Effectiveness of vasectomy using cautery

Abstract

BackgroundLittle evidence supports the use of any one vas occlusion method. Data from a number of studies now suggest that there are differences in effectiveness among different occlusion methods. The main objectives of this study were to estimate the effectiveness of vasectomy by cautery and to describe the trends in sperm counts after cautery vasectomy. Other objectives were to estimate time and number of ejaculations to success and to determine the predictive value of success at 12 weeks for final status at 24 weeks.MethodsA prospective, non-comparative observational study was conducted between November 2001 and June 2002 at 4 centers in Brazil, Canada, the UK, and the US. Four hundred men who chose vasectomy were enrolled and followed for 6 months. Sites used their usual cautery vasectomy technique. Earlier and more frequent than normal semen analyses (2, 5, 8, 12, 16, 20, and 24 weeks after vasectomy) were performed. Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation.ResultsA total of 364 (91%) participants completed follow-up. The overall failure rate based on semen analysis was 0.8% (95% confidence interval 0.2, 2.3). By 12 weeks 96.4% of participants showed azoospermia or severe oligozoospermia (< 100,000 sperm/mL). The predictive value of a single severely oligozoospermia sample at 12 weeks for vasectomy success at the end of the study was 99.7%. One serious unrelated adverse event and no pregnancies were reported.ConclusionCautery is a very effective method for occluding the vas. Failure based on semen analysis is rare. In settings where semen analysis is not practical, using 12 weeks as a guideline for when men can rely on their vasectomy should lessen the risk of failure compared to using a guideline of 20 ejaculations after vasectomy.

Vasectomy surgical techniques in South and South East Asia

“…Visits to 3 to 6 major vasectomy centers in urban and rural areas were done. Vasectomy techniques performed in each center visited were precisely described based on direct observation, when possible, using a data collection grid previously used in a FHI/EngenderHealth study [11,13]. In addition, with the consent of local authorities and the patients involved, vasectomy procedures performed by the providers were videotaped for further meticulous analyses.…”

“…Given the results of the RCT showing relatively high failure rates even with FI, the second study, an exploratory observational study of cautery of the vas lumen,[11] was initiated based on the recommendations from the Expert Consultation on Vasectomy Effectiveness, a meeting organized by FHI and EngenderHealth. [12] This study was conducted at four centers that routinely used cautery for vas occlusion.…”

A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition

“…The methods of the fascial interposition and cautery studies have been previously described [4,6]. In brief, the fascial interposition study involved eight sites in seven countries.…”

“…Three sites used the no-scalpel approach to the vas. Graphic depictions of the four methods used have been published [6]. Of 400 men enrolled, 389 are included in this comparative analysis.…”

“…Based on that recommendation, we conducted an observational study of vasectomy by cautery [6] and then conducted this comparative analysis. Even if some researchers decide that additional research is needed, the data from this comparative analysis should provide a strong basis for planning further research.…”