Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases.

OBJECTIVE: To determine the incidence of complications, including recanalization, in a series of 6248 consecutive vasectomies performed with a section-fulguration-fascial interposition technique. PATIENTS AND METHODS: Over a 38-year period, 6248 vasectomies were performed by one surgeon (S.S.S.) as a clinic procedure under local anaesthesia with no resection of a vasal segment. The mucosa of the cut ends of the vas was destroyed by cauterization and the fascial sheath of the vas was interposed as a barrier. Semen specimens were examined until two specimens, one month apart, showed no sperm. RESULTS: Complications were minimal, with few cases of haematoma or wound infection. Spermatic granulomas were uncommon. No post-vasectomy pregnancies were reported and no patient showed a persistence of sperm. CONCLUSION: The section-fulguration-fascial interposition technique of vasectomy was uniformly effective, with few post-operative problems.

Phonation threshold pressure in a physical model of the vocal fold mucosa.

The vocal fold mucosa, which consists of the epithelium and the superficial layer of the lamina propria, has been modeled by a fluid encapsulated in a silicone membrane. The artificial mucosa was attached to a rigid (metal) vocal fold body and introduced into an airflow channel, creating a rectangular glottis. Flow-induced oscillation of the mucosa was achieved at various subglottal pressures and glottal diameters. Phonation threshold pressure, the parameter of interest, was lowest (on the order of 0.4 kPa) for glottal diameters between 0.0 and 0.1 mm and for fluids with the lowest viscosity. There was a consistent hysteresis effect; that is, phonation threshold pressure was always lower for oscillation offset than onset.

Gangrene of the bladder due to over distention.

Massive over distention of the bladder in a man caused necrosis of the mucosa and submucosa, which then separated from the muscularis of the bladder. Suprapubic removal of the necrotic tissue followed by prolonged drainage resulted in regeneration of the mucosa. Normal bladder function returned after transurethral resection of the obstructing prostate. Diagnosis of this rare condition is confirmed when necrotic tissue occludes the eyes of catheters so that fluid can be instilled into but not removed from the bladder.

An evaluation of the liquefaction potential for Louisville, Kentucky

A statistical regression method is used to evaluate the liquefaction potential in Jefferson County, Kentucky due to large earthquake in the New Madrid Seismic Zone. The potential is represented as a liquefaction severity index scaled to the tickness of susceptible soil layers, The method uses soil data from the existing geotechnical borehole logs and water well logs that include soil type, SPT results, depth to bedrock and water table level information. The modifying effect of the soil profile on the local bedrock acceleration is accounted for through a one dimensional, linear mode, soil response analysis (AU)

The vas after vasectomy: comparison of cauterization methods.

A histologic study of the vas ends was carried out in 21 patients undergoing vasovasostomy. All had undergone prior vasectomy by the same surgeon, with a technique identical except for the type of cautery used to seal the vas ends. A superior sealing of the vas, as shown by fewer cases of vasitis nodosa and spermatic granuloma, followed use of the thermal cautery ("red-hot wire") than the electrosurgical cautery (23% vs 60.7% suboptimal sealing rate). The thermal cautery is a superior method of sealing the vas at vasectomy.

The Sturgeon Vas Cautery: the first 600 cases.

The Sturgeon Vas Cautery, an inexpensive, reusable battery-powered modular unit, has been used in 600 consecutive successful vasectomies with a minimum of complications and without equipment breakdown.

Pseudocysts of the tunica albuginea: benign invasion by testicular tubules.

We describe a patient undergoing exploration for an epididymectomy in whom a unique apparently multicystic lesion of the testis resulted in orchiectomy. On microscopic examination the lesion was proved to be a benign, previously unreported condition wherein the tunica albuginea was split by an invasion of testicular tubules. We postulate that this condition is a developmental anomaly.

Vasectomy.

Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.

PIP: In this discussion of vasectomy, attention is directed to preoperative counseling, performance of vasectomy as an office or clinic procedure -- anesthesia and surgical techniques, and postoperative care. Vasectomy requires preoperative counseling. Every man is aware of the effects of castration, and it is essential to explain to a man how and why vasectomy differs. He also must understand that sterility is not immediate. The couple's every question must be answered. Although counseling may take the form of movie, booklet, or conversation with a trained counselor or the surgeon, or any combination of these, preoperative contact with the surgeon is very important. Patient confidence is essential. In the US, vasectomy for sterilization is generally legal, but this does not protect the surgeon from malpractice suits. The patient should sign a written consent containing the following points: that the patient requests the operation for the purpose of preventing him from fathering further children; that he realizes that the operation could fail to produce sterility; and that he agrees to submit semen specimens for testing and to use contraception until testing has shown that he is sterile. A number of local anesthetics may be used when performing a vasectomy. Both procaine, which takes effect in 1 minute, and lidocaine, effective in 5 seconds, are safe and given anesthesia for at least 1 hour in 1% strengths. The most common vasectomy technique worldwide is that of dividing the vas, removing a segment, and either ligating the cut ends of the vas or closing them with metal clips. This usually fails in 1-3% of patients, either initially or by subsequent recanalization of the vas. Regarding postoperative care, the patient should apply an icebag over the bandages for the 1st several hours with the scrotum immobilized and abstain from sexual activity for the first 2 days. To ensure that a spontaneous anastomosis has not occurred, this surgeon requests 2 semen specimens, 1 month apart. The complications of the operation are largely preventable. Preoperative counseling has prevented most psychological complications. The specific complications of vasectomy include spermatic granulomas of the vas and epididymis, and antisperm antibodies. Numerous studies have reported no deleterious effects upon the patient's general health.

Transseptal crossed vasovasostomy.

We examined 11 patients with acquired obstructive azoospermia resulting from irreparable obstruction of 1 vas deferens and severe damage to the contralateral testis. All of the patients underwent transseptal crossed vasovasostomy with no morbidity. Of 8 patients evaluated with postoperative semen analyses 4 (50 per cent) demonstrated total sperm counts of 29 to 205 million and 2 pregnancies (25 per cent) have been reported, with followup ranging from 5 months to 2 years. The etiologies of the vasal obstruction included previous inguinal surgery in 7 patients, vasectomy in 1, ejaculatory duct obstruction in 1, ectopic ureter in 1 and vasal agenesis in 1. Factors leading to loss of the contralateral testis were torsion in 5 patients, mumps orchitis in 2, varicocele in 1, pediatric inguinal herniorrhaphy in 1, epididymal blow out in 1 and unknown in 1. A representative case involving a unilateral ectopic ureter emptying into the seminal vesicle and subsequent contralateral testicular torsion is presented. The results indicate that a transseptal crossed vasovasostomy should be done in patients satisfying the criteria presented.

Vasectomy failure and open-ended vasectomy.

PIP: The author of this letter comments on the earlier exchange of letters on vasectomy failure. In the present author's opinion, vasectomy failures are most often caused by the inadequate creation of a barrier of fascia between the cut ends of the vas. The use of a magnifier makes it easier to spot and correct this error. The conventional electrosurgical unit is the worst cautery used due to the potential for current leakage between the wall of the vas and the fascia. The desiccating effect of cautery units using red hot wire makes this the unit of choice. At present, the open-end technique appears to be most effective, although the creation of a spermatic granuloma risks involvement of the spermatic nerve. Research is needed in terms of observations of the vas end in humans after open-end vasectomy and an explanation of the difference in spermatic granulomas between cases in which the end of the vas is sealed and those in which the testicular end of the vas is left open. It is speculated that this difference is due to the difference in time of development of these granulomas. Finally, it is recommended in cases of postoperative orchialgia that the vas be transected about 1 cm proximal to the vasectomy and be left open to reduce the pressure within the epididymis and create a low-pressure spermatic granuloma.^ieng