Male sterilization

Abstract

This review of recent information and advances in the area of male sterilization deals with recent epidemiologic studies that discuss potential ill effects hypothesized to be a result of vasectomy, including carcinoma of the prostate and carcinoma of the testicle. Rebuttals to these hypotheses are presented. Recent advances in techniques of vasectomy including the "no-scalpel" vasectomy technique and open-ended vasectomy are presented, including the rationale for their use. A good deal of attention is given to postvasectomy follow-up, particularly the use of the technique of measuring numbers of ejaculations following vasectomy rather than the period of time afterward to determine when a man is sterile. The final two sections deal with complications of vasectomy and the most recent percentages on reversing vasectomy with particular reference to return of sperm to the ejaculate and pregnancy rates.

PIP: Between 250,000 and 300,000 US men undergo vasectomy each year. The Association for Voluntary Surgical Contraception has performed almost 400,000 vasectomies worldwide since 1982. 2 hospital-based case control studies indicate a 1.7-5 fold increased risk of prostate cancer in vasectomized patients, but other studies do not find this association. Besides, there is no biologic basis for such an association. A theoretical relationship does exist between testicular cancer and vasectomy, however, since testicular biopsy studies reveal abnormalities, perhaps secondary to back pressure. No epidemiologic studies have yet found such a link, though. In China, some 8 million men have undergone the no-scalpel vasectomy developed in the 1970s. This technique has fewer complications than the traditional technique (e.g., a hematoma rate of only .08%). Indeed, hematomas are the most common complication. Other complications include epididymitis, congested epididymis, and sperm granuloma. The open-ended vasectomy (proximal testicular end of vas left open and closure of the distal end) reduces postoperative testicular and epididymal discomfort and increases the likelihood of vas reversal (1 surgeon reports a success rate of 100%). Regardless of the vasectomy technique, vas reanastomosis is more likely to be successful if performed within 5 years after the vasectomy (e.g., 1 study reported a pregnancy rate of 52% for reanastomosis within 5 years vs. 30% for 5 years; p .02). Physicians recommend a postvasectomy semen analysis after 20 ejaculations to determine if azoospermia has been achieved. If not, another analysis is needed after 10 more postvasectomy ejaculations. If motile sperm still exist, the vasectomy has failed. Yet, many men (36-45% in the US) do not return for analysis. Return visits are often difficult, impractical, and embarrassing for men, so physicians should suggest patients use condoms until after they have achieved a predetermined number of ejaculations to ensure protection against pregnancy.