Antisperm Antibody Levels After Vasectomy Reversal Are Not Associated With Pregnancy Rates or Method of Conception.

OBJECTIVE: To examine the relationship between antisperm antibody (ASA), pregnancy rates, and method of conception following vasectomy reversal, given that before and after vasectomy reversal, patients wonder if ASAs will prevent them from achieving pregnancy and American Urological Association vasectomy guidelines call for additional research to answer this question. METHODS: We performed retrospective chart review and phone interview of patients who underwent vasectomy reversal at our institution from 1/1/2000 to 12/31/2018. We excluded patients who underwent vasectomy reversal for pain, or without postoperative semen analysis with ASA. We categorized patients as having low (<50%) or high (≥50%) ASA levels using the first postoperative semen analysis. Our primary outcome was pregnancy rate, including method of conception. Differences in pregnancy rates were tested using Fisher exact test. RESULTS: Two hundred and four patients were chart reviewed. Median age at time of surgery was 40years and median obstruction interval was 7.3years. Median partner age was 32years. One hundred sixty-four (80%) patients underwent bilateral vasovasostomy. Eighty-five patients (42%) had low (<50%) ASA levels and 119 (58%) had high (≥50%) ASA levels. Sixty-seven patients completed phone interviews. Of 27 men with low ASA levels, 19 (70%) achieved a pregnancy with 16 (59%) spontaneous pregnancy. Of 40 men with high ASA levels, 30 (75%) achieved a pregnancy with 16 (40%) spontaneous pregnancy. The Fisher exact test P-value was .2. CONCLUSION: ASA levels are not associated with pregnancy rate or method of conception after vasectomy reversal. These findings can improve patient counseling before and after vasectomy reversal.

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.

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.

Vasectomy and vasectomy reversal: a comprehensive approach to the evolving spectrum of care.

Male reproduction and male contraception form an important spectrum within men's health. In this issue's Views and Reviews, four author groups detail important new developments in vasectomy clinical practice guidelines, emerging and investigational techniques in the fields of hormonal and nonhormonal male contraception, useful paradigms for patient care when deciding between sperm extraction with in vitro fertilization and vasectomy reversal, and finally, a state-of-the-art overview of recent developments in vasectomy reversal microsurgery. These articles will provide readers with a contemporary understanding of the rapidly evolving spectrum of male reproductive and contraceptive health care.

Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis.

OBJECTIVE: To explore the primary options available to men who desire fertility after a vasectomy. DESIGN: Literature review. SETTING: University of Miami Miller School of Medicine. PATIENT(S): Men with a previous vasectomy now seeking fertility. INTERVENTION(S): The two main options to achieve paternity for men following vasectomy include vasectomy reversal (VR) and surgical sperm retrieval with subsequent in vitro fertilization (IVF). MAIN OUTCOME MEASURE(S): We reviewed and compared the important considerations for men deciding between these 2 options, including: obstructive interval, female partner age, antisperm antibodies, male partner age, female infertility factors, and cost. RESULT(S): Both VR and IVF represent reasonable options for the couple seeking fertility after vasectomy. Specific circumstances may favor one modality over another, depending on obstructive interval, possible female fertility factors, female partner age, male partner age, and cost. In the absence of insurance coverage, VR is often more cost-effective than IVF. Alternatively, when a female factor may contribute to infertility in addition to vasectomy, IVF is often the better choice. Antisperm antibodies are unlikely to contribute to infertility following a successful VR. CONCLUSION(S): VR or surgical sperm retrieval with IVF are reasonable options for couples seeking children after vasectomy. Pregnancy rates for both options are overall similar, so prior to pursuing either option, a thorough discussion with a reproductive urologist who possesses microsurgical skills in VR and a reproductive endocrinologist with expertise in IVF is imperative. Making a final choice through shared decision-making while considering these points is ideal.

Lidocaine and bupivacaine as part of multimodal pain management in a C57BL/6J laparotomy mouse model.

While the use of local anesthesia as part of multimodal pain management is common practice in human and veterinarian surgery, these drugs are not applied routinely in rodent surgery. Several recommendations on the use of local anesthesia exist, but systematic studies on their efficacy and side effects are lacking. In the present study, male and female C57BL/6J mice were subjected to a sham vasectomy or a sham embryo transfer, respectively. We tested whether a mixture of subcutaneously injected Lidocaine and Bupivacaine in combination with systemic Paracetamol applied via drinking water results in superior pain relief when compared to treatment with local anesthesia or Paracetamol alone. We applied a combination of methods to assess behavioral, emotional, and physiological changes indicative of pain. Voluntary Paracetamol intake via drinking water reached the target dosage of 200 mg/kg in most animals. Local anesthesia did not lead to obvious side effects such as irregular wound healing or systemic disorders. No relevant sex differences were detected in our study. Sevoflurane anesthesia and surgery affected physiological and behavioral measurements. Surprisingly, Paracetamol treatment alone significantly increased the Mouse Grimace Scale. Taken together, mice treated with a combination of local anesthesia and systemic analgesia did not show fewer signs of post-surgical pain or improved recovery compared to animals treated with either local anesthesia or Paracetamol.

Association of partner vasectomy, depot medroxyprogesterone acetate and intrauterine contraceptive devices with ovarian cancer.

PURPOSE: To assess the associations between ovarian cancer and depot medroxyprogesterone acetate (DMPA), intrauterine contraceptive devices (IUDs), and partner vasectomy. METHODS: We undertook a New Zealand-wide population-based case-control study. During 2013-2015, 205 eligible cases were identified from the cancer registry (152 [74%] participated) and 1,735 eligible controls were randomly selected from the electoral roll (837 [48%] participated). A postal questionnaire was used to gather information. RESULTS: Ever-use of vasectomy was inversely associated with ovarian cancer in age-adjusted analysis, but not in multivariable analysis (OR = 0.67, 95% CI = 0.46-0.96, and OR = 0.82; 95% CI = 0.54-1.23, respectively). A suggestive trend towards lower risk with longer duration of reliance on partner vasectomy was observed (P-trend = 0.08). Ever-use and duration of use of DMPA were not associated with ovarian cancer. Although ever-use of IUDs was not associated with ovarian cancer, duration of use of IUDs was associated with higher risk (P-trend = 0.04). There were also statistically significant inverse associations between ovarian cancer and use of oral contraceptives, parity, and breastfeeding. CONCLUSIONS: Prolonged use of IUDs may increase the risk of ovarian cancer. It is also possible that an inverse association exists between ovarian cancer and partner vasectomy.

Association between vasectomy and risk of prostate cancer: a meta-analysis.

BACKGROUND: The debate over the association between vasectomy and prostate cancer has been lasted about 40 years and there is no sign of stopping. In the present study, we aimed to evaluate whether vasectomy is associated with prostate cancer based on the most comprehensive and up-to-date evidence available. METHODS: The PubMed, Cochrane Library, and EMBASE databases were systematically searched inception to March 14, 2021 without year or language restriction. Multivariable adjusted risk ratios (RRs) were used to assess each endpoint. Risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: A total of 58 studies involving 16,989,237 participants fulfilled inclusion criteria. There was significant association of vasectomy with risk of any prostate cancer (risk ratio, 1.18, 95% CI, 1.07-1.31). Association between vasectomy and advanced prostate cancer (risk ratio, 1.06, 95% CI, 1.01-1.12), low-grade prostate cancer (risk ratio, 1.06, 95% CI, 1.02-1.10), and intermediate-grade prostate cancer (risk ratio, 1.12, 95% CI, 1.03-1.22) were significant. There was no significant association between vasectomy and prostate cancer-specific mortality (risk ratio, 1.01, 95% CI, 0.93-1.10). CONCLUSIONS: This study found that vasectomy was associated with the risk of any prostate cancer and advanced prostate cancer. From the current evidence, patients should be fully informed of the risk of prostate cancer before vasectomy.

Vasovasostomy and vasoepididymostomy: indications, operative technique, and outcomes.

The basic principles of vasal reconstruction have endured since their initial description over a century ago, yet the nuances and technical approaches have evolved. Prior to performing vasectomy reversal, the clinician should perform a focused history, physical and laboratory assessment, all of which are critical for patient counseling and preoperative planning. Operative success is contingent on appropriate intraoperative decision making and technical precision in completing a tension-free, watertight, and patent anastomosis. Outcomes of vasectomy reversal differ on the basis of the type of reconstruction required, reconstructive technique, and patient-specific factors. Here we review the indications, surgical techniques, and outcomes of vasectomy reversal.

Vasectomy: a guidelines-based approach to male surgical contraception.

Except for condom use, vasectomy is the only approved form of male contraception. The American Urological Association published guidelines on vasectomy in 2012, which clearly outlined patient counseling, vasectomy techniques to maximize successful occlusion, and postvasectomy care. However, there are certainly areas of further improvement to be addressed. Vasectomy is severely underutilized compared with tubal ligation for sterilization, likely due to lack of patient awareness. Although the majority of vasectomies are performed in the office with local anesthesia, some patients are still routinely prescribed narcotics for postprocedural pain, despite the well-described opioid pandemic. Finally, although patients are counseled on the necessity of a postvasectomy semen analysis to confirm sterility prior to the discontinuation of alternative contraceptives, more than 50% of men do not complete this test. Therefore, alternative strategies must be pursued to improve patient compliance.

[Vasectomy : Current information]. / Vasektomie : Aktuelle Informationen.

Vasectomy is considered to be the simplest, most effective and cheapest method of fertility control in men, with a significantly lower risk of morbidity and mortality compared to tubal ligation in women. Patient informed consent is particularly important and should include potential irreversibility, surgical options, anesthesia, possible complications as well as postoperative behavior and the need for re-evaluation. There are different access routes available with conventional and no-scalpel vasectomy as well as different techniques for closing the ends of the vas deferens. To confirm sterility the European Association of Urology (EAU) recommends that an ejaculate analysis should be performed 3 months after the procedure and after approximately 20 ejaculations. Complications are relatively rare, although particularly vasectomy failure due to recanalization has to be considered. Approximately 3-6% of vasectomized men strive for a refertilization, which with experienced surgeons is successful in about 90% of cases.

Pain and anxiety during vasectomies while distracting patients with video glasses or virtual reality glasses.

OBJECTIVE: To determine whether it is possible to reduce the amount of pain and anxiety experienced during a vasectomy by use of two-dimensional (2D) video glasses or virtual reality (VR) glasses during the vasectomy. PATIENTS AND METHODS: A non-randomised controlled trial was performed between October 2017 and March 2018. A total of 176 patients were planned for a vasectomy in an outpatient setting and 141 of these patients were divided sequentially into three groups: Control, 2D video glasses and VR glasses. Follow-up lasted 7 days. One patient was lost to follow-up. The main outcomes were pain (visual analogue scale [VAS] score 0-10) and anxiety ((VAS score 0-10), and State-Trait Anxiety Inventory for Adults [STAI-AD] score 20-80) during the vasectomy. Data were compared using analysis of variance or chi-square measurements. RESULTS: No significant differences in pain were found (VAS score of 2 in all groups). The odds ratio (OR) and (95% confidence interval [CI]) in the 2D video glasses group was 1.15 (0.92-1.48) and in the VR group was 0.98 (0.76-1.26). Patients in the VR group experienced significantly more anxiety during the procedure (OR 1.40, 95% CI 1.07-1.85). Also, patients without prior hospitalisation reported significantly more pain than patients with one or more hospitalisations (OR 1.35, 95% CI 1.11-1.65). CONCLUSIONS: The VR and 2D video glasses did not reduce pain or stress during the vasectomy. In the VR group, the anxiety levels during the procedure were even higher.

Vasectomy and prostate cancer risk: a meta-analysis of prospective studies.

Epidemiological cohort studies investigating the association between vasectomy and prostate cancer risk have yielded inconsistent results. The aim of the present meta-analysis is to update the evidence on the association between vasectomy and prostate cancer. A comprehensively literature search of relevant studies was performed in December 2019 using PubMed. A DerSimonian and Laird random-effects model was used to calculate the summary relative risk (RR) and its 95% confidence interval (CI). A total of 15 eligible cohort studies (16 data sets) with more than four million of participants were eventually included in this meta-analysis. There was a statistically significant higher risk of prostate cancer among men who underwent vasectomy (RR: 1.09, 95% CI: 1.04-1.13) with obvious heterogeneity among included studies (P < 0.001, I2 = 64.2%). Vasectomy was also associated with the risk of advanced prostate cancer (RR: 1.07, 95% CI: 1.02-1.13), which is less likely to be affected from detection bias. In conclusion, findings from this meta-analysis of prospective studies indicate that vasectomy may be positively associated with the risk of prostate cancer. Further large prospective studies with long follow-up are warranted to verify the findings from this meta-analysis. In addition, the potential underlying molecular mechanism needed further exploration with in vitro and animal studies.

The Utility of Sperm Cryopreservation at the Time of Vasectomy Reversal.

PURPOSE: We retrospectively evaluated the utility of sperm cryopreservation at the time of vasectomy reversal. MATERIALS AND METHODS: From April 2016 through December 2018 a total of 26 men underwent vasectomy reversal. Sperm cryopreservation is routinely offered at the time of vasectomy reversal at our institution. We sought to assess utilization of cryopreserved sperm by those men with early or late vasectomy reversal failure. RESULTS: Of 26 patients presenting for vasectomy reversal 22 (85%) elected to cryopreserve sperm. Sperm were obtained for freezing from the vasal (7 patients) or epididymal fluid (3), or via testicular biopsy (12). Three patients were lost to followup postoperatively. Of the 23 who presented for post-procedure followup 19 either had semen analyses with motile sperm or a live birth (83% success rate). There were 4 early failures and 2 late failures; all patients with failures had elected to cryopreserve sperm at the time of initial reversal. Three of the 6 individuals (50%) with vasectomy reversal failure elected to use cryopreserved sperm for in vitro fertilization/intracytoplasmic sperm injection, with 2 of these (67%) resulting in live births. CONCLUSIONS: Of those patients who experienced vasectomy reversal failure 50% elected to use cryopreserved sperm that had been procured at the time of initial reversal. Given the potential for early or late failure, cryopreservation of sperm at the time of vasectomy reversal should be routinely offered as a means of avoiding the added expense and potential morbidity of future surgical sperm retrieval.

Preoperative Predictors of Failure of Microsurgical Spermatic Cord Denervation for Men With Chronic Orchialgia.

OBJECTIVE: To evaluate predictors of failure of microsurgical spermatic cord denervation (MSCD) for men with chronic orchialgia. METHODS: Retrospective chart review of men who underwent MSCD. Outcomes were recorded with potential preoperative predictors of failure. RESULTS: One hundred and five men underwent MSCD, and of those, 38 were bilateral for a total of 143 testicular units. Overall, 97 of 143 (67.8%) had complete resolution of pain, 27 of 143 (18.9%) had improvement of pain, and 19 of 143 (13.3%) were considered failures with either no improvement or less than 50% improvement in pain after MSCD with a 1-year follow-up period. Overall, 59 of 143 (41%) presented with intermittent orchialgia while 84 of 143 (59%) presented with constant pain. The mean preoperative visual analog scale was 6.8 ± 2 and the mean duration of pain prior to MSCD was 62.5 ± 100 months. Potential etiologies of pain per testicular unit included previous scrotal/inguinal surgery 17 of 143 (11.9%), postvasectomy pain syndrome (PVPS) 30 of 143 (21%), infectious epididymitis 9 of 143 (6.3%), trauma 15/143 (10.5%), and idiopathic 72/143 (50.3%). The only pre-operative predictor having an association with predicting failure was the etiology of orchialgia. Relative to men who had idiopathic orchialgia or prior scrotal/inguinal surgery inciting orchialgia, men with PVPS had increased odds of failure with MSCD. CONCLUSION: PVPS is an etiology associated with a higher risk of failure to respond to MSCD than idiopathic chronic orchialgia or chronic orchialgia subsequent to scrotal/inguinal surgery.

Vasectomy and male sexual dysfunction risk: A systematic review and meta-analysis.

BACKGROUND: Unintended pregnancy is popular all over the world, accounting for 40% to 50% of all pregnancies. The condition not only exerts pressure on the relationship of couples and severely impacts the quality of life, but also imposes a heavy burden on the health of women and child. Recently, more than 220 million couples have chosen to be sterilized to obtain contraception, 47.3% of married couples select sterilization, of which vasectomy accounts for 17.1%. Vasectomy is currently the most convenient and effective method of male contraception. We will perform the systematic review and meta-analysis to assess the correlation between vasectomy and male sex dysfunction and provide evidence-based evidence for the couple METHODS:: The electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, Clinicaltrials.org., China National Knowledge Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database (CBM), VIP Science Technology Periodical Database, Chinese Clinical Trial Registry, and Cochrane Library will be retrieved before November 20, 2021. We will search English literature and Chinese literature with proper Medical Subject Heading or text key words. RevMan 5.3 and Stata 14.0 will be used for Systematic review and Meta-analysis. This protocol reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement. CONCLUSION AND DISSEMINATION: The aim of this study was to evaluate the effect of vasectomy on the sexual function of patients after operation. The results will be published in a public issue journal to provide evidence-based medical evidence for urologists and andrologists to make clinical decisions. REGISTRATION INFORMATION: INPLASY202080014.

The meaning of words - closing the gap in understanding between doctors and patients in 21st century consent.

'When I use a word' Humpty Dumpty said, in a rather scornful tone, 'it means just what I choose it to mean, neither more nor less'. 'The question is' said Alice 'whether you can make words mean so many different things'. Through the Looking-Glass, Lewis Carroll, 1872.

Paternity seven years after a negative post-vasectomy semen analysis: a case report.

BACKGROUND: Vasectomy is one of the permanent methods of contraception; however, the risk of conception still exists. Early failure, defined as a postoperative semen analysis showing persistent motile sperm, occurs in 1 in every 250 patients. Late failure, defined as the rejoining of the severed ends of the vas deferens, occurs in 1 in every 2000 patients. CASE PRESENTATION: A healthy 37-year-old British male presented to our clinic because his wife had conceived seven years after he had undergone a vasectomy. The result of his semen analysis after the vasectomy was negative, and the histopathological report confirmed that the sample contained tissue from both the left and right vas deferens. His wife conceived seven years after the procedure, and semen analysis at that time confirmed a total of 0.5 million sperm per milliliter of semen in a total semen sample of 6.3 ml. The total number of motile sperm recorded was 2.5 million. CONCLUSION: This case shows that late recanalization can occur up to seven years after a vasectomy. Patients should be informed prior to the procedure that late recanalization, although rare, may still occur. Post-vasectomy paternity necessitates further counseling to ensure that the patient and the patient's partner fully understand the implications and options available to them.