Vasectomy by epithelial curettage without suture or cautery: a pilot study in humans

Abstract

Curettage of the epithelium of the vas deferens might be a safe and effective method of male sterilization. We conducted a pilot study of vasectomy by epithelial curettage with a novel microcurette called the Vas-X in 12 normal men requesting elective sterilization. Seminal fluid analysis was obtained monthly after the procedure for 6 months. Pain was assessed by questionnaire. Three months after the procedure, all men attained sperm concentrations of less than 0.2 million sperm per mL, and seven were azoospermic. Post-procedural pain was minimal. Nine men ultimately achieved and maintained azoospermia; however, 4 to 6 months after the procedure, sperm concentrations increased in three of the 12 subjects, necessitating repeat vasectomy. Microscopic examination of the vas deferens from these failures revealed re-canalization. Vasectomy by epithelial curettage can result in effective sterilization; however, 1/4 of the subjects were not effectively sterilized by the procedure due to re-canalization of the vas deferens. Epithelial curettage will require further refinement to determine if it is a viable form of vasectomy.

Trial registration: ClinicalTrials.gov NCT00663533.

Figure 1

Vasectomy by epithelial curettage using the Vas-X. The vas is uncovered bilaterally using the no-scalpel approach. The Vas-X microcurette (A) is introduced into the hemisected vas, engaging the epithelium (B), which is then stripped out and adheres to the microcurette (C).

Figure 2

Histological appearance of resected vas deferens from subjects #7 and #8 6 months after failed Vas-X vasectomy. Hematoxylin and eosin stain (A, C, E, G); adjacent section stained with the anti-epithelial cytokeratin stain AE1/AE3 (B, D, F, H). (A), (B): Intact portion of the right ductus deferens of subject #7. (C), (D): Scar tissue with no indication of the epithelium from the left vas of subject #7. (E), (F): Left vas of subject #8 showing the scarred central area with a single epithelium-lined narrow channel. (G), (H): Right vas of subject #8 showing numerous epithelium-lined channels in the lamina propria, some with apparent spermatozoa in the lumen. Scale bars = 100 μm.