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.

Telehealth Sterilization Consultation Does Not Impact Likelihood of Vasectomy: A Retrospective Institutional Analysis.

OBJECTIVE: To evaluate if telehealth consultations would impact the likelihood of patients following through with vasectomies. METHODS: We utilized electronic medical records from the past 5 years to retrospectively evaluate male patients undergoing a sterilization consult. Telehealth consultations have been offered since March 2020 due to the COVID-19 pandemic. Patients were stratified to in-office or telehealth consultation. We then utilized billing codes to determine if patients underwent a vasectomy. Percentages of patients who subsequently underwent vasectomy were compared using Chi-square analysis. Logistic regression was performed to identify factors associated with completing vasectomy. RESULTS: There were a total of 369 patients who underwent a telehealth male sterilization consultation and 1664 patients who were seen in the office. We found that 66.9% of telehealth patients ultimately underwent a vasectomy (n.ß=.ß247) compared to 64.3% of patients who were seen via office assessment (n.ß=.ß1070) (X2 =.ß0.646, p.ß=.ß.724). Younger age was the only variable on univariate logistic regression that was associated with completing vasectomy (p.ß=.ß.002) via either an in-person or televisit, while body mass index, race, and ethnicity were not significant. CONCLUSION: Only 2/3 of the men completing a vasectomy consult receive a subsequent vasectomy. Both in-office and telehealth consultations resulted in comparable rates of vasectomy. This is the first study to report on the likelihood of following through with a surgical procedure comparing in-office vs.ßtelehealth assessment in male sexual and reproductive medicine. As vasectomy consultations continue to rise, clinicians can be reassured by the effectiveness of telehealth consultations prior to vasectomy.

The Omission of Genitourinary Physical Exam in Telehealth Pre-Vasectomy Consults Does not Reduce Rates of Office Procedure Completion.

OBJECTIVE: To determine whether the omission of preprocedure genitourinary exam for vasectomy inherent to a virtual consultation reduces the likelihood of successfully completing in-office vasectomy. Currently, the AUA Vasectomy guidelines encourage in-person examination when possible, though COVID-19 has catalyzed the uptake of virtual consultations at many institutions. We hypothesized that rates of completed in-office vasectomy do not significantly differ between patients examined during consultation in the office and those seen virtually with no exam. METHODS: Virtual vasectomy consults from April to December 2020 were retrospectively reviewed and compared to a size-matched, randomly-selected control group who underwent in-office vasectomy consultation. The primary outcome was completion of in-office bilateral vasectomy. Baseline demographic characteristics were compared. Fisher's exact test and Student's t-test were performed on categorical and continuous variables, respectively. RESULTS: Of 211 patients who underwent virtual vasectomy consultation during the study period, 153 presented for in-office vasectomy. They were compared to 153 vasectomies from the in-person consult cohort. No demographic differences were observed between virtual and in-office consult groups. No statistical difference was observed in completion rates of in-office vasectomy, which was 97.4% (149/153) in the virtual consult cohort and 98.7% (151/153) in the in-office consultation cohort (P = .68). CONCLUSION: Rates of completed in-office vasectomy did not significantly differ based on consult platform, suggesting that a pre-vasectomy physical exam is not required to predict successful completion of the procedure. Telehealth should be utilized as an additional platform to improve access for male contraceptive procedures in a young and busy population.

[Clinical significance of sperm presence in post-vasectomy seminograms. Analysis of a 2,168 patients serie]. / Significación clínica de la presencia de espermatozoides en los seminogramas posvasectomía. Análisis de una serie de 2.168 pacientes.

INTRODUCTION: Vasectomy is a safe and effective technique to achieve azoospermia, although the failure rate of the technique is less than 1%. Sterility is not immediate so the post-vasectomy seminogram continues o be essential to ensure the success of the technique. The aim of this trial is to establish the attitude when dealing with immobile residual sperm patients. MATERIAL AND METHODS: Cross-sectional analysis of 2,168 vasectomies performed between January 2010 and March 2017. The first post-vasectomy seminogram was performed at 3 months. Those patients with azoospermia did not undergo further controls. Patients with immobile sperm (<100,000/ml o>100,000/ml) were considered potentially fertile and were followed with monthly seminograms until azoospermia was obtained. RESULTS: Of a total of 1,807 patients were included; 1,297 of these had azoospermia at 3 months seminogram and 501 patients had immobile residual sperm. Only 24 patients of this last group showed more than 100.000 sperm/ml; 9 cases showed mobile sperm. All patients who presented immobile residual sperm underwent serial seminograms. Azoospermia was achieved in an average time of 4,5 months in a rage of 4-10 months, regardless of the initial sperm count. An average of 2,5 tests were performed on each patient. All of the patients with mobile sperm required a reintervention. CONCLUSION: All patients with immobile sperm on the first post-vasectomy seminogram will achieve azoospermia regardless of the initial count. Therefore, serial controls until a negative seminogram is obtained are unnecessary.

[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.

The Effects of Sperm and Seminal Fluid of Immunized Male Mice on In Vitro Fertilization and Surrogate Mother-Embryo Interaction.

The latest vaccination campaign has actualized the potential impact of antigenic stimuli on reproductive functions. To address this, we mimicked vaccination's effects by administering keyhole limpet hemocyanin (KLH ) to CD1 male mice and used their sperm for in vitro fertilization (IVF). Two-cell embryos after IVF with spermatozoa from control (C) or KLH-treated (Im) male mice were transferred to surrogate mothers mated with vasectomized control (C) or KLH-treated (Im) male mice, resulting in four experimental groups: C-C, Im-C, C-Im, and Im-Im. The pre-implantation losses were significantly lower in the Im-C group than in the C-Im group. At the same time, the resorption rates reduced markedly in the C-Im compared to the Im-C group. Embryo and placenta weights were significantly higher in the Im-Im group. Although the GM-CSF levels were lower in the amniotic fluid of the gestating surrogate mothers in the Im-Im group, they were strongly correlated with embryo mass. The number-size trade-off was only significant in the Im-Im group. This suggests a positive, cooperative effect of spermatozoa and seminal fluid from immune-primed males on embryo growth and the optimal distribution of surrogate mother maternal resources despite the negative impact of males' antigenic challenge on the IVF success rate.

"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.

Vasectomy and Photoperiodic Regimen Modify the Protein Profile, Hormonal Content and Antioxidant Enzymes Activity of Ram Seminal Plasma.

This work aimed to determine the contribution of the testis and epididymis and the effect of the photoperiodic regimen on ram seminal plasma (SP). Semen was collected from 15 mature rams located in an equatorial (Colombian Creole and Romney Marsh, eight intact and two vasectomized) or a temperate climate (Rasa Aragonesa, three intact and two vasectomized). SP proteins were analyzed by Bradford, SDS-PAGE and difference gel electrophoresis (DIGE). Melatonin and testosterone concentrations were quantified by ELISA, and activity of glutathione peroxidase (GPx), glutathione reductase (GRD), and catalase by enzymatic assays. Vasectomy increased protein concentration and the intensity of high molecular weight bands (p < 0.001), with no differences between breeds. DIGE revealed the absence of six proteins in vasectomized rams: angiotensin-converting enzyme, lactotransferrin, phosphoglycerate kinase, sorbitol dehydrogenase, epididymal secretory glutathione peroxidase and epididymal secretory protein E1. Vasectomy also decreased melatonin concentrations in seasonal rams, and testosterone in all of them (p < 0.001), but did not affect antioxidant enzyme activity. Equatorial rams showed lower melatonin and testosterone concentration (p < 0.01) and catalase, but higher GPx activity (p < 0.05). In conclusion, vasectomy modifies the protein profile and hormonal content of ram seminal plasma, whereas the exposure to a constant photoperiod affects hormonal concentration and antioxidant enzymes activity.

Vasectomía: conductos deferentes con atipia celular tipo vesícula seminal / Vasectomy: Vas deferens with cellular atypia seminal vesicle type

No disponible

[E-Cadherine and GATA-3 are useful in the confirmation of the vas deferens in vasectomy specimens]. / Cadherina E y GATA-3 son útiles para confirmar la presencia de conducto deferente en muestras de vasectomía.

INTRODUCTION AND OBJECTIVES: Urologists often submit the resected tissue from vasectomies for histopathological examination in order to confirm the presence of the vas deferens. Microscopy is simple and based on haematoxylin-eosin staining; however, sample artefacts can sometimes cause confusion and immunohistochemistry can be used to identify the vas deferens. MATERIALS AND METHODS: We investigated the utility of immunohistochemical analysis using E-cadherin and GATA-3 to confirm the presence of vas deferens epithelium in 110 vasectomy sections with different artefacts, using monoclonal antibodies and a multimer conjugated with peroxidase based technique; 5 renal arteries and 5 renal veins were stained as negative controls. RESULTS: Membrane staining was observed for E-cadherin, which was moderate (2.7%) or strong (97.3%) in the vas deferens epithelium in all cases: 35 without artefacts, 7 with denuded epithelium, 56 with compressed/distorted epithelium, 8 with detached epithelium and 4 with displaced epithelium. GATA-3 showed moderate (31%) or strong (69%) nuclear staining in all cases, including the 76 with artefacts. In the control group, arteries and veins were negative for both markers in the endothelium, but GATA-3 occasionally stained lymphocytes in the blood vessel wall. CONCLUSIONS: E-cadherin membrane positivity and GATA-3 nuclear expression are useful for the identification of the vas deferens in vasectomy samples containing artefacts. Vascular endothelium is negative for both markers and any possible GATA-3 staining of the lymphocytes in the blood vessel wall should not be misinterpreted.

Nuevos marcadores de inmunohistoquímica para confirmar la presencia de conducto deferente en muestras de vasectomía / New immunohistochemistry markers to determine presence of vas deferens in vasectomy specimen

OBJETIVOS: El estudio anatomopatológico de las muestras de vasectomía para confirmar la presencia de conducto deferente generalmente es sencillo se realiza con tinción rutinaria de hematoxilina-eosina. En aquellos casos con artefacto del epitelio, el uso de técnicas de inmunohistoquímica puede ayudar al diagnóstico y sirve, además para diferenciar deferente de vaso sanguíneo. Hemos investigado la utilidad de CD31, CD34, ERG y PAX8 para estos fines. MATERIAL Y MÉTODOS: Se han estudiado 81 secciones de muestras de vasectomía en las que alguna sección presentaba algún tipo de artefacto en el epitelio. Se realizó inmunohistoquímica con anticuerpos monoclonales para CD31 (clon JC70), CD34 (clon QBEnd/10), ERG (clon EPR3864) y PAX8 (clon MRQ-50) evaluando la tinción en el epitelio deferencial y en el endotelio vascular. RESULTADOS: Histológicamente, el epitelio del conducto deferente aparecía conservado en 18 secciones (22,2%), denudado en 6 (7,4%), con artefacto de compresión o distorsión en 48 secciones (59,3%), desprendidoen 5 (6,2%) y desplazado fuera de la luz del conducto en 4 (4,9%). En la mayoría de las secciones el epitelio del CD presentó positividad citoplasmática para CD31, que fue débil (86,4%) o moderada (9,9%), y expresó intensamente PAX8 en los núcleos, con tinción granular en el epitelio denudado o artefactado. Fueron negativos CD34 y ERG. El endotelio capilar de los vasos de la pared del conducto deferente mostró intensa positividad citoplasmática para CD31 y CD34, y nuclear para ERG, siendo PAX8 negativo. CONCLUSIONES: PAX8 es un anticuerpo útil para confirmar la presencia de conducto deferente en muestras de vasectomía con artefacto. Son negativos CD34 yERG, que, por el contrario, marcan endotelio vascular, presentando ERG la ventaja de que la tinción es nuclear.CD31, marcador endotelial clásico, no es tan específico como se había propuesto puesto que presenta expresión débil en el epitelio del deferente

OBJECTIVES: The pathological examination of vasectomy specimens to confirm the presence of vas deferens is usually simple and is done by routine hematoxylin and eosin staining. Use of immunohistochemical techniques can aid to the diagnosis in those cases with artifacts of the epithelium, and they are also useful to differentiate vas deferens from blood vessel. We have investigated the usefulness of CD31, CD34, ERG and PAX8 for these purposes. MATERIAL AND METHODS: 81 sections from vasectomy specimens in which any section showed some kind of epithelial artifact were analyzed. Immunohistochemistry was performed with monoclonal antibodies for CD31 (clone JC70), CD34 (clone QBEnd/10), ERG (clone EPR3864) and PAX8 (clone MRQ-50). Evaluation of the vas deferens and vascular endothelial staining was done. RESULTS: Histologically, vas deferens epithelium was well-preserved in 18 sections (22.2%), denuded in 6 (7.4%), crushed or distorted in 48 sections (59.3%), detached in 5 (6,2%), and misplaced out of the vas deferens lumen in 4 (4.9%). In most of the sections the epithelium showed weak (86.4%) or moderate (9.9%) CD31 cytoplasmic staining, as well as strong nuclear PAX8 reactivity in all of the sections, exhibiting a granular pattern in the detached or artifacted epithelium. CD34 and ERG were negative in the epithelium. Capillary vessel endothelium in the vas deferens wall showed strong cytoplasmic positivity for CD31 and CD34, as well as nuclear ERG reactivity, being PAX8 negative. CONCLUSIONS: PAX8 is a useful antibody to confirm the presence of vas deferens in artifacted vasectomy specimens. CD34 and ERG are negative in the epithelium, and, otherwise, they are expressed by vascular endothelium, with the advantage of nuclear staining pattern for ERG. CD31, a classic endothelial marker, is not so specific as it had been stated as it shows weak or moderate expression in the vas deferens epithelium

Continuing the search for a hormonal male contraceptive.

This chapter discusses the mechanisms of action of hormonal male contraception, which suppresses the hypothalamic-pituitary-testis axis. When the intratesticular concentration of testosterone is subsequently suppressed to adequately low concentrations, spermatogenesis is arrested. Androgens are a necessary hormonal male contraceptive component because they not only suppress the hypothalamic-pituitary-testis axis, but also provide the male hormone necessary to maintain peripheral androgen functions. Past studies using testosterone alone and testosterone combined with progestins demonstrated contraceptive efficacy in the female partner at rates similar to combined hormonal female methods. Newer hormonal male contraceptive formulations and the alternative routes of administration are discussed, along with potential barriers, challenges, and opportunities for hormonal male contraceptive development. Novel methods that are safe, effective, reversible, user-friendly, and coitus-independent are intrinsic to equitably meet the various needs and limitations of an increasingly diverse population.

Risk of vasectomy failure by ligation and excision with fascial interposition: A prospective descriptive study.

OBJECTIVE: To evaluate the occlusive failure risk of ligation and excision with fascial interposition vasectomy technique. There are doubts about the effectiveness of this technique largely used in Asia and Latin America. STUDY DESIGN: We conducted a prospective longitudinal observational descriptive study among men who underwent a vasectomy performed under local anesthesia in a clinic specializing in sexual and reproductive health services in Bogotá, Colombia. Three urologists used the Percutaneous No-Scalpel Vasectomy technique to isolate the vas deferens. They then ligated the vas, excised a 1 cm segment between ligations, and ligated the fascia on the prostatic end to cover the testicular end. We requested all patients to submit a semen sample three months after the vasectomy. We defined probable and confirmed vasectomy failure as 1-4.9 million sperm/ml and 5 million sperm/ml or more or any number of motile sperm observed on the last semen sample available, respectively. RESULTS: Among 1149 participants, 581 (51%) had at least one post-vasectomy semen analysis. The overall failure risk was 5.2% (30/581; 95% confidence interval [CI] 3.6%-7.3%) with probable and confirmed failure risk of 1.9% (11/581; 95% CI 1.1%-3.4%) and 3.3% (19/581; 95% CI 2.1%-5.1%), respectively. Older men and one urologist had statistically significant higher risk of overall failure. CONCLUSION: Our study confirmed that the ligation and excision with fascial interposition vasectomy technique is associated with an unacceptable risk of failure. IMPLICATIONS: Surgeons who use the ligation and excision with fascial interposition vasectomy technique and countries with large vasectomy programs in Asia and Latin America that still recommend this technique should consider adopting alternatives to reduce the failure risk to below 1% as recommended by the American Urological Association.

Open/close-ended vasectomy technique by single incision on vervet monkeys (Chlorocebus pygerythrus).

Vervet monkeys (Chlorocebus pygerythrus), considered a species of "least concern" by the International Union for Conservation of Nature (IUCN), are widely maintained at primate sanctuaries in South Africa. Permanent surgical contraception is a necessary method for the management of this species in captivity. In this study, a new vasectomy technique was evaluated and involves a prescrotal approach with only one surgical incision, aiming to excise a piece of vas deferens, leaving open the testicular side, and creating a loop on the prostatic side to avoid future recanalization. The birth rate was studied to assess the success of the technique. This technique significantly reduced breeding in the study population from 33 births in the first year to four births during the last year of the study. These results show that this type of vasectomy is a fast, simple, and safe technique for controlling monkey populations in sanctuaries.

Vasectomy and Prostate Cancer Risk: A 38-Year Nationwide Cohort Study.

BACKGROUND: A man's risk of prostate cancer has been linked to his prior reproductive history, with low sperm quality, low ejaculation frequency, and a low number of offspring being associated with increased prostate cancer risk. It is, however, highly controversial whether vasectomy, a common sterilization procedure for men, influences prostate cancer risk. METHODS: We established a cohort of all Danish men (born between 1937 and 1996) and linked information on vasectomy, doctor visits, socioeconomic factors, and cancer from nationwide registries using unique personal identification numbers. Incidence risk ratios for prostate cancer by time since vasectomy and age at vasectomy during the follow-up were estimated using log-linear Poisson regression. RESULTS: Overall, 26 238 cases of prostate cancer occurred among 2 150 162 Danish men during 53.4 million person-years of follow-up. Overall, vasectomized men had an increased risk of prostate cancer compared with nonvasectomized men (relative risk = 1.15, 95% confidence interval = 1.10 to 1.20). The increased risk of prostate cancer following vasectomy persisted for at least 30 years after the procedure and was observed regardless of age at vasectomy and cancer stage at diagnosis. Adjustment for the number of visits to the doctor and socioeconomic factors did not explain the association. CONCLUSIONS: Vasectomy is associated with a statistically significantly increased long-term risk of prostate cancer. The absolute increased risk following vasectomy is nevertheless small, but our finding supports a relationship between reproductive factors and prostate cancer risk.

Application of a laparoscopic technique for vasectomy in standing horses.

This report describes a technique for standing laparoscopic vasectomy in stallions through a prospective descriptive study. A preliminary study was carried out with two experimental intact male horses and subsequently the procedure was performed in two clinical cases. These horse owners want to keep their animals in the most possible natural way, preserving its stallion behaviour in a herd without generating offspring. The horses were sedated and restrained in stocks and laparoscopic vasectomy was performed using three portal sites in both paralumbar fossae recording surgical times. A 4-cm segment of each ductus deferens (DD) was occluded with laparoscopic vessel sealing devices and subsequently excised. Semen collection was performed using an artificial vagina before the laparoscopic procedure and at 15 and 60 days postoperatively. Sexual behaviour and spermiogram were analysed. Two months after vasectomy, control laparoscopy was performed in experimental horses to assess the surgical site. Bilateral vasectomy could be performed without intraoperative complications in a mean surgical time of 20 min per DD. Success of the procedure was confirmed in all cases by azoospermic ejaculates 60 days after vasectomy. This is the first time that the technique for laparoscopic vasectomy is described in horses.

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.

Vasectomy in Mouse Model Using Electrosurgery Machine.

Vasectomy in laboratory animals is a crucial step in the production of surrogate female mice. The surrogate mothers play a key role in successful embryo transfer, most important steps for the production of transgenic animal models, investigation of the preimplantation embryo development, and revitalization of cryopreserved strains. Abdominal and scrotal surgeries are common surgical procedures used in routine veterinary practice to produce vasectomized males. Two different surgical practice, namely electrosurgery and cold surgical practice, have been used as common techniques in operating rooms. Based on current knowledge, there is no published &ldquo;technical note&rdquo; as a detailed and step by step guideline to describe vasectomy using an electrosurgery machine (i.e., Bovie machine) in laboratory animal research and breeding facilities.The common problem during the laboratory animal surgery would be animal mortalities as a consequence of profound bleeding. The use of Bovie machine leads to the prevention of profound bleeding during the surgical practice.