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.

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.

Prospective comparison of ligation and bipolar cautery technique in non-scalpel vasectomy

Objectives: There is no trial comparing bipolar cautery and ligation for occlusion of vas in non-scalpel vasectomy. This study aimed to compare the effectiveness of these vasectomy occlusion techniques. Materials and Methods: Between January 2002-June 2009, patients were allocated in alternate order. We recruited 100 cases in cautery group and 100 cases in ligation group. Non-scalpel approach was performed during vasectomy and fascial interposition was performed in all cases. First semen analysis was done 3 months after vasectomy. Vasectomy success was defined as azoospermia or non-motile sperm lower than 100.000/mL. Results: Four patients from the cautery group were switched to the ligation group due to technical problem of cautery device. Thus, data of 96 patients as cautery group and 104 patients as ligation group were evaluated. After vasectomy, semen analyses were obtained from 59 of 96 (61.5%) patients in cautery group and to 66 of 104 (63.5%) patients in ligation group. There was no statistical significant difference between the two groups in terms of the success of vasectomy (p=0.863). Conclusion: Although bipolar cautery technique is safe, effective and feasible in non-scalpel vasectomy, it has no superiority to ligation. There was no statistically significant difference in terms of the success and complications between the two groups.

An inexpensive yet realistic model for teaching vasectomy

Purpose Teaching the no-scalpel vasectomy is important, since vasectomy is a safe, simple, and cost-effective method of contraception. This minimally invasive vasectomy technique involves delivering the vas through the skin with specialized tools. This technique is associated with fewer complications than the traditional incisional vasectomy (1). One of the most challenging steps is the delivery of the vas through a small puncture in the scrotal skin, and there is a need for a realistic and inexpensive scrotal model for beginning learners to practice this step. Materials and Methods After careful observation using several scrotal models while teaching residents and senior trainees, we developed a simplified scrotal model that uses only three components–bicycle inner tube, latex tubing, and a Penrose drain. Results This model is remarkably realistic and allows learners to practice a challenging step in the no-scalpel vasectomy. The low cost and simple construction of the model allows wide dissemination of training in this important technique. Conclusions We propose a simple, inexpensive model that will enable learners to master the hand movements involved in delivering the vas through the skin while mitigating the risks of learning on patients. .

Vasectomía sin bisturí: resultados de una cohorte de 309 pacientes / No-scalpel vasectomy

Introducción: La vasectomía es una técnica segura y efectiva para el control de la fertilidad masculina. A pesar de esto, en el mundo se realizan el doble de esterilizaciones femeninas respecto a vasectomías, lo cual es más acentuado en países en vías de desarrollo. Objetivos: El objetivo de este trabajo es presentar nuestra experiencia y resultados en pacientes sometidos a una vasectomía sin bisturí. Materiales y Métodos: Se incluyó un total de 309 pacientes sometidos a una vasectomía sin bisturí entre junio de 2009 y mayo de 2010. En cada caso se evaluó la edad, tiempo operatorio, espermiograma a los 3 y 6 meses (en caso de ser necesario) y la morbilidad perioperatoria. Resultados: 281 pacientes (91 por ciento) se controlaron con al menos un espermiograma. En 189 pacientes (67 por ciento) se evidenció azoospermia en el espermiograma a los 3 meses. En 81 pacientes (29 por ciento) se evidenció un recuento con < 100.000 espermatozoides 100 por ciento inmóviles. En 9 pacientes (3,2 por ciento) se necesitó un segundo espermiograma para obtener menos de 100.000 espermatozoides 100 por ciento inmóviles. Seis pacientes (2 por ciento) consultaron por complicaciones menores: orquialgia, epididimitos o hematoma del sitio operatorio. A 2 años de seguimiento, no se registraron embarazos. Conclusiones: La vasectomía sin bisturí es un método seguro y reproducible de anticoncepción masculina, presentando tasas de efectividad superiores al resto de los métodos anticonceptivos. Un espermiograma de control debe ser realizado a los 3 meses de realizado el procedimiento. La tasa de falla temprana se estima en 0,3 por ciento de los pacientes.

Introduction: Vasectomy is a safe and effective technique of male fertility control. Despite this, in the world are carried out more than double female sterilization in comparison with vasectomies, that is more pronounced in less developed countries. Aims: To present our experience and results in patients undergoing a no-scalpel vasectomy. Methods and Material: A total of 309 patients undergoing a no-scalpel vasectomy between June 2009 and May 2010 were included. For each case was record age, operative time, sperm count at 3 months post vasectomy and peri-operative morbidity. Results: 309 vasectomies were performed, 281 patients (91%) were controlled with at least one sperm count. Azoospermia was obtained in the first sperm count at 3 months in 189 patients (67%). In 81 patients (29%) were observed ≤ 100,000 sperm 100% immobile. 9 patients (3.2%) needed a second semen analysis and 2 patients a third one for less than 100,000 sperm that were 100% immobile. 6 patients (2%) consulted by minor complications such as postoperative pain, epididymitis or hematoma with spontaneous resolution. Conclusions: Vasectomy is a safe and reproducible method of male contraception, presenting an effectiveness rates higher than others contraceptive methods. There are no absolute contraindications for performing the procedure. A sperm count should be done at 3 months of the procedure. The early failure rate in our study is 0.3%.

Vasectomy occlusion technique combining thermal cautery and fascial interposition

INTRODUCTION: Recent research on vasectomy shows that combining cautery and fascial interposition (FI) achieves the most effective occlusion of the vas and minimizes the risk of failure. We present a technique that combines cautery and FI and is suitable for low-resource settings. SURGICAL TECHNIQUE: The surgical technique consists of 1) exposing the vas with the no-scalpel approach; 2) cauterizing the epithelium of lumen of the vas using a portable battery-powered cautery device; 3) performing FI by grasping internal spermatic fascia and applying a free tie with suture material on the fascia to cover the prostatic stump of the vas and separate the two ends of the cut vas; and 4) excising a small 0.5 to 1 cm of the testicular stump. COMMENTS: To maximize vasectomy effectiveness, vasectomy providers should consider learning thermal cautery and FI to occlude vas deferens.

Vasectomia sem bisturi - experiência ambulatorial / No-scalpel vasectomy - out-patient experience

Projeto piloto, não-comparativo para avaliar a experiência regional da vasectomia sem bisturi como um método contraceptivo permanente em um serviço de planejamento familiar, em nível ambulatorial, que poderia ser realizada por ginecologistas e médicos generalistas. Métodos: O estudo foi realizado no Serviço de Planejamento Familiar do Hospital Municipal de Ituiutaba, Minas Gerais, em convênio com o Departamento de Ginecologia e Obstetrícia da Universidade Federal de Minas Gerais, aprovado pelo Conselho de Ética daquele Hospital. Após ações educativas sobre todos os métodos contraceptivos, escolha espontânea do método pelo casal com assinatura de consentimento pós-informado, foram submetidos à vasectomia 181 pacientes com a idade variando de 25 a 52 anos, em um período de dois anos. Os procedimentos foram realizados em regime ambulatorial. Dos 181 casos operados, houve um caso de reanastomose espontânea que foi submetido à nova cirurgia, dois pacientes apresentaram epidimites que foram resolvidas com antibióticos e um caso de pequeno hematoma, que solucionou espontaneamente. Conclusão: A vasectomia sem bisturi demonstrou ser um método seguro, simples, com boa aceitabilidade, apresentando pequenos índices de falhas e de complicações que pode ser realizada por ginecologistas ou médicos generalistas num ambiente de ambulatório.

Hablemos de la planificación familiar / Let us speak of the family planning / Lo que los y las adolescentes queremos saber

Presenta los aspectos que deben saber los adolescentes acerca de la importancia de la planificación familiar. Da a conocer todos los metodos anticonceptivos que pueden utilizar y que tan seguros son para evitar un embarazo. Explica como afecta el uso de anticonceptivos a una adolescente. También aborda la causa de la infertilidad femenina

No-scalpel vasectomy--hope for future: historical aspects.

The author gives the historical aspects of no-scalpel vasectomy (NSV) and concludes that the procedure will replace the conventional vasectomy and hopes that NSV is going to stay.

Estudo morfológico de ducto deferente em ratos submetidos à vasectomia convencional e a laser de argônio / Morphological study of the vas deferens in rats submitted to conventional and argonium laser vasectomy

Dois grupos de 5 ratos foram submetidos a vasectomia convencional (A) e a raio laser de Argônia (B). No trigésimo dia de pós-operatório os animais foram sacrificados e os ductos deferentes observados sob visäo direta e ao microscópio óptico. Macroscopicamente observou-se em todos os casos a formaçäo de uma tumoraçäo no ápice do coto proximal do ducto deferente. O restante do aparelho permaneceu íntegro. Microscopicamente em ambos os grupos notou-se uma dilataçäo da luz do ducto, o epitélio tornou-se plano com perda de estereocílios e esgarçamento da camada muscular. Além disso, observou-se uma formaçäo tumoral com conteúdo espermático e colóide, circundada por macrófagos e células gigantes, envoltos por uma camada fibrosa. Esta formaçäo constitui-se no granuloma espermático. Näo foram observados significativas entre os métodos aplicados