reproductive age who rely on vasectomy in African countries such as Nigeria, is less than 1 percent. This review was conducted to gain a broader understanding of current sociocultural and health systems' conditions that need to be addressed to expand the integration and acceptability of vasectomy as an option for family planning in Nigeria. To explore this, a scoping of existing literature on vasectomy in Nigeria between 2009 to 2021 was conducted. The review focused on qualitative studies and grey literatures. The findings reveal that there is a strong awareness of vasectomy among men in Nigeria. Yet, several factors such as fear and religious and cultural beliefs prevent men from having the same confidence in vasectomy as they have in female biomedical methods. These findings have implications for future family planning policies, strategies and programmes in the country.

[Imaging quality of the robotic visualization 4K3D system and its application in microscopic vasectomy reversal in rats].

OBJECTIVE: To quantitatively assess the performance of the new robotic visualization system (Zeiss, KINEVO 900) in terms of visual imaging effect and evaluate its potential application in microscopic vasectomy reversal. METHODS: We made a parallel comparison between the effects of the plane and stereo visual images of KINEVO 900 and optical surgical microscopy (Zeiss, S7), and performed microscopic vasectomy reversal on the rat model using KINEVO 900. RESULTS: Compared with S7, KINEVO 900 provided an even longer working distance (200－625 mm), a 3－4 times larger effective field area and a 1.5－2 times deeper front depth of field with the same working distance of 200 mm. No statistically significant difference was observed in the average anastomosis time and immediate patency rate between the two platforms (P > 0.05). CONCLUSION: The 4K3D video image stream outputted by KINEVO 900 is not inferior to that of the optical surgical microscope represented by S7 and is sufficient for microsurgeries in urology and andrology. More prospective randomized clinical animal experiments are needed to further evaluate its application value in andrology.

Can a Low Sperm Concentration without Assessing Motility Confirm Vasectomy Success? A Retrospective Descriptive Study.

PURPOSE: A fresh post-vasectomy semen analysis showing 100,000 nonmotile sperm/mL or less confirms sterility. Mailed sample or self-testing at home with SpermCheck® Vasectomy decreases the inconvenience of producing a fresh sample, but without assessing motility. We evaluated if there is a sperm concentration under which no motile sperm are observed that could fortify the use of these alternatives. MATERIALS AND METHODS: We conducted a study of post-vasectomy semen analyses performed at the andrology laboratory of the Quebec City university hospital, Canada. Sperm concentration and motility were assessed on fresh noncentrifuged 10 µL samples at 400× magnification. We calculated the proportion of post-vasectomy semen analysis showing motile sperm according to sperm concentration for all and first prescribed post-vasectomy semen analysis by the 5 physicians who performed the most vasectomies. RESULTS: We identified 6,492 post-vasectomy semen analyses prescribed by 169 physicians. The 5 vasectomists prescribed 95.6% (6,204) of the post-vasectomy semen analyses; 96.1% (5,965) were first tests. We observed motility in all sperm concentration strata but it decreased with lower concentrations. At the first post-vasectomy semen analysis, among patients with less than 1 million, 250,000 and 100,000 sperm/mL, 0.5% (27/5,842) and 0.3% (19/5,760 and 17/5,725) had motility, respectively. CONCLUSIONS: If the first post-vasectomy semen analysis on a mailed sample shows less than 1 million sperm/mL, we recommend requesting an additional mailed sample instead of a fresh sample. SpermCheck Vasectomy could falsely indicate a successful vasectomy in a very small proportion of cases. The optimal post-vasectomy semen analysis strategy must involve shared decision making, balancing the inconvenience of providing a fresh sample with the risk of a false-negative result.

TESE-ICSI outcomes per couple in vasectomized males are negatively affected by time since the intervention, but not other comorbidities.

RESEARCH QUESTION: Does time since vasectomy (as obstructive interval) and the presence of different male comorbidities adversely affect the likelihood of achieving a newborn for vasectomized males undergoing testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI)? DESIGN: This retrospective study included 364 couples with vasectomized males undergoing TESE-ICSI cycles with autologous oocytes at IVI Valencia. The main outcome was live birth rate (LBR). Subjects were divided according to the male risk factor evaluated into quartiles (obstructive interval, body mass index [BMI]) or groups (hypertension, diabetes mellitus, dyslipidaemia). The reproductive outcomes were calculated per embryo transfer, per ovarian stimulation completed, and per couple. RESULTS: The average obstructive interval was 11.3 years. The LBR was 34.4% (95% CI 30.1-38.6) per embryo transfer, 27.8% (95% CI 24.1-31.5) per ovarian stimulation and 46.2% (95% CI 41.8-51.3) per couple. When considering obstructive interval, a significantly lower LBR per couple (P = 0.04) was found in the group with the longest obstruction time: Q1 42.1% (95% CI 33.5-50.7), Q2 49.1% (95% CI 36.1-62.1), Q3 56.3% (95% CI 46.7-65.9) and Q4 37.2% (95% CI 26.5-47.9) but the cumulative live birth rate (CLBR) was not affected (P = 0.63). LBR per ovarian stimulation of males with hypertension was significantly lower (P = 0.04) than healthy males: 13.5% (95% CI 2.5-24.5) and 28.6% (95% CI 24.7-32.5), respectively. The group of diabetic vasectomized males had a significantly higher CLBR (P = 0.02). The remaining risk factors assessed (smoking, dyslipidaemia and a high BMI) did not affect LBR compared with their healthy counterparts. CONCLUSION: Time since vasectomy appears to negatively influence the LBR when assessed per couple. The CLBR was not affected by the obstructive interval or the presence of other male comorbidities apart from diabetes, which had a significant effect.