No-scalpel vasectomy — a new approach to male surgical contraception: a single center experience

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

vasectomy / no-scalpel vasectomy / male contraception

References

[1] 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.)

[2] Европейское региональное бюро ВОЗ. Планирование семьи: универсальное руководство для поставщиков услуг по планированию семьи. Обновленное 3-е изд. 2018 г. Копенгаген: Европейское региональное бюро ВОЗ, 2021. 580 с.

[3] 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

[4] Kreutzig-Langenfeld T., Lellig E., Hinz P., Zilg F. Vasectomy: Current information // Der Urologe. 2021. Vol. 60, No. 4. P. 523–532. DOI: 10.1007/s00120-021-01494-9

[5] Peterson HB, Curtis KM. Clinical practice. Long-acting methods of contraception. N Engl J Med. 2005;353(20):2169–2175. DOI: 10.1056/NEJMcp044148

[6] Peterson H.B., Curtis K.M. Clinical practice. Long-acting methods of contraception // N Engl J Med. 2005. Vol. 353, No. 20. P. 2169–2175. DOI: 10.1056/NEJMcp044148

[7] 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.

[8] Martinez G.M., Chandra A., Abma J.C., 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. Vol. 26. P. 1–142.

[9] 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

[10] Дикке Г.Б., Ерофеева Л.В. Контрацепция в современной России: применение и информированность (популяционное исследование) // Акушерство и гинекология. 2016. № 2. С. 108–113. DOI: 10.18565/aig.2016.2.108-113

[11] 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

[12] Li S., Goldstein M., Zhu J., Huber D. The no-scalpel vasectomy // J Urol. 1991. Vol. 145, No. 2. P. 341–344. DOI: 10.1016/s0022-5347(17)38334-9

[13] 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

[14] Cook L.A., Pun A., Gallo M.F., et al. Scalpel versus no-scalpel incision for vasectomy // Cochrane Database Syst Rev. 2014. Vol. 3. ID Cd004112. DOI: 10.1002/14651858

[15] 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.)

[16] Руководство ВОЗ по исследованию и обработке эякулята человека. 5-е изд. / под ред. Л.Ф. Курило; пер. с англ. Н.П. Макарова. Москва: Капитал Принт, 2012. 291 с.

[17] 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

[18] Ostrowski K.A., Holt S.K., Haynes B., et al. Evaluation of vasectomy trends in the United States // Urology. 2018. Vol. 118. P. 76–79. DOI: 10.1016/j.urology.2018.03.016

[19] 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

[20] Sharlip I.D., Belker A.M., Honig S., et al. Vasectomy: AUA guideline // J Urol. 2012. Vol. 188, No. 6S. P. 2482–2491. DOI: 10.1016/j.juro.2012.09.080

[21] 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

[22] Velez D., Pagani R., Mima M., Ohlander S. Vasectomy: a guidelines-based approach to male surgical contraception // Fertil Steril. 2021. Vol. 115, No. 6. P. 1365–1368. DOI: 10.1016/j.fertnstert.2021.03.045

[23] 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.

[24] 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. Vol. 24, No. 2. P. 8744–8748.

[25] 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).

[26] Christensen P., al-Aqidi O.A., Jensen F.S., Dørflinger T. Vasektomi. Et prospektivt, randomiseret studie af vasektomi med dobbeltsidig incision vs. vasektomi a. m. Li // Ugeskr Laeger. 2002. Vol. 164, No. 18. P. 2390–2394.

[27] 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

[28] 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. Vol.14, No. 2. P. 172–177. DOI: 10.3126/ajms.v14i2.50457

[29] 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

[30] Chawla A., Bowles B., Zini A. Vasectomy follow-up: clinical significance of rare nonmotile sperm in postoperative semen analysis // Urology. 2004. Vol. 64, No. 6. P. 1212–1215. DOI: 10.1016/j.urology.2004.07.007

[31] 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

[32] Dhar N.B., Bhatt A., Jones J.S. Determining the success of vasectomy // BJU Int. 2006. Vol. 97, No. 4. P. 773–776. DOI: 10.1111/j.1464-410X.2006.06107.x

[33] 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

[34] Schiff J., Chan P., Li P.S., et al. Outcome and late failures compared in 4 techniques of microsurgical vasoepididymostomy in 153 consecutive men // J Urol. 2005. Vol. 174, No. 2. P. 651–655. DOI: 10.1097/01.ju.0000165573.53109.92

[35] 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.

[36] 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. Vol. 2, No. 1. ID 6. DOI: 10.1186/1741-7015-2-6.

[37] 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

[38] Chen-Mok M., Bangdiwala S.I., Dominik R., et al. Termination of a randomized controlled trial of two vasectomy techniques // Controll Clin Trials. 2003. Vol. 24, No. 1. P. 78–84. DOI: 10.1016/s0197-2456(02)00267-2

[39] 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

[40] 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. Vol. 4, No. 1. ID 12. DOI: 10.1186/1471-2490-4-12

[41] Schmidt SS. Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases. Br J Urol. 1995;76(3): 373–374.

[42] Schmidt S.S. Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases // Br J Urol. 1995. Vol. 76, No. 3. P. 373–374.

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