Are evidence-based vasectomy surgical techniques performed in low-resource countries?

Area of Science:

• Urology
• Public Health
• Global Health

Background:

• Established evidence from 10-15 years ago highlights the impact of surgical techniques on vasectomy effectiveness and safety.
• Vasectomy procedures involve two key steps: isolation/exposition and occlusion of the vas deferens.

Purpose of the Study:

• To assess the integration of evidence-based vasectomy surgical techniques into programs in selected low-resource countries.
• To compare national standards with international clinical practice guidelines for vasectomy.

Main Methods:

• Extracted recommended surgical techniques from current evidence-based clinical practice guidelines.
• Reviewed male sterilization standards and practices in Kenya, Rwanda, India, Nepal, Mexico, Honduras, Colombia, and Haiti.
• Assessed the adequacy of country-specific practices against international recommendations.

Main Results:

• The optimal techniques include no-scalpel vasectomy (NSV) for isolation and cautery with fascial interposition (FI) for occlusion.
• NSV is widely adopted for vas isolation in the studied countries.
• Ligation and excision (LE) with FI is the most common occlusion method, while recommended cautery is rarely used.

Conclusions:

• Effective vasectomy occlusion techniques exist but are underutilized in many low-resource settings.
• Adoption of superior surgical techniques can enhance user confidence, satisfaction, and overall acceptance of male sterilization.
• Improving technique implementation is crucial for increasing uptake of vasectomy services.