Academic
Publications
Effectiveness and Complications Associated With 2 Vasectomy Occlusion Techniques

Effectiveness and Complications Associated With 2 Vasectomy Occlusion Techniques,10.1097/00005392-200212000-00034,Journal of Urology,MICHEL LABRECQUE,

Effectiveness and Complications Associated With 2 Vasectomy Occlusion Techniques   (Citations: 20)
BibTex | RIS | RefWorks Download
Purpose: We compared the effectiveness and complications associated with 2 common vasec- tomy occlusion techniques, namely clipping and excision of a small vas segment and thermal cautery with fascial interposition and an open testicular end. Materials and Methods: We retrospectively reviewed the computerized records of 3,761 men who underwent initial vasectomy at a single university hospital family planning clinic and at 2 private clinics in the Quebec City, Canada area, including concurrent and historical controls. All procedures were performed by 1 surgeon, who used the scalpel-free technique to expose the vas. Results: The risk of vas occlusion failure in men with at least 1 semen analysis was much greater in the clipping and excision group than in the cautery, interposition and open testicular end group (126 of 1,453 or 8.7% versus 3 of 1,165 or 0.3%, OR 37, 95% CI 12 to 116). Medical consultations for hematoma or infection were more frequent in the cautery group (28 of 1,721 cases or 1.6% versus 10 of 2,040 or 0.5%, OR 3.4, 95% CI 1.6 to 6.9). Consultations for noninfec- tious pain were similar for the 2 techniques (71 of 1,721 cases or 4.1% versus 72 of 2,040 or 3.5%, OR 1.2, 95% CI 0.8 to 1.6). Conclusions: Cautery and interposition with an open testicular end are much more effective than clipping and excision. The effectiveness and morbidity associated with the components of the cautery, interposition and open testicular end technique need further evaluation.
Journal: Journal of Urology - J UROL , vol. 168, no. 6, pp. 2495-2498, 2002
Cumulative Annual
View Publication
The following links allow you to view full publications. These links are maintained by other sources not affiliated with Microsoft Academic Search.
    • ...However, these findings support the results from numerous large case series showing that the occlusive effectiveness of cautery, especially when combined with FI on the prostatic end, is high, with failures well below 1%. [1,14-21]...
    • ...ML has performed over 9000 vasectomies over the last 20 years, most using NSV combined with various occlusion techniques including cautery and FI. [1,15,24-26] Cautery handles and tips manufactured in USA (Advance Meditech International) and Canada (Walsh Medical Devices Inc.) were brought along in order to assess the feasibility of carrying out procedures under local conditions...

    Michel Labrecqueet al. Vasectomy surgical techniques in South and South East Asia

    • ...In 13 research articles [14,15,20,26,27,29-36], multiple techniques were compared, therefore description of these articles may appear in more than one of the following sections...
    • ...Vas occlusion using ligation compared with cautery We found eleven studies (17 articles) comparing ligation with cautery (Tables 19 to 22, Additional file 6). There were two moderate quality studies: a non-randomized parallel clinical trial [32] and a case series with concurrent controls [34]...
    • ...In the other study [34], with a much larger sample size, cautery was reported to be much more significantly effective with regards to occlusion than ligation with clips (0.3% versus 8.7%)...
    • ...FI was used with cautery in six of the eleven studies [14,20-24,27,28,33,34,36]...
    • ...Four studies [14,15,27,28,33,34] used thermal cautery, five [23-26,35,36,47] used electro-cautery and two [20- 22,32] used both cautery techniques...
    • ...Complications assessed varied among studies and included hematoma [14,20-24,27,28,32-34], infection [14,20-24,27,28,32-34], granuloma [20-24,33,34], orchiepididymitis [20-24,32-34], and pain [33,34] (Table 22, Additional file 6). With the exception of one retrospective study [33], none of the studies explicitly described the criteria used to assess their main complication outcome measures...
    • ...Complications assessed varied among studies and included hematoma [14,20-24,27,28,32-34], infection [14,20-24,27,28,32-34], granuloma [20-24,33,34], orchiepididymitis [20-24,32-34], and pain [33,34] (Table 22, Additional file 6). With the exception of one retrospective study [33], none of the studies explicitly described the criteria used to assess their main complication outcome measures...
    • ...Complications assessed varied among studies and included hematoma [14,20-24,27,28,32-34], infection [14,20-24,27,28,32-34], granuloma [20-24,33,34], orchiepididymitis [20-24,32-34], and pain [33,34] (Table 22, Additional file 6). With the exception of one retrospective study [33], none of the studies explicitly described the criteria used to assess their main complication outcome measures...
    • ...Complications assessed varied among studies and included hematoma [14,20-24,27,28,32-34], infection [14,20-24,27,28,32-34], granuloma [20-24,33,34], orchiepididymitis [20-24,32-34], and pain [33,34] (Table 22, Additional file 6). With the exception of one retrospective study [33], none of the studies explicitly described the criteria used to assess their main complication outcome measures...
    • ...Complications assessed varied among studies and included hematoma [14,20-24,27,28,32-34], infection [14,20-24,27,28,32-34], granuloma [20-24,33,34], orchiepididymitis [20-24,32-34], and pain [33,34] (Table 22, Additional file 6). With the exception of one retrospective study [33], none of the studies explicitly described the criteria used to assess their main complication outcome measures...
    • ...Techniques with and without leaving the testicular end open (openend vasectomy) Seven studies comparing vas occlusion techniques with and without leaving the testicular end open were found (Tables 23 to 26, Additional file 7). Two were of moderate quality: a non-randomized parallel clinical trial [32] and a case series with concurrent controls [34]...
    • ...Isolation of the vas was incisional in two studies [13,48], NSV in three [32-34] and mixed incisional and NSV in one study [14]...
    • ...A variety of occlusion methods were used for both the closed-end and open-end vasectomy groups within and between studies (Table 23, Additional file 7). Four of the seven studies used cautery and FI in combination with open-end vasectomy [13,14,33,34]...
    • ...The remaining two studies found lower risk of failure with open-versus closed-end [33,34]...
    • ...Assessed complications included bleeding/hematoma and infection [14,32-34], granuloma [14,15,33,34], epididymitis [13-15], [32-34] and pain [15,33,34] (Table 26, Additional file 7). In three of the four studies that reported surgical complications (hematoma/bleeding and infection) risk was slightly higher for open-end vasectomy, however the occlusion techniques in the open- and closed-end groups were not comparable [32-34]...
    • ...Assessed complications included bleeding/hematoma and infection [14,32-34], granuloma [14,15,33,34], epididymitis [13-15], [32-34] and pain [15,33,34] (Table 26, Additional file 7). In three of the four studies that reported surgical complications (hematoma/bleeding and infection) risk was slightly higher for open-end vasectomy, however the occlusion techniques in the open- and closed-end groups were not comparable [32-34]...
    • ...Assessed complications included bleeding/hematoma and infection [14,32-34], granuloma [14,15,33,34], epididymitis [13-15], [32-34] and pain [15,33,34] (Table 26, Additional file 7). In three of the four studies that reported surgical complications (hematoma/bleeding and infection) risk was slightly higher for open-end vasectomy, however the occlusion techniques in the open- and closed-end groups were not comparable [32-34]...
    • ...Assessed complications included bleeding/hematoma and infection [14,32-34], granuloma [14,15,33,34], epididymitis [13-15], [32-34] and pain [15,33,34] (Table 26, Additional file 7). In three of the four studies that reported surgical complications (hematoma/bleeding and infection) risk was slightly higher for open-end vasectomy, however the occlusion techniques in the open- and closed-end groups were not comparable [32-34]...
    • ...Assessed complications included bleeding/hematoma and infection [14,32-34], granuloma [14,15,33,34], epididymitis [13-15], [32-34] and pain [15,33,34] (Table 26, Additional file 7). In three of the four studies that reported surgical complications (hematoma/bleeding and infection) risk was slightly higher for open-end vasectomy, however the occlusion techniques in the open- and closed-end groups were not comparable [32-34]...
    • ...More painful granulomas were reported with open-end vasectomy in one study [33] and the risk was similar in the other [34]...
    • ...More cases of epididymitis were reported with open-end vasectomy in one study [33], risk was similar in another [34] and the numbers were too small to interpret in the remaining two [15,32]...
    • ...Pain with no other diagnosis was higher with closed-end in one study [33] and similar in open- and closed-end in another study [34]...

    Michel Labrecqueet al. Vasectomy surgical techniques: a systematic review

    • ...These reports suggest that ligation and excision without fascial interposition may not be a satisfactory occlusion technique [3-8]...
    • ...Results of the two best quality studies comparing ligation and excision to cautery (rated by the review paper's authors as moderate quality) are conflicting; one study found a higher failure risk based on semen analysis for cautery [15] and the other found a lower risk [5]...
    • ...A recent study found no association between the length of vas excised and the risk of recanalization [21] and success has been reported when no vas tissue is removed with occlusion by cautery combined with fascial interposition [5,22-24]...

    Mark A Baroneet al. Effectiveness of vasectomy using cautery

    • ...However, recently reported data based on observational studies and individual surgeons' reports suggest that failures are more common than expected following vasectomies performed using ligation and excision [4-7]...
    • ...In fact, a broad range of failure rates based on semen analysis and pregnancy have been reported for vasectomy by ligation and excision; including rates as high as 3–10% [4-7]...
    • ...In a Canadian study of clip ligation and excision, using two clips per vas, careful follow up showed a failure rate of 8.7% based on semen analyses [6]...

    David Sokalet al. Vasectomy by ligation and excision, with or without fascial interposit...

Sort by: