No-scalpel vasectomy — a new approach to male surgical contraception: a single center experience
- Authors: Ryzhkov A.I.1,2, Sokolova S.Y.2, Shormanov I.S.1
-
Affiliations:
- Yaroslavl State Medical University
- LLC «Mother and Child Yaroslavl»
- Issue: Vol 13, No 3 (2023)
- Pages: 259-266
- Section: Original articles
- URL: https://journals.eco-vector.com/uroved/article/view/569222
- DOI: https://doi.org/10.17816/uroved569222
- ID: 569222
Cite item
Abstract
BACKGROUND: No-scalpel vasectomy is a modern approach to performing vasectomy, in which access to the vas deferens is achieved through a puncture of the scrotum.
AIM: To analyze of own experience in the use of no-scalpel vasectomy.
MATERIALS AND METHODS: During the period from April 2017 to December 2022, 32 men underwent non-scalpel vasectomy at the Mother and Child Clinic Yaroslavl. Three operations were performed under intravenous anesthesia, 29 under local anesthesia. Occlusion of the vas deferens was achieved by excision of the fragment, coagulation of the lumen, ligation of the ends of the duct and fascial interposition.
RESULTS: The average age of the patients was 39 years (range 35 to 62 years). All patients were married. The mean number of children in patients undergoing vasectomy was 2.3 ± 0.4. In all cases, the reason for performing a vasectomy was cited by patients as dissatisfaction with other methods of contraception. The average operation time was 19.0 ± 4.0 minutes. The average size of the scrotal skin puncture was 9.3 ± 1.3 mm (range 7 to 11 mm). The severity of pain during surgery, as assessed on a visual analogue scale (VAS), varied from 1 to 3 points, with an average of 2.3 ± 0.5 points. In the postoperative period, one patient developed acute epididymitis (3.1%), and one patient (3.1%) developed a small hematoma (up to 1 cm) in the area of the surgical wound. A week after surgery, 15 patients (46.8%) reported the presence of pain with a visual analogue scale score of 1 to 3 points, with an average of 2.2 ± 0.7 points. One month after the operation, no pain was noted in any patient. The results of the study of the ejaculate 3 months after the operation showed the presence of azoospermia in 27 (84.4%) patients and the presence of single immobile spermatozoa (less than 100,000/ml) in 5 (15.6%) patients, which allowed us to state 100% occlusive effectiveness of vasectomy.
CONCLUSIONS: No-scalpel vasectomy is a less traumatic and safe method of male surgical contraception. The operation under local anesthesia is associated with minimal discomfort for the patient. Maximum success rates can be achieved using the technique of vas deferens occlusion through excision of the fragment, coagulation of the lumen, ligation of the ends of the duct, and fascial interposition.
Keywords
Full Text
About the authors
Aleksei I. Ryzhkov
Yaroslavl State Medical University; LLC «Mother and Child Yaroslavl»
Author for correspondence.
Email: 1129682@gmail.com
ORCID iD: 0000-0001-7919-9830
SPIN-code: 8699-2647
MD, Cand. Sci. (Med.), assistant professor of the Department of urology with nephrology, urologist
Russian Federation, Yaroslavl; YaroslavlSvetlana Yu. Sokolova
LLC «Mother and Child Yaroslavl»
Email: ntvbyfntnrf@mail.ru
ORCID iD: 0000-0002-3673-0713
urologist
Russian Federation, YaroslavlIgor S. Shormanov
Yaroslavl State Medical University
Email: i-s-shormanov@yandex.ru
ORCID iD: 0000-0002-2062-0421
SPIN-code: 7772-8420
Dr. Sci. (Med.), professor, head of the Department of Urology with Nephrology
Russian Federation, YaroslavlReferences
- Evropeiskoe regional’noe byuro VOZ. Planirovanie sem’i: universal’noe rukovodstvo dlya postavshchikov uslug po planirovaniyu sem’i. 3rd edition. 2018. Copenhagen: Evropeiskoe regional’noe byuro VOZ, 2021. 580 p. (In Russ.)
- Kreutzig-Langenfeld T, Lellig E, Hinz P, Zilg F. Vasectomy: Current information. Der Urologe. 2021;60(4):523–532. doi: 10.1007/s00120-021-01494-9
- Peterson HB, Curtis KM. Clinical practice. Long-acting methods of contraception. N Engl J Med. 2005;353(20):2169–2175. doi: 10.1056/NEJMcp044148
- Martinez GM, Chandra A, Abma JC, et al. Fertility, contraception, and fatherhood: data on men and women from cycle 6 (2002) of the 2002 National Survey of Family Growth. Vital Health. 2006;26: 1–142.
- Dikke GB, Erofeeva LV. Contraception in Russia today: use and awareness (a population-based study). Obstetrics and Gynecology. 2016;(2):108–113. (In Russ.) doi: 10.18565/aig.2016.2.108-113
- Li S, Goldstein M, Zhu J, Huber D. The no-scalpel vasectomy. J Urol. 1991;145(2):341–344. doi: 10.1016/s0022-5347(17)38334-9
- Cook LA, Pun A, Gallo MF, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev. 2014;3:Cd004112 doi: 10.1002/14651858
- Kurilo LF, editor. Rukovodstvo VOZ po issledovaniyu i obrabotke ehyakulyata cheloveka. 5th edition. Transl. from engl. Makarov NP. Moscow: Kapital Print, 2012. 291 p. (In Russ.)
- Ostrowski KA, Holt SK, Haynes B, et al. Evaluation of vasectomy trends in the United States. Urology. 2018;118:76–79. doi: 10.1016/j.urology.2018.03.016
- Sharlip ID, Belker AM, Honig S, et al. Vasectomy: AUA guideline. J Urol. 2012;188(6S):2482–2491. doi: 10.1016/j.juro.2012.09.080
- Velez D, Pagani R, Mima M, Ohlander S. Vasectomy: a guidelines-based approach to male surgical contraception. Fertil Steril. 2021;115(6):1365–1368. doi: 10.1016/j.fertnstert.2021.03.045
- Furr J, Baker R, Pham Q, Sindhwani P. Comparative analysis of anticipated pain versus experienced pain in patients undergoing office vasectomy. Can J Urol. 2017;24(2):8744–8748.
- Christensen P, al-Aqidi OA, Jensen FS, Dørflinger T. Vasectomy. A prospective, randomized trial of vasectomy with bilateral incision versus the Li vasectomy. Ugeskr Laeger. 2002;164(18):2390–2394. (In Danish).
- Ramakrishnan R, Ponnusamy P, Poovathai S, et al. No scalpel vasectomy, a novel technique for permanent male sterilization — Our institutional experience. Asian J Med Sci. 2023;14(2):172–177. doi: 10.3126/ajms.v14i2.50457
- Chawla A, Bowles B, Zini A. Vasectomy follow-up: clinical significance of rare nonmotile sperm in postoperative semen analysis. Urology. 2004;64(6):1212–1215. doi: 10.1016/j.urology.2004.07.007
- Dhar NB, Bhatt A, Jones JS. Determining the success of vasectomy. BJU Int. 2006;97(4):773–776. doi: 10.1111/j.1464-410X.2006.06107.x
- Schiff J, Chan P, Li PS, et al. Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men. J Urol. 2005;174(2):651–655. doi: 10.1097/01.ju.0000165573.53109.92
- Sokal D, Irsula B, Hays M, et al. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Med. 2004;2(1):6. doi: 10.1186/1741-7015-2-6.
- Chen-Mok M, Bangdiwala SI, Dominik R, et al. Termination of a randomized controlled trial of two vasectomy techniques. Controll Clin Trials. 2003;24(1):78–84. doi: 10.1016/s0197-2456(02)00267-2
- Sokal D, Irsula B, Chen-Mok M, et al. A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition. BMC Urol. 2004;4(1):12. doi: 10.1186/1471-2490-4-12
- Schmidt SS. Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases. Br J Urol. 1995;76(3): 373–374.