Proceso de toma de decisión de la vasectomía desde la teoría fundamentada / Vasectomy decision-making process from grounded theory / Processo de tomada de decisão sobre vasectomia a partir da teoria fundamentada

Objetivo: Describir el proceso en la toma de decisión para la aceptación o rechazo de la vasectomía desde la perspectiva de los hombres mexicanos. Materiales y método: Estudio cualitativo, exploratorio, con metodología en teoría fundamentada, la muestra fue de 17 hombres; la información se recolectó mediante entrevista semiestructurada, con un análisis artesanal. Resultados: La codificación inicial generó 130 códigos, se encontraron 58 códigos focales que dieron origen a 8 códigos axiales. La codificación teórica genero 3 códigos teóricos: alcance de la información; dualidad en la toma de decisión para la vasectomía; factores para la toma de decisión para la vasectomía. La categoría central denominada pro-ceso para la toma de decisión para la aceptación o rechazo de la vasectomía. Discusión: Esta indagación da pauta a interrogantes que se enfoquen más al proceso en la toma de decisión de los hombres, para un mejor entendimiento de este proceso y eventualmente direccionar de mejor manera los programas de promoción de la vasectomía, las intervenciones de salud y políticas públicas acordes a la realidad que viven los hombres. Conclusión: Los hombres viven un proceso "complejo, lleno de altibajos" para poder tomar la decisión de realizarse la vasectomía o bien rechazarla.

Objective: To describe the decision-making process for the acceptance or rejection of vasec-tomy from the perspective of Mexican men. Method: Qualitative study, exploratory, method-ology with a grounded theory, the sample was 17 men; the information was collected through a semi-structured interview, artisanal analysis. Results: The initial coding generated 130 codes, 58 focal codes were found, which gave rise to 8 axial codes. The theoretical coding generated 3 theoretical codes: scope of information; duality in decision making for vasecto-my; factors for decision making for vasectomy. The central category called the decision-mak-ing process for the acceptance or rejection of vasectomy. Discussion: This investigation gives rise to questions that focus more on the decision-making process of men, for a better under-standing of this process and eventually better direct vasectomy promotion programs, health interventions and public policies according to the reality that men live. Conclusion: Men go through a "complex, full of ups and downs" process to be able to make the decision to have a vasectomy or reject it

Objetivo: Descrever o processo de tomada de decisão para a aceitação ou rejeição da vasec-tomia na perspectiva de homens mexicanos. Método: Estudo qualitativo, exploratório, com metodologia de teoria fundamentada, a amostra foi de 17 homens; as informações foram co-letadas por meio de entrevista semiestruturada, análise artesanal. Resultados: A codificação inicial gerou 130 códigos, foram encontrados 58 códigos focais, que deram origem a 8 códi-gos axiais. A codificação teórica gerou 3 códigos teóricos: escopo da informação; dualidade na tomada de decisão para vasectomia; factores para a tomada de decisão de vasectomia. A categoria central denominou o processo decisório para a aceitação ou rejeição da vasectomia. Discussão: Esta investigação suscita questões que focam mais no processo de tomada de decisão dos homens, para uma melhor compreensão deste processo e, eventualmente, melhor direcionar os programas de promoção da vasectomia, intervenções e políticas públicas de acordo com a realidade que os homens vivem. Conclusão: Os homens passam por um pro-cesso "complexo, cheio de altos e baixos" para poder tomar a decisão de fazer a vasectomia ou rejeitá-la

Vasectomy reversal in China during the recent decade: insights from a multicenter retrospective investigation / 亚洲男科学杂志(英文版)

To date, there is little information about the demography of vasectomy reversal (VR) patients or the factors currently influencing VR effectiveness in China, especially after the universal two-child policy was released in 2015. In this research, demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China. Meanwhile, a telephone survey of the patients was conducted to collect follow-up information. Eventually, 448 VR cases from the past 13 years were included. The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate. Appropriately statistical methods were used, and all of the protocols were approved by the Ethics Committees of the institutes in this research. The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented. Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate. A follow-up survey showed that the general postoperative pregnancy rate was 27.2%. For female partners over the age of 35 years, the postoperative pregnancy rate showed a more severe decline, but only 35.5% of them had been given a fertility examination before their husbands' VR surgery. Our work revealed that more patients in China have been demanding VR in recent years. High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR. Clinical andrologists should perform a preoperative fertility evaluation of the patients' female partners.

Vasectomy re-reversal: effectiveness and parameters associated with its success

ABSTRACT Introduction: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. Purpose: To determine the VRR effectiveness and whether specific parameters can be associated with its success. Materials and Methods: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). Results: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). Conclusions: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.

Knowledge and Acceptance towards Vasectomy in a Sample of Medicine Students, Meta 2018 / Conocimientos y aceptación sobre vasectomía en una muestra de estudiantes de medicina, Meta 2018

Introduction The low adherence to vasectomy is associated with the cultural environment, with false beliefs, and with lack of knowledge. In Colombia, the practice of vasectomy increased 3% between 1990 and 2015. Medical education seeks to have an impact on the general population; therefore, medicine students should have knowledge and attitudes toward birth control that include a significant participation of the male gender. Objective To describe the level of knowledge, beliefs, and acceptance of vasectomy in a sample of Colombian medicine students. Methods Cross-sectional descriptive study, nonprobabilistic sample by convenience with a total of 112 medicine students from different universities of the country attending at a university event. A total of 20 dichotomous questions were used. Results A total of 72.3% of the students answered correctly most of the answers; the knowledge level was grouped in high (53.35%), medium (41.07%), and low (5.35%). Up to 95.5% of the students recognized vasectomy as a male birth control method. Regarding beliefs, > 99% considered that family planning is not just a responsibility of women, although only 75% of the men would accept undergo a vasectomy. Conclusions Colombian medicine students have a good level of knowledge about vasectomy, they recommend performing the surgery, and recognize the active participation of males in contraception; nevertheless, a higher willingness to perform a vasectomy would be expected from this population. Training on the subject would break barriers about beliefs and promote proper counseling in birth control consultations.

Introducción La poca adherencia a la vasectomía se asocia al entorno cultural, falsas creencias y bajo conocimiento. En Colombia, su prevalencia incrementó 3% entre los años 1990 y 2015. La educación Médica busca tener impacto sobre la población general, por lo cual el estudiante de medicina debe tener conocimientos y actitudes sobre la planificación familiar, que incluya una participación significativa del sexo masculino. Objetivo Describir el nivel de conocimiento, creencias y aceptación de la vasectomía en una muestra de estudiantes de medicina colombianos. Métodos Estudio descriptivo transversal, muestra no probabilista por conveniencia de 112 estudiantes de medicina, de diferentes universidades del país asistentes a un evento universitario. Se emplea instrumento de 20 preguntas dicotómicas. Resultados El 72,3% de los estudiantes acertó correctamente en la mayoría de las respuestas, se agrupó nivel de conocimiento en alto 53,35%, medio 41,07% y bajo 5,35%. Hasta un 95,5% reconoció la vasectomía como método de planificación masculina. En cuanto a creencias, más del 99% manifiesta que la planificación familiar no es responsabilidad solo de la mujer, aunque sólo el 75% de los hombres aceptó realizarse la vasectomía. Conclusiones Los estudiantes de medicina colombianos tienen un buen nivel de conocimientos sobre vasectomía, recomiendan su realización y reconocen la participación activa masculina dentro de la anticoncepción, sin embargo, se esperaría una mayor disposición, por parte de esta población, a la realización de la vasectomía. La capacitación sobre el tema puede romper las barreras de creencias y promover un adecuado asesoramiento en las consultas de planificación familiar.

Contracepção masculina: a visão de candidatos à vasectomia / Male contraception: the view of vasectomy candidates / Anticoncepción masculina: la visión de candidatos para la vasectomia

Objetivo: analisar a percepção de homens, candidatos à esterilização, sobre a vasectomia e identificar os motivos que os levaram a escolher tal procedimento. Método: pesquisa qualitativa descritiva, realizada com 14 homens em um hospital universitário, do município do Rio Grande/RS, em 2019. Foram realizadas entrevistas semiestruturadas, submetidas à análise de conteúdo. Estudo aprovado pelo Comitê de Ética em Pesquisa. Resultados: a idade média foi de 31,8 anos, e a maioria tinha filhos com a atual e com ex-parceiras. O conhecimento vago sobre vasectomia foi reforçado após encontro com assistente social. A influência de conhecidos foi positiva na tomada de decisão. A proteção da saúde da esposa foi um dos motivos para a realização do procedimento. O histórico de vida cercado por violência na infância também serviu como motivação. Conclusão: é preciso um olhar ampliado, dos profissionais da saúde sobre o tema; considerando o contexto e o projeto de vida do cliente nas situações de planejamento familiar.

Objective: to analyze the perception of men, candidates for sterilization, about vasectomy and to identify the reasons that led them to choose the method. Method: qualitative descriptive research, carried out with 14 men in a university hospital, in the municipality of Rio Grande/RS, in 2019. Semi-structured interviews were carried out, submitted to content analysis. Study approved by the Research Ethics Committee. Results: the average age was 31.8 years, and most had children with the current and former partners. Knowledge about vasectomy was reformed after meeting with a social worker. A known influence was positive in decision making. The protection of the wife's health was one of the reasons for carrying out the procedure. The life history surrounded by childhood violence also serves as an individual motivation. Conclusion: an expanded look is needed by health professionals, taking into account the context and the life project in family planning situations.

Objetivo: analizar la percepción de los hombres, candidatos a la esterilización, sobre la vasectomía e identificar las razones que los llevaron a elegir el método. Método: investigación descriptiva cualitativa, realizada con 14 hombres en un hospital universitario, en el municipio de Rio Grande/RS, en 2019. Se realizaron entrevistas semiestructuradas, sometidas a análisis de contenido. Estudio aprobado por el Comité de Ética en Investigación. Resultados: la edad promedio fue de 31.8 años, y la mayoría tenía hijos con las parejas actuales y anteriores. El conocimiento sobre la vasectomía se reformó después de reunirse con un trabajador social. Una influencia conocida fue positiva en la toma de decisiones. La protección de la salud de la esposa fue una de las razones para llevar a cabo el procedimiento. La historia de la vida rodeada de violencia infantil también sirve como una motivación individual. Conclusión: los profesionales de la salud necesitan una mirada más amplia, teniendo en cuenta el contexto y el proyecto de vida en situaciones de planificación familiar

Factores que inciden en la aceptabilidad de la vasectomía / Factors that influence the acceptability of vasectomy

La vasectomía es un procedimiento que genera mínimas complicaciones y ostenta una tasa de éxito del 99 %; además tiene menor costo que la esterilización femenina, por lo cual se debe tener en cuenta el rol que desempeña el hombre en el número de hijos que se proyecta tener. En esta revisión de tema se identificaron los factores que inciden en la aceptabilidad de la vasectomía. Se realizó la búsqueda de la literatura en las bases de datos de PubMed, ProQuest, BioMed Central, ScienceDirect y Clinical Key para el periodo 2008-2017. Se seleccionaron 39 artículos por haber cumplido los criterios de inclusión: (a) publicado entre el 2008 y el 2017, en inglés, español o portugués y b) reportar resultados afines al tema de interés con evidencia de calidad científica durante la aplicación de las listas de chequeo. La sistematización y análisis de la información permitió la construcción de tres categorías temáticas: Entorno cultural, Condiciones sociales y Educación e información. Sobre la temática se evidenció que los factores como las creencias, el entorno sociocultural y la educación e información que tienen los hombres y sus parejas sobre la vasectomía influyen en la decisión de realizarse o no este procedimiento. Un hallazgo novedoso fue que el sexo de la descendencia también incide en esta decisión. Se recomienda una educación masiva para aumentar el acceso y conocimiento de la vasectomía.

Vasectomy is a procedure that generates minimum complications and garners a success rate of 99 %; In addition, it is an inex-pensive procedure in comparison to female sterilization, consequently the role of men should be taken into account when considering family planning. In this review of the topic, the factors that currently affect the acceptability of vasectomy were identified. We searched PubMed, ProQuest, BioMed Central, ScienceDirect and Clinical Key databases for articles published between 2008-2017 in English, Spanish or Portuguese, and included articles that met the inclusion criteria and showed scien-tific quality during the application of checklists. A total of 39 articles were admitted into the topic review. The systematization and analysis of the information allowed the construction of three thematic categories: cultural-environment, social conditions, and education and information. In this review, it is evidenced that factors such as beliefs, socio-cultural environment, and education and information that men and their partners have about vasectomy influences the decision to undergo or avoid this procedure. The sex of the offspring was evidenced as a novel factor because the children's gender influenced the decision. Therefore, mass education to increase the access and knowledge about vasectomy is recommended

Attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students in a Malaysian private medical college

INTRODUCTION@#This study explored attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students, and determined the association between their demographic characteristics, and attitudes and acceptance.@*METHODS@#A cross-sectional survey was conducted among clinical-year medical students from a Malaysian private medical college using a self-administered questionnaire.@*RESULTS@#There were 330 participants with a female preponderance and a mean age of 22.0 ± 1.1 years. The largest proportion of respondents were from Year 3. The vast majority were ethnically Malay (91.8%) and followed Islam (92.4%). Overall, 60.9% of participants had a positive attitude towards vasectomy and 76.0% showed good acceptance. Gender, academic year, ethnicity and religion variables were not associated with attitudes and acceptance (p > 0.05). A significantly higher proportion of male respondents thought that vasectomy was religiously forbidden and would give a bad impression. A significantly higher proportion of Year 5 students agreed to the statement 'I would recommend vasectomy to relatives, friends and people close to me' compared to Year 3 and 4 students.@*CONCLUSION@#Students' perception of vasectomy as a contraceptive method was encouraging. Our results suggest that their knowledge improved as medical training progressed, and attitudes evolved for the better irrespective of their traditional, cultural and religious beliefs - highlighting the importance of providing students with evidence-based learning about male sterilisation, which is more cost-effective and is associated with lower morbidity than female sterilisation. A qualitative study involving students from different ethnicities and religions would provide a better understanding of this subject.

Vasectomía: nuestra experiencia / Vasectomy: our experience

Objetivo: Describir la experiencia de 6 años en la realización de vasectomías en el sector de Cirugía Menor Ambulatoria del Hospital Público Materno Infantil de Salta. Materiales y métodos: Estudio retrospectivo, descriptivo y cualitativo. Se analizaron las estadísticas de vasectomía desde julio de 2010 a abril de 2016, considerándose datos socioeconómicos. Resultados: Se efectuaron 187 vasectomías con técnica tradicional. El promedio de edad de hombres que se sometieron a vasectomía fue de 34,6 años. El preservativo fue el método anticonceptivo más utilizado previo a la realización de la vasectomía. La edad promedio de inicio de las relaciones sexuales fue de 16,4 años. La mayoría tenía hijos al momento de la vasectomía y se sintió muy satisfecho con los resultados. Conclusión: Consideramos la vasectomía un procedimiento seguro, efectivo y de baja morbilidad, pero que requiere seguir un protocolo(AU)

Objective: To describe the experience achieved after 6 years performing vasectomies in the Minor Ambulatory Surgery sector of the Hospital Público Materno Infantil de Salta. Materials and methods: Retrospective, descriptive and qualitative study. Vasectomy statistics were analyzed from July 2010 to April 2016 considering socioeconomic data. Results: 187 traditional vasectomies were performed. The average age of men who had vasectomy was 34.6. The condom was the most used contraceptive method before they had a vasectomy. The average age of onset of sexual intercourse was 16.4 years. Most had children at the time of vasectomy and felt very satisfied with the results. Conclusion: We consider vasectomy a safe, effective and of low morbidity procedure, though it requires to follow a protocol(AU)

Effect of ductus deferens lavage on the time to achieve azoospermia in patients undergoing vasectomy

OBJECTIVE: To evaluate the effect of normal saline lavage of the distal vas deferens ampulla in patients undergoing vasectomy on the time to achieve azoospermia. METHODS: A prospective randomized study of 60 men divided into two groups, group lavage (GL, n=30) in which distal vas deferens ampulla lavage was performed with 10 ml of normal saline during the vasectomy, and group without lavage (GWL, n=30) in which control patients received only a vasectomy. The patients provided sperm for semen analysis at the 5th, 10th, 15th, 20th and 25th ejaculations. RESULTS: Fifteen participants in GL and 16 in GWL, for a total of 31 patients, were excluded due to not completing the control spermiogram. The tests carried out at the five ejaculations showed immobile spermatozoa in 40 and 85.71%, 66.67 and 78.57%, 93.33 and 85.71%, 86.67 and 71.43%, and 93.33 and 85.71% of participants in GL and GWL, respectively. CONCLUSION: Vas deferens duct lavage with 10 ml of normal saline during vasectomy did not decrease the time required to achieve postoperative azoospermia.

Satisfaction with the use of contraceptive methods among women from primary health care services in the city of São Paulo, Brazil / Satisfação com o uso de métodos contraceptivos entre usuárias de unidades básicas de saúde da cidade de São Paulo

Abstract Objectives: to assess satisfaction with the use of contraceptive methods among women attending primary health care services in São Paulo, Brazil. Methods: crosssectional study conducted with a sample of 668 women aged 1849 years, who were enrolled in 38 primary health care facilities in São Paulo city, Brazil, in 2015. Exclusion criteria were no sexual initiation, use of irreversible contraceptive methods for more than five years, pregnancy and no contraceptive method use. Data were analyzed using chisquare and multivariate logistic regression. Results: in general, women were satisfied with current contraceptive method (78.7%). The higher percentage of satisfaction was observed among IUD users (94.7%), and female and male sterilization users (93.5% and 91.7%, respectively). Withdrawal users were less satisfied (52.9%). Contraceptive method itself was the only factor associated with satisfaction. Barrier or traditional method users were less likely to be satisfied with their contraceptive methods than irreversible method users. Conclusions: long acting contraceptive method and irreversible method users were more satisfied with their contraceptive methods. Efforts should be undertaken in order to make these contraceptives available and accessible in primary health care facilities in Brazil.

Resumo Objetivos: avaliar a satisfação com o método contraceptivo em uso entre usuárias de unidades básicas de saúde da cidade de São Paulo/SP. Métodos: estudo transversal conduzido com 668 mulheres com idade entre 18 e 49 anos, usuárias de 38 unidades básicas de saúde da cidade de São Paulo, Brasil, em 2015. Foram excluídas mulheres que não haviam iniciado a vida sexual, tinham feito laqueadura/parceiro foi vasectomizado há mais de cinco anos, estavam grávidas e não usavam métodos contraceptivos. Dados foram analisados usando teste de diferença entre proporções pelo quiquadrado e regressão logística múltipla. Resultados: a maior parte das mulheres estava satisfeita com o método contraceptivo utilizado (78,7%). A maior satisfação foi observada entre usuárias do DIU (94,7%), da laqueadura (93,5%) e vasectomia (91,7%). A menor satisfação foi entre usuárias de coito interrompido (52,9%). O tipo de método foi o único aspecto associado à satisfação com o método contraceptivo. Mulheres que usavam métodos de barreira ou tradicionais tiveram menos chance de estar satisfeitas com o método usado, quando comparadas às mulheres queusavam métodos irreversíveis. Conclusões: usuárias de métodos contraceptivos de longa duração ou irreversíveis relataram estar mais satisfeitas. Esforços devem ser empreendidos para que esses métodos estejam disponíveis nas unidades básicas de saúde e o acesso a eles seja facilitado.

Vasectomy has no obvious longterm influence on the levels of serum androgens in aging males / 中华男科学杂志

Objective@#To explore the longterm influence of vasectomy on the levels of serum androgens in aging males.@*METHODS@#Using stratified random sampling, we conducted a questionnaire survey and physical examinations among 437 adult males aged ≥40 years, 232 with and 205 without the history of vasectomy. In addition, we measured the levels of serum total testosterone (TT), sexhormone binding globulin (SHBG), calculated free testosterone (cFT), testosterone secreting index (TSI), free testosterone index (FTI), and luteinizing hormone (LH).@*RESULTS@#Compared with the nonvasectomy group, the vasectomy group showed significantly increased levels of serum TT (［16.01±5.41］ vs ［17.39±6.57］ nmol/L), SHBG (［58.91±36.89］ vs ［70.28±40.90］ nmol/L), and LH (［8.86±6.49］ vs ［10.85±11.73］ IU/L) (all P0.05), nor after adjustment for relevant factors in TT (β: 1.015, 95% CI: －0.180－2.210), SHBG (β: 5.118, 95% CI: －2.069－12.305), cFT (β: 0.003, 95% CI: －0.011－0.018), FTI (β: －0.012, 95% CI: －0.035－0.011), TSI (β: 0.138, 95% CI: －0.131－0.407), and LH (β: 1.011, 95% CI: －0.811－2.834) (all P>0.05).@*CONCLUSIONS@#Vasectomy has no obvious longterm influence on the levels of serum androgens in aging males.

Conocimientos, actitudes y creencias entorno a la elección de la vasectomía en ecatepec-méxico / Knowledge, attitudes, and beliefs about the choice of vasectomy

INTRODUCCION: La vasectomía es uno de los métodos más seguros, sencillos y económicos para la anticoncepción. En México, constituye solo 2% del total de métodos usados comparado contra 10% en otros países. OBJETIVO: Analizar conocimientos, actitudes y creencias entorno a la elección de la vasectomía. MATERIAL Y METODOS: Estudio observacional, analítico de corte transversal, con 111 varones del Servicio de Planificación Familiar de la Unidad de Medicina Familiar Número 93 de Ecatepec-México, de enero a junio del 2016. Se aplicó una encuesta estructurada sometida a validación de contenido por expertos, que incluye conocimientos, actitudes y creencias que determinan la aceptación o rechazo de la vasectomía. Se realizó un análisis multivariado con regresión logística binaria por Método de Wald. RESULTADOS: El alcanzar el total de hijos planeados es el factor principal para optar por la vasectomía con un riesgo superior a dieciocho. En un análisis multivariado mediante regresión lineal binaria se encontró que la paridad satisfecha se debe acompañar de una información clara del procedimiento, una buena relación de pareja y consultar la decisión con la misma. El candidato debe poseer tres o menos parejas sexuales en su vida para asegurar una elección por el método superior al 90%. CONCLUSIONES: Conocimientos, creencias y actitudes del individuo, y de la pareja intervienen en la elección de la vasectomía, conocer un perfil de riesgo acerca de la elección del método permite acercar a mayor población a esta opción anticonceptiva.

INTRODUCTION: Vasectomy is one of the safest, simplest and most economical methods for contraception. In Mexico, it constitutes only 2% of the total methods used compared to 10% in other countries. OBJETIVE: Analyze knowledge, attitudes, and beliefs about the choice of vasectomy. MATERIAL AND METHOD: Analytical cross-sectional study, with 111 males of the Family Planning service of the Family Medicine Unit Number 93 of Ecatepec-Mexico, from January to June 2016. A structured survey was applied subject to validation of content by experts., which includes knowledge, attitudes, and beliefs that determine the acceptance or rejection of vasectomy. A multivariate analysis was performed with binary logistic regression by the Wald method. RESULTS: To reach the total of planned children is the main factor to opt for vasectomy with a risk higher than eighteen. In a multivariate analysis using binary linear regression, it was found that satisfied parity must be accompanied by clear information about the procedure, a good relationship between couples and consultation with the decision. The candidate must have three or fewer sexual partners in his life to ensure a choice by the method of more than 90%. CONCLUSION: Knowledge, beliefs, and attitudes of the individual and the couple involved in the choice of vasectomy, knowing a risk profile about the choice of method allows to approach a larger population to this contraceptive option.

Vasectomía sin bisturí - sin aguja con dispositivo madajet: Introducción de la técnica en Chile / No-scalpel needle-less vasectomy with madajet device: Itroduction of the tecnique in Chile

La vasectomía es un método simple, seguroy efectivo de control de fertilidad que tiene múltiples ventajas comparativas respecto a la ligadura tubaria. A pesar de esto, continúa representando sólo un pequeño porcentaje de las esterilizaciones efectuadas en nuestro país.El costo del procedimiento y el temor a la cirugía siguen siendo algunas de las barreras que impiden una mayor realización y aceptación del procedimiento. Estas aprehensiones podrían ser evitadas a través del uso de la técnica de vasectomía sin bisturí - sin aguja con el uso del dispositivo Madajet. El equipo Madajet es un aparato mecánico que permite inyectar un volumen fijo de 0,1 cc de anestésico local, con una penetración del liquido a 4-5 mm de la superficie epitelial, generando una pápula de 5-6 mm de diámetro que evita la distensión tisular producida por la inyección del anestésico con aguja.AU

Vasectomy is a simple, safe and effective fertility control method that has multiple comparative advantages over tubal ligation. Despite this, it continues to represent only a small percentage of the sterilizations carried out in our country. The cost of the procedure and the fear of surgery continue to be some of the barriers that prevent further implementation and acceptance of the procedure. These shortcomings could be avoided by using the no-scalpel needle-less technique incorporating the Madajet device. The Madajet device is a mechanical device that allows the injection of a fixed volume of 0.1 cc of local anesthetic, with a penetration of the fluid to 4-5 mm of the epithelial surface, generating a papule 5-6 mm in diameter that avoids the Tissue distention produced by injection of anesthetic with needle.AU

Reversión de vasectomía: técnica simplificada / Reversal vasectomy: a simpliefed technique

Introducción. Aproximadamente un 3 por ciento de los hombres que se han sometido a una vasectomía se realizan posteriormente una reversión de ésta con intención de fertilidad. La vasovasostomía (VV) microquirúrgica como técnica de reversión de vasectomía, permite la recanalización de los conductos deferentes, ofreciendo muy buenos resultados. Objetivo. Describir los resultados quirúrgicos y la efectividad de la VV en una serie de pacientes operados mediante una técnica simplificada. Materiales y Métodos. Estudio retrospectivo. Se analizaron antecedentes demográficos y quirúrgicos. Se utilizó una técnica de VV simplificada que consiste en realizar una miniincisión de abordaje (1 cm), sin evaluar el líquido seminal mediante la graduación de Silber y realizar la anastomosis en un plano único con material de sutura no reabsorbible 9-0. Se controló con espermiograma al primer y tercer mes post-cirugía, evaluando concentración espermática, motilidad progresiva, morfología y volumen seminal entre otros. Se calculó la tasa de permeabilidad deferencial (definida como presencia de espermatozoides en el eyaculado) y la tasa de embarazo post VV. Resultados. Un total de 75 pacientes fueron incluidos en el estudio, operados entre agosto de 2009 y julio de 2016 por 2 cirujanos (CP, MM). La edad media (± desviación estándar) de los pacientes y de sus parejas fue de 43,9 ± 6,4 años y 34,4 ± 4,2 años, respectivamente. La mediana del tiempo transcurrido entre la vasectomía y la VV fue de 8 años (2 ­ 21 años). La mediana del tiempo quirúrgico fue de 110 minutos (85 ­ 183 minutos), con menos de un 3 por ciento de complicaciones post-operatorias (todas grado-I según escala Clavien-Dindo). Al primer mes el 93% de los pacientes tenía espermatozoides en el eyaculado, con una mediana de concentración de 12 x 10

Introduction. Approximately 3 pertcent of men subjected to a vasectomy undergo a subsequent reversal with fertility purposes. The microsurgical vasovasostomy (VV) as a vasectomy reversal technique allows recanalization of the deferential ducts, offering very good results. Objetive. To describe the surgical results and effectiveness of VV in a series of patients in whom a simplified technique was performed. Materials y Methods. Restrospective study. Demographic and surgical records were analyzed. The VV was performed using a simplified technique, meaning a mini-incision approach (1 cm), avoidance of the proximal seminal fluid analysis using the Silber score and performing the anastomosis in a single-layered fashion with a 9-0 non-absorbable suture. A sperm analysis was performed at first and third postoperative month., assesing sperm concentration, progressive motility, morphology and sperm volume among other factors. The deferential permeability rate (defined as presence of spermatozoids in semen) and pregnancy rates after VV were calculated. Results. A total of 75 patients were included in the study. All surgeries were performed by 2 surgeons (CP, MM) between August 2009 and July 2016. The average age (± standard deviation) of patients and their sexual partners were 43.9 ± 6.4 years and 34.4 ± 4.2 years, respectively. The median time span between the vasectomy and reversal was 8 years (range 2 ­ 21 years). The median surgical time was 110 minutes (range 85 ­ 183 minutes), with less than a 3 pertcent rate of postoperative complications (all grade-I according to Clavien-Dindo classification). At the first postoperative month 93 pertcent of the patients had spermatozoids in the eyaculate, with a median concentration of 12 x 10

Loupe-Assisted Vasovasostomy Using a Prolene Stent: A Simpler Vasectomy Reversal Technique

PURPOSE: Microsurgical vasovasostomy is associated with high patency and pregnancy rates, but is difficult and requires significant effort and time to learn. Therefore, we assessed a simplified loupe-assisted vasovasostomy method using a Prolene stent. MATERIALS AND METHODS: The medical records of 82 patients who underwent loupe-assisted vasovasostomy with a Prolene stent by a single surgeon between January 2004 and December 2015 were reviewed. The association between the vasal obstructive interval (VOI) and the success rate was evaluated. RESULTS: The average age at the time of vasovasostomy was 39.8 years (range, 29~57 years). The mean VOI was 6.6 years (range, 1~19 years). The mean operation time was 87.0 minutes (range, 55.0~140.0 minutes). The overall patency and natural pregnancy rates were 90.2% and 45.1%, respectively. The success rate decreased as time after vasectomy increased (odds ratio, 0.869; 95% confidence interval, 0.760~0.993; p=0.039). The cases were divided into 2 groups according to the mean VOI: group A (>7 years) and group B (≤7 years), with 31 cases (37.8%) and 51 cases (62.2%), respectively. The patency and pregnancy rates of group A were 80.6% and 51.6%, respectively, while those of group B were 96.1% and 41.2%, respectively. CONCLUSIONS: Loupe-assisted vasovasostomy using a Prolene stent is a safe and effective method.

Unilateral absence of vas deferens: prevalence among 23, 013 men seeking vasectomy

ABSTRACT Purpose: To determine the prevalence of unilateral absence of vas deferens (UAVD) in men with both testes seeking vasectomy. Materials and Methods: Computerized charts of 23,013 patients encountered between January 1994 and December 2013 in one university hospital and two community clinics of Quebec City, Canada, were searched. Pre-vasectomy consultation, operative reports and semen analysis results were reviewed to identify cases of UAVD. Cases were categorized as confirmed (unilateral vasectomy and success confirmed by semen analysis) or possible congenital UAVD further sub-categorized according to whether or not a scrotal anomaly was present. Results: Among 159 men identified as potentially having UAVD, chart review revealed that 47 had only one testicle, 26 had bilateral vasa, and four were misdiagnosed (post-vasectomy semen analysis [PVSA] showing motile sperm after unilateral vasectomy) leaving 82 men deemed cases of UAVD (0.36%, 95% confidence interval 0.28% to 0.43%). These were classified as confirmed (n=48, 0.21%) and possible (n=34, 0.15%; 22 without and 12 with scrotal anomalies) congenital UAVD. The misdiagnosis ratio of UAVD was low when scrotal content was otherwise normal (1:48), but higher if anomalies were present (3:12). Conclusions: Most surgeons who perform vasectomy will encounter cases of UAVD. In most suspected cases, it is safe and effective to proceed with unilateral vasectomy under local anesthesia while stressing the need for PVSA. Further studies or scrotal exploration may be considered in patient with prior scrotal surgery.

The current status of public sperm bank in Korea

Sperm banking is an important option to maintain the male fertilization capacity or induce pregnancy even though under the era of in vitro fertilization. The medical indications for sperm banking are generally consisted of 3 categories. There are cases on planning the permanent contraception like vasectomy or cancer patients to be scheduled the chemotherapy or radiotherapy as first category, male infertile patients with severe oligozoospermia or artificially harvested sperm ie, from microscopic epididymal sperm aspiration or testicular sperm extraction et cetera for the artificial insemination with husband sperm as second category, and the therapeutic donor insemination as third category. Of these three categories, the sperm donation program accompanies various complicated practical, ethical and legal issues. Therefore, highly regulated statements are mandatory in order to secure safety and the complete practices for voluntary sperm donors and infertile couples both. In aspect of administrative structure of sperm bank, there are 3 types that are national based to be established in the most of European countries and China, public based in Japan, and commercially available in the USA. Additionally, each country has different standard guidelines, regulation statements, act and law to control the sperm donation program as well as different cultural or religious background. Nevertheless, we need a consensus document to operate the sperm bank with the standard guidelines to be well revised according to each country's ethical perspectives as well as contemporary scientific evolution. This article will provide what is the Korean model for ideal sperm bank with the history of sperm cryopreservation and banking, background and prerequisite for the public sperm bank operation, and also expected effects.