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Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

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Vasectomy occlusion techniques for male sterilization.

L A Cook¹, H Van Vliet, L M Lopez

¹Christchurch School of Medicine, Public Health and General Practice, Christchurch, New Zealand. lynley.cook@xtra.co.nz

The Cochrane Database of Systematic Reviews

|April 20, 2007

Summary

Fascial interposition reduces vasectomy failure, while intra-vas devices are less effective than no-scalpel vasectomy. More research is needed to compare various vasectomy techniques for male sterilization.

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Area of Science:

Reproductive medicine
Urology
Family planning

Background:

Vasectomy is a popular and effective male sterilization method.
Current guidelines often rely on observational data, highlighting the need for randomized controlled trials (RCTs).
Various techniques exist, including different occlusion methods, irrigation, and fascial interposition.

Purpose of the Study:

To compare the effectiveness, safety, acceptability, and costs of different vasectomy techniques for male sterilization.

Main Methods:

Searched multiple databases (CENTRAL, MEDLINE, EMBASE, POPLINE, LILACS) and reference lists.
Included randomized controlled trials (RCTs) comparing vasectomy techniques.
Assessed titles and abstracts; two reviewers independently extracted data on contraceptive efficacy, safety, discontinuation, and acceptability.

Main Results:

Six RCTs were included. Vas occlusion with clips showed no difference in azoospermia rates compared to conventional methods.
Vasectomy with irrigation (water or euflavine) did not differ in time to azoospermia, though euflavine showed a lower median ejaculation count.
Fascial interposition reduced vasectomy failure but increased surgical difficulty; side effects were similar.
Intra-vas devices were less likely to achieve azoospermia than no-scalpel vasectomy, though user satisfaction was higher.

Conclusions:

Low-quality studies preclude conclusions on vas occlusion with clips or vas irrigation.
Fascial interposition is effective in reducing vasectomy failure.
Intra-vas devices are less effective for sperm count reduction compared to no-scalpel vasectomy.
More high-quality RCTs are needed to evaluate various vasectomy techniques.