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Effectiveness of vasectomy using cautery.

Barone MA, Irsula B, Chen-Mok M, Sokal DC, Investigator study gro - BMC Urol (2004)

Bottom Line: Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation.Cautery is a very effective method for occluding the vas.Failure based on semen analysis is rare.

View Article: PubMed Central - HTML - PubMed

Affiliation: EngenderHealth, New York, NY 10001, USA. mbarone@engenderhealth.org

ABSTRACT

Background: Little evidence supports the use of any one vas occlusion method. Data from a number of studies now suggest that there are differences in effectiveness among different occlusion methods. The main objectives of this study were to estimate the effectiveness of vasectomy by cautery and to describe the trends in sperm counts after cautery vasectomy. Other objectives were to estimate time and number of ejaculations to success and to determine the predictive value of success at 12 weeks for final status at 24 weeks.

Methods: A prospective, non-comparative observational study was conducted between November 2001 and June 2002 at 4 centers in Brazil, Canada, the UK, and the US. Four hundred men who chose vasectomy were enrolled and followed for 6 months. Sites used their usual cautery vasectomy technique. Earlier and more frequent than normal semen analyses (2, 5, 8, 12, 16, 20, and 24 weeks after vasectomy) were performed. Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation.

Results: A total of 364 (91%) participants completed follow-up. The overall failure rate based on semen analysis was 0.8% (95% confidence interval 0.2, 2.3). By 12 weeks 96.4% of participants showed azoospermia or severe oligozoospermia (< 100,000 sperm/mL). The predictive value of a single severely oligozoospermia sample at 12 weeks for vasectomy success at the end of the study was 99.7%. One serious unrelated adverse event and no pregnancies were reported.

Conclusion: Cautery is a very effective method for occluding the vas. Failure based on semen analysis is rare. In settings where semen analysis is not practical, using 12 weeks as a guideline for when men can rely on their vasectomy should lessen the risk of failure compared to using a guideline of 20 ejaculations after vasectomy.

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Related in: MedlinePlus

Sperm concentration (number sperm per mL) categories by week of follow-up (N = 389).
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Figure 3: Sperm concentration (number sperm per mL) categories by week of follow-up (N = 389).

Mentions: To examine trends in sperm counts over the 24 week follow-up period, semen analysis results at each time point were divided into six categories from azoospermia to 10 million or more sperm/mL (Figure 3). At the 2 week follow-up, 49.7% (190/382) of participants showed azoospermia or severe oligozoospermia, rising to 96.4% (354/367) by the 12 week half way point of the study, and eventually reaching 99.4% (361/363) by the 24 week study endpoint. This analysis considers the available data for all men at each follow-up week and, unlike the Kaplan-Meier estimates presented below, ignores the classification of each participant at previous weeks. For example, in Figure 3, a participant may be classified in a lower sperm concentration category at a particular follow-up week, and later on, be classified in a higher sperm concentration category.


Effectiveness of vasectomy using cautery.

Barone MA, Irsula B, Chen-Mok M, Sokal DC, Investigator study gro - BMC Urol (2004)

Sperm concentration (number sperm per mL) categories by week of follow-up (N = 389).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC503392&req=5

Figure 3: Sperm concentration (number sperm per mL) categories by week of follow-up (N = 389).
Mentions: To examine trends in sperm counts over the 24 week follow-up period, semen analysis results at each time point were divided into six categories from azoospermia to 10 million or more sperm/mL (Figure 3). At the 2 week follow-up, 49.7% (190/382) of participants showed azoospermia or severe oligozoospermia, rising to 96.4% (354/367) by the 12 week half way point of the study, and eventually reaching 99.4% (361/363) by the 24 week study endpoint. This analysis considers the available data for all men at each follow-up week and, unlike the Kaplan-Meier estimates presented below, ignores the classification of each participant at previous weeks. For example, in Figure 3, a participant may be classified in a lower sperm concentration category at a particular follow-up week, and later on, be classified in a higher sperm concentration category.

Bottom Line: Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation.Cautery is a very effective method for occluding the vas.Failure based on semen analysis is rare.

View Article: PubMed Central - HTML - PubMed

Affiliation: EngenderHealth, New York, NY 10001, USA. mbarone@engenderhealth.org

ABSTRACT

Background: Little evidence supports the use of any one vas occlusion method. Data from a number of studies now suggest that there are differences in effectiveness among different occlusion methods. The main objectives of this study were to estimate the effectiveness of vasectomy by cautery and to describe the trends in sperm counts after cautery vasectomy. Other objectives were to estimate time and number of ejaculations to success and to determine the predictive value of success at 12 weeks for final status at 24 weeks.

Methods: A prospective, non-comparative observational study was conducted between November 2001 and June 2002 at 4 centers in Brazil, Canada, the UK, and the US. Four hundred men who chose vasectomy were enrolled and followed for 6 months. Sites used their usual cautery vasectomy technique. Earlier and more frequent than normal semen analyses (2, 5, 8, 12, 16, 20, and 24 weeks after vasectomy) were performed. Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation.

Results: A total of 364 (91%) participants completed follow-up. The overall failure rate based on semen analysis was 0.8% (95% confidence interval 0.2, 2.3). By 12 weeks 96.4% of participants showed azoospermia or severe oligozoospermia (< 100,000 sperm/mL). The predictive value of a single severely oligozoospermia sample at 12 weeks for vasectomy success at the end of the study was 99.7%. One serious unrelated adverse event and no pregnancies were reported.

Conclusion: Cautery is a very effective method for occluding the vas. Failure based on semen analysis is rare. In settings where semen analysis is not practical, using 12 weeks as a guideline for when men can rely on their vasectomy should lessen the risk of failure compared to using a guideline of 20 ejaculations after vasectomy.

Show MeSH
Related in: MedlinePlus