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. 2014 Mar 30;2014(3):CD003991.
doi: 10.1002/14651858.CD003991.pub4.

Vasectomy occlusion techniques for male sterilization

Lynley A Cook  1 , Huib A A M Van Vliet, Laureen M Lopez, Asha Pun, Maria F Gallo
Affiliations

Vasectomy occlusion techniques for male sterilization

Lynley A Cook et al. Cochrane Database Syst Rev. .

Abstract

Background: Vasectomy is an increasingly popular and effective family planning method. A variety of vasectomy techniques are used worldwide, including vas occlusion techniques (excision and ligation, thermal or electrocautery, and mechanical and chemical occlusion methods), as well as vasectomy with vas irrigation or with fascial interposition. Vasectomy guidelines largely rely on information from observational studies. Ideally, the choice of vasectomy techniques should be based on the evidence from randomized controlled trials (RCTs).

Objectives: The objective of this review was to compare the effectiveness, safety, acceptability and costs of vasectomy techniques for male sterilization.

Search methods: In February 2014, we updated the searches of CENTRAL, MEDLINE, POPLINE and LILACS. We looked for recent clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform. Previous searches also included EMBASE. For the initial review, we searched the reference lists of relevant articles and book chapters.

Selection criteria: We included RCTs comparing vasectomy techniques, which could include suture ligature, surgical clips, thermal or electrocautery, chemical occlusion, vas plugs, vas excision, open-ended vas, fascial interposition, or vas irrigation.

Data collection and analysis: We assessed all titles and abstracts located in the literature searches. Two reviewers independently extracted data from articles identified for inclusion. Outcome measures include contraceptive efficacy, safety, discontinuation, and acceptability. Peto odds ratios (OR) with 95% confidence intervals (CI) were used for dichotomous outcomes, such as azoospermia. The mean difference (MD) was used for the continuous variable of operating time.

Main results: Six studies met the inclusion criteria. One trial compared vas occlusion with clips versus a conventional vasectomy technique. No difference was found in failure to reach azoospermia (no sperm detected). Three trials examined vasectomy with vas irrigation. Two studies looked at irrigation with water versus no irrigation, while one examined irrigation with water versus the spermicide euflavine. None found a difference between the groups for time to azoospermia. However, one trial reported that the median number of ejaculations to azoospermia was lower in the euflavine group compared to the water irrigation group. One high-quality trial compared vasectomy with fascial interposition versus vasectomy without fascial interposition. The fascial interposition group was less likely to have vasectomy failure. Fascial interposition had more surgical difficulties, but the groups were similar in side effects. Lastly, one trial found that an intra-vas was less likely to produce azoospermia than was no-scalpel vasectomy. More men were satisfied with the intra-vas device, however.

Authors' conclusions: For vas occlusion with clips or vasectomy with vas irrigation, no conclusions can be made as those studies were of low quality and underpowered. Fascial interposition reduced vasectomy failure. An intra-vas device was less effective in reducing sperm count than was no-scalpel vasectomy. RCTs examining other vasectomy techniques were not available. More and better quality research is needed to examine vasectomy techniques.

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Conflict of interest statement

L Lopez is employed at FHI 360 (formerly known as Family Health International), where the included study of Sokal 2004 was conducted. M Gallo was employed at FHI at the time of the initial review. Neither were involved in that study.

Figures

1.1
1.1. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 1 Azoospermia at 2 months.
1.2
1.2. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 2 Azoospermia at 3 months.
1.3
1.3. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 3 Pain by 12‐month follow up.
1.4
1.4. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 4 Wound infection or ligature abscess by 12‐month follow up.
1.5
1.5. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 5 Vasitis/epididymo‐orchitis by 12‐month follow up.
1.6
1.6. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 6 Hematoma by 12‐month follow up.
1.7
1.7. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 7 Acute hydrocele by 12‐month follow up.
1.8
1.8. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 8 Palpable nodule (sperm granuloma) by 12‐month follow up.
1.9
1.9. Analysis
Comparison 1 Vasectomy with clips versus conventional vasectomy, Outcome 9 Dissatisfaction with operation by 12‐month follow up.
2.1
2.1. Analysis
Comparison 2 Vasectomy with irrigation versus standard vasectomy, Outcome 1 Azoospermia at 16 weeks.
2.2
2.2. Analysis
Comparison 2 Vasectomy with irrigation versus standard vasectomy, Outcome 2 Lingering sperm at 40 weeks.
3.1
3.1. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 1 Vasectomy success by 34 weeks.
3.2
3.2. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 2 Vasectomy failure by 34 weeks.
3.3
3.3. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 3 Sperm granuloma by 6 weeks.
3.4
3.4. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 4 Epididymitis or orchitis by 6 weeks.
3.5
3.5. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 5 Scrotal pain or swelling by 6 weeks.
3.6
3.6. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 6 Hematomas by 6 weeks.
3.7
3.7. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 7 Infection by 6 weeks.
3.8
3.8. Analysis
Comparison 3 Vasectomy by ligation and excision, with versus without fascial interposition, Outcome 8 Mild or moderate scrotal pain within 3 months of 12‐week follow up among men with vasectomy success.
4.1
4.1. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 1 Azoospermia at 3rd month.
4.2
4.2. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 2 Azoospermia at 12th month.
4.3
4.3. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 3 Pain with surgery.
4.4
4.4. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 4 Pain by 12th month.
4.5
4.5. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 5 Congestive epididymitis by 12th month.
4.6
4.6. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 6 Granuloma by 12th month.
4.7
4.7. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 7 Satistaction with procedure at 12th month.
4.8
4.8. Analysis
Comparison 4 Intra‐vas device versus no‐scalpel vasectomy, Outcome 8 Operating time.
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Update of

References

References to studies included in this review

Berthelsen 1975 {published data only}
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Gandrup 1981 {published data only}
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Gupta 1977 {published data only}
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Mason 2002 {published data only}
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References to studies excluded from this review

Clausen 1983 {published data only}
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Jee 2010 {published data only}
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Kothari 1978 {published data only}
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Nirapathpongporn 1990 {published data only}
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Pearce 2002 {published data only}
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Singh 2010 {published data only}
    1. Singh D, Dasila NS, Vasudeva P, Dalela D, Sankhwar S, Goel A, et al. Intraoperative distal vasal flushing‐‐does it improve the rate of early azoospermia following no‐scalpel vasectomy? A prospective, randomized, controlled study. Urology. 2010/05/11 2010; Vol. 76, issue 2:341‐4. - PubMed
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Sommer 2001 {published data only (unpublished sought but not used)}
    1. Sommer F, Eusan A, Caspers HP, Esders K, Reddy P, Engelmann U. Effect of flushing the vasa deferentia at the time of vasectomy on the rate of azoospermia. British Journal of Urology International 2001;88(Suppl 1):9.

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