European Association of Urology Guidelines on Vasectomy
Authors:
G. R. Dohle 1; T. Diemer 2; Z. Kopa 3; C. Krausz 4; A. Giwercman 5; A. Jungwirth 6
Authors‘ workplace:
Department of Urology, Erasmus University Medical Centre, Rotterdam, The Netherlands
1; Department of Urology, Paediatric Urology and Andrology, University Hospital Giessen and Marburg GmbH, Campus Giessen, Justus-Liebig-University Giessen, Germany
2; Andrology Centre Department of Urology Semmelweis University, Budapest, Hungary
3; Sexual Medicine and Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
4; Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
5; EMCO Private Clinic, Department of Urology and Andrology, Bad Dürrnberg, Austria
6
Published in:
Urol List 2012; 10(2): 83-88
Category:
Guidelines
Overview
Context:
The European Association of Urology presents its guidelines for vasectomy. Vasectomy is highly effective, but problems can arise that are related to insufficient preoperative patient information, thesurgical procedure, and postoperative follow-up.
Objective:
These guidelines aim to provide information and recommendations for physicians who perform vasectomies and to promote the provision of adequate information to the patient before the operation to prevent unrealistic expectations and legal procedures.
Evidence acquisition:
An extensive review of the literature was carried out using Medline, Embase, and the Cochrane Database of Systematic Reviews from 1980 to 2010. The focus was on randomised controlled trials (RCTs) and meta-analyses of RCTs (level 1 evidence) and on well-designed studies without randomisation (level 2 and 3 evidence). A total of 113 unique records were identified for consideration. Non–English language publications were excluded as well as studies published as abstracts only or reports from meetings.
Evidence synthesis:
The guidelines discuss indications and contraindications for vasectomy, preoperative patient information and counselling, surgical techniques, postoperative care and subsequent semen analysis, and complications and late consequences.
Conclusions:
Vasectomy is intended to be a permanent form of contraception. There are no absolute contraindications for vasectomy. Relative contraindications may be the absence of children, age < 30 yr, severe illness, no current relationship, and scrotal pain. Preoperative counselling should include alternative methods of contraception, complication and failure rates, and the need for postoperative semen analysis. Informed consent should be obtained before the operation. Although the use of mucosal cautery and fascial interposition have been shown to reduce early failure compared to simple ligation and excision of a small vas segment, no robust data show that a particular vasectomy technique is superior in terms of prevention of late recanalisation and spontaneous pregnancy after vasectomy. After semen analysis, clearance can be given in case of documented azoospermia and in case of rare nonmotile spermatozoa in the ejaculate at least 3 mo after the procedure. Take
Home Message:
Vasectomy should be considered as a permanent method of contraception with few relative contraindications. Comprehensive preprocedure patient information is of the utmost importance, and the decision to proceed should be based on all relevant information available. All potential postoperative complications, although rare, have to be mentioned, and patients should be informed that the procedure is not 100% effective and that recanalisation may occur over time. A written consent form is strongly advised for this procedure.
Key words:
vasectomy, sterilisation, male contraceptives, vasectomy reversal, pregnancy, testis, vasovasostomy, EAUguidelines
Sources
1. Schwingl PJ, Guess HA. Safety and effectiveness of vasectomy. Fertil Steril 2000; 73(5): 923–936.
2. Awsare NS, Krishnan J, Boustead GB et al. Complications of vasectomy. Ann R Coll Surg Engl 2005; 87(6): 406–410.
3. Philp T, Guillebaud J, Budd D. Complications of vasectomy: review of 16,000 patients. Br J Urol 1984; 56(6): 745–748.
4. Leslie TA, Illing RO, Cranston DW et al. The incidence of chronic scrotal pain after vasectomy: a prospective audit. BJU Int 2007; 100(6): 1330–1333.
5. Alderman PM. The lurking sperm. A review of failures in 8879 vasectomies performed by one physician. JAMA 1988; 259(21): 3142–3144.
6. Davies AH, Sharp RJ, Cranston D et al. The long-term outcome following “special clearance” after vasectomy. Br J Urol 1990; 66(2): 211–212.
7. Philp T, Guillebaud J, Budd D. Late failure of vasectomy after two documented analyses showing azoospermic semen. Br Med J 1984; 289(6437): 77–79.
8. Holman CD, Wisniewski ZS, Semmens JB et al. Population-based outcomes after 28,246 in-hospital vasectomies and 1,902 vasovasostomies in western Australia. BJU Int 2000; 86(9): 1043–1049.
9. Oxford Centre for Evidence-based Medicine – Levels of Evidence (March 2009). Centre for Evidence-based Medicine Web site.
http://www.cebm.net/index.aspx?o=1025.
10. Verhulst AP, Hoekstra JW. Paternity after bilateral vasectomy. BJU Int 1999; 83(3): 280–282.
11. Goldacre MJ, Wotton CJ, Seagroatt V et al. Cancer and cardiovascular disease after vasectomy: an epidemiological database study. Fertil Steril 2005; 84(5): 1438–1443.
12. Labrecque M, Dufresne C, Barone MA et al. Vasectomy surgical techniques: a systematic review. BMC Med 2004; 2: 21.
13. Cook LA, Van Vliet H, Lopez LM et al. Vasectomy occlusion techniques for male sterilization. Cochrane Database Syst Rev 2007; (2): CD003991.
14. Sokal D, Irsula B, Hays M et al. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Med 2004; 2: 6.
15. Barone MA, Irsula B, Chen-Mok M et al. Effectiveness of vasectomy using cautery. BMC Urol 2004; 4: 10.
16. Griffin T, Tooher R, Nowakowski K et al. How little is enough? The evidence for post-vasectomy testing. J Urol 2005; 174(1): 29–36.
17. Hancock P, McLaughlin E. British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002). J Clin Pathol 2002; 55(11): 812–816.
18. World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge University Press, Cambridge, UK, 2010.
19. Korthorst RA, Consten D, van Roijen JH. Clearance after vasectomy with a single semen sample containing < than 100 000 immotile sperm/mL: analysis of 1073 patients. BJU Int 2010; 105(11): 1572–1575.
20. Chawla A, Bowles B, Zini A. Vasectomy follow-up: clinical significance of rare nonmotile sperm in postoperative semen analysis. Urology 2004; 64(6): 1212–1215.
21. O’Brien TS, Cranston D, Ashwin P et al. Temporary reappearance of sperm 12 months after vasectomy clearance. Br J Urol 1995; 76(3): 371–372.
22. Benger JR, Swami SK, Gingell JC. Persistent spermatozoa after vasectomy: a survey of British urologists. Br J Urol 1995; 76(3): 376–379.
23. Pryor JP, Yates-Bell AJ, Packham DA. Scrotal gangrene after male sterilization. Br Med J 1971; 1(5743): 272.
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Paediatric urologist UrologyArticle was published in
Urological Journal
2012 Issue 2
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