Original Research ArticleRisk of vasectomy failure by ligation and excision with fascial interposition: A prospective descriptive study☆,☆☆
Introduction
Vasectomy consists of two specific surgical steps: (1) isolating and exposing the vas deferens outside of the scrotum and (2) occluding the vas. The No-Scalpel Vasectomy technique to expose the vas was developed in China by Dr. Li Shunquiang in 1974 [1] and promoted internationally by EngenderHealth since at least 1992 [2]. This minimally invasive technique to expose the vas is the most extensively studied approach to expose the vas [3]. There is high-quality evidence demonstrating that it reduces the risk of hematoma and infections [3], [4], [5].
For occluding the vas, EngenderHealth recommends putting two silk ligatures on the vas, excising about a 1-cm vas segment between the ligatures, and interposing the vas sheath (fascia) on the testicular end of the divided vas with a silk suture tied on the abdominal end (Fig. 1) [2]. However, the failure risk of this technique, based on the post-vasectomy semen analysis, seems to be greater than 1%, which is the highest acceptable failure risk recommended by experts [3]. Risks of occlusion failure of 0% [6], 2.1% [7] 2.5% [8], 2.6% [9], and 7.6% [10] have been reported for the aforementioned occlusion technique, with the most robust result from a high-quality randomized clinical trial reported at 5.9% [11].
Nevertheless, this technique is still the recommended standard in large vasectomy programs in countries with limited resources such as India, Nepal, Mexico, and Colombia [12]. The American Urology Association recommends using this technique if experienced surgeons consistently obtain satisfactory results [3]. However, due to the doubts about the effectiveness of this occlusion technique, we evaluated its failure risk in a large cohort of men vasectomized by experienced surgeons in Colombia.
Section snippets
Study design
We conducted a prospective longitudinal observational descriptive study of a cohort of adult men who voluntarily underwent a vasectomy under local anesthesia between April 7, 2017 and January 15, 2018, at a private clinic specializing in sexual and reproductive health services in Bogotá, Colombia.
Recruitment of participants
Men requesting a vasectomy at the clinic routinely have a pre-vasectomy visit with general practitioners. They provide counselling on vasectomy, perform a medical history and physical exam, and
Results
Among 2358 men who had a vasectomy at the clinic during the study period, 1149 eligible men participated in the study and 581 (51%) participants produced at least one sample for post-vasectomy semen analysis (Fig. 2). Among these, 482 (83%) were recommended to stop other contraceptive methods based on the results of the first post-vasectomy semen analysis. In the remaining 99 men, 55 (56%) provided a second semen sample. The status related to success or failure of vasectomy remained unchanged,
Discussion
We observed that vasectomy occlusion performed with ligation and excision with fascial interposition is associated with a high risk of failure based on the post-vasectomy semen analysis results. Our study confirms the results of five out of six previously published studies showing that the failure risk of this technique is unacceptable [10], [11], [12], [13], [14], [15]. The acceptable failure risk of a vasectomy occlusion technique should be under 1% [3]. Even in younger men and men
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Funding: This research benefited from a small grant from Universidad El Bosque, Bogota, Colombia. The Michel-Labrecque Fund for Male Reproductive Health (4476) from the Laval University Foundation supported travel to Colombia for investigator meetings. We did not receive specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
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Declarations of interest: none.
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Present address: Profamilia, Calle 59 # 50 – 17, Barranquilla – Atlántico, Colombia.