Vasectomy, vas ligation and vas occlusion.
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Adult↗
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Prophylaxis of postoperative epididymitis. Vasectomy or vas ligation?
Preoperative vasectomy for the prevention of postoperative epididymitis in 103 cases is compared to preoperative vas ligation in 132 cases performed by the same surgical team. Both methods showed good results. However, vas ligation is easier to perform and seems to have less complications. The vas ligation procedure is discussed.
Aged↗
Intrapelvic vas ligation at the time of prostatectomy.
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Humans↗
The physiologic consequences of vas ligation.
Although the number of studies involving vasectomized men has been limited there appears to be no significant long-term effects. Endocrine function continues virtually unaltered. With a small number of exceptions spermatogenesis in man, as judged by a return of normal seminiferous tubule morphology, remains unchanged. However, the quality of the sperm may vary. The immunologic consequences of vasectomy have not been investigated fully. Although it is attractive to postulate that cross-reactive antibodies may develop to sperm antigens no autoimmune diseases in man secondary to vasectomy have been demonstrated. The increased incidence of atherosclerosias not been established in man. Presently, vasectomy remains a simple and safe means of permanent contraception.
Animals↗
The influence of the testis on the fertilizing life of spermatozoa in the ligated vas deferens of the golden hamster.
Spermatozoa in the vas deferens of the hamster lose their fertilizing capacity 3 days after ligation of the initial part of the duct and after 2 days if the testes are removed at the time of ligation. Sham-ligation had no effect on the fertilizing life of vasal spermatozoa on the contralateral side even 3 days after bilateral castration. Unilateral castration for 3 days had no effect on the fertilizing capacity of spermatozoa from the ipsilateral unobstructed duct, whereas no eggs were fertilized by spermatozoa from the contralateral ligated duct associated with the remaining testis. Unlike testosterone, 5alpha-dihydrotestosterone injected daily or implanted subcutaneously in Silastic tubes maintained normal fertilizing capacity for 2 days in castrates and for 3 days in intact males. Within each group, ligation had no effect on the level of fructose in the seminal vesicle on that side compared with the level in the gland on the other side.
Androgens↗
Humoral sperm antibodies: a 10-year follow-up of vas-ligated men.
Fourteen men were studied over a period of 10 years before and after bilateral was ligation. Seven men (50%) continued to have demonstrable circulating sperm-agglutinating antibodies, and one man had persistent sperm-immobilizing antibodies at a low titer of 1:2. None of the 10 ejaculates submitted contained spermatozoa or antibody activity, although two of the seminal plasma specimens immediately immobilized donor spermatozoa upon contact. There were no adverse medical reactions or conditions noted in these men during the course of the study.
Antibodies↗
Bilateral vas ligation: sperm antibodies.
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Agglutination Tests↗
The effects of ligation of vas deferens, corpus epididymidis and vasa efferentia on the testicular function in rats.
The effects of ligation of the vas deferens, the corpus epididymidis and the vasa efferentia on the testicular function were studied in sexually mature rats. The significant decrease in the testicular weight was observed after ligation of the corpus epididymidis and the vasa efferentia. However, neither the weight of the ventral prostate and of the seminal vesicle, nor the plasma testosterone level showed significant changes. The results suggest that the ligation at the three locations would not affect the endocrine function of the testis. The changes in the testis would mainly affect the spermatogenesis. The effects of sperm stasis on the testicular function were also discussed.
Animals↗
When and why does occlusion of the vas deferens affect the testis?
The motility of spermatozoa from successive segments of human and animal epididymides was examined under the phase-contrast microscope. The segments were taken from laboratory rodents unilaterally vas ligated for three to five months and from human orchiectomy specimens. Evidence for testicular alteration, caused by epididymal stasis proven by the phase-contrast motility profile, was sought by weight, gross observation, and histologic examination. Two observations were made on the animals: (1) the ligature about the vas seldom resulted in epididymal stasis because the ligature cut through the muscular wall of the vas (permitting a leak);and, (2) when stasis was achieved, gross and microscopic alterations of the testis from the normal were inevitable. The observations of the human material showed that a progressive loss of sperm motility during passage through the epididymis occurred in more than one half the specimens. The motility profile of these epididymides closely resembled that seen in the unilaterally vas-ligated animals. The suggestion is made that senescence of a testicle may be caused by occlusion of its excurrent ducts. These observations seemed to support the hypothesis that faulty sperm transport and faulty maturation, becuase of epididymal rupture and fibrosis (rather than the presence of autoantibodies to sperm) probably cause the unreliability of vasovasostomy. Storage of frozen semen offers more certainty than the possibility of successful vasovasostomy.
Animals↗
Microsurgical vasovasostomy for reversal of elective bilateral segmental vasectomy.
Microsurgical vasovasostomy for the reversal of elective bilateral segmental vasectomy (vasectomy, vas ligation) was done in 57 patients (61 operations) between May 1977 and March 1984. The length of time between elective segmental vasectomy and subsequent vasovasostomy ranged from 12 to 216 months; the longest period between vasectomy and vasovasostomy resulting in a subsequent pregnancy was 108 months. The patency rate was 83%, with 51% of these patients fathering one or more children (overall pregnancy rate of 41%). Unlike previous studies, ours showed no positive correlation between the presence of postvasectomy sperm granulomas and either patency or pregnancy rate after microsurgical vasovasostomy. The major factor that seemed to affect the success of the procedure was the number of years between vas ligation and vasovasostomy.
Adult↗
Vasography - Clinical and experimental investigations.
In order to examine the effect of contrast mediums of different concentration and composition upon the vas, experiments in 90 rats were done. In comparison to three control groups of 10 animals each (surgery only, vas ligation only, saline injection) six contrast mediums caused a varying degree of damage to the vas deferens. The latter included irritation of the epithelium, inflammation, cellular infiltration, fibrosis of the wall, septum-formation and fenestration within the vas and actual obliteration. According to these experiments only hydrophilic contrast mediums of low concentration should be used in humans for vasography.
Animals↗
Recanalization rate following methods of vasectomy using interposition of fascial sheath of vas deferens.
A small but definite recanalization rate has followed the vas ligation method of partial vasectomy for sterilization. Interposition of the fascial sheath between the divided ends of the vas reduced the recanalization rate to 0. Fulguration of the lumen of the cut vas ends was used but was not the significant factor in this zero recanalization rate.
Adult↗
Radiographic study of fluid transport in the rabbit vas deferens during sexual rest and after sexual activity.
The movement of radio-opaque medium in the vas deferens of rabbits during sexual rest, after sexual stimulation, and after ejaculation, was followed. Bilateral injections of 20 microliter Ethiodol were given at the vas-epididymal junction in the urethral direction. Serial radiographs revealed proximal transport of the dye (towards the testis) within 24 h and total containment in the cauda epididymidis within 1-4 days. Subsequently, small amounts of dye moved from the epididymis through the vas and out of the urethra during sexual rest until no dye remained (11 days-8 weeks). Animals with a ligated vas deferens showed no decrease in dye density. Sexual stimulation moved the dye from the epididymis into the vas. The dye was then either rapidly transported proximally during subsequent rest or removed distally if ejaculation followed stimulation. Ejaculation removed some vasal and epididymal dye via the urethra; however, dye left in the vas after ejaculation was rapidly (< 30 min) transported to the proximal duct and then into the epididymis by 24 h. It is concluded that vasal contents are transported in both urethral and testicular directions during sexual rest and that, after stimulation and ejaculation, the rate of proximal transport is increased. This may be indicative of a sperm removal mechanism by the vas deferens which involves the maintenance of an optimal sperm number in the cauda epididymidis at all times.
Animals↗
Micropuncture and microanalytic studies of the effect of vasectomy on the rat testis and epididymis.
Micropuncture techniques adapted for in vivo use in the male reproductive tract were used to study the effect of vasectomy on the concentration and morphology of spermatozoa in the seminiferous tubules and ductus epididymidis of the rat. Regardless of surgical technique, 85% of all rats which had previously under vasectomy developed a speratic granuloma at the proximal end of the ligated vas deferens. Vasectomy did not affect the weights of the ipsilateral (vasectomized) testes. Vasectomy without granuloma formation resulted in an elevation in the weight of the ipsilateral epididymis and an increase in the concentration of spermatozoa in the ipsilateral cauda. Vasectomy complicated by granuloma formation caused a significant increase in the ratio of the spermatocrit in the seminiferous tubule to that in the caput. In the vasectomized rat without granuloma, significantly more abnormal spermatozoa were in the caput than in the cauda; in the normal rat, the concentrations of abnormal spermatozoa in the two regions were not significantly different. Vasectomies with and without granuloma formation are distinct phenomena and should be investigated separately.
Animals↗
Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia.
The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.
Canada↗
Fate of alpha-1,4-glucosidases and cathepsin D in the rat epididymis after vasectomy.
Short-term vasectomy was studied in adult male rats in order to ascertain whether cytosolic or lysosomal hydrolases were differently affected 100 days after vas ligation. The secretory form of alpha-1,4-glucosidase remained unchanged while the lysosomal form of the enzyme and also cathepsin D increased in the cytosol of both caput and cauda epididymis. This set of data demonstrates for the first time that a triggering mechanism which stimulates lysosomal activity is present all along the rat epididymis. Disposal of the continuous influx of spermatozoa from the testis could therefore require both an active and a passive process.
Animals↗
Male sterilization in El Salvador: A preliminary report.
The expectation that male sterilization would not be an acceptable method of fertility control to the Latin American male has not been upheld in the initial phases of male sterilization programs in Colombia, Costa Rica, Guatemala, and El Salvador. On the contrary, in all of these programs and also at the Asociación Demográfica Salvadoreña, a free-standing, non-profit family planning clinic in San Salvador, the initial success has been impressive, with 180 men accepting sterilization during the first two years (February, 1972 to February, 1974). All sterilizations were performed by excising a 10-15 mm segment of each vas and ligating each vas end. Procedures were performed on an outpatient basis using a local anesthetic. Follow-up examinations were conducted at one week and three months after the procedure. Although complications were reported by 24.0% of the subjects at the one-week follow-up, the complications were minor: most were scrotal infections not requiring antibiotic therapy. Rates of complications were low for subjects returning for a three-month examination and semen test. Only one subject had a positive semen test.
Adult↗