VASECTOMY OCCLUSION: WHICH IS THE BEST TECHNIQUE?
The highly esteemed Cochrane group aimed to ‘compare the effectiveness, safety, acceptability and costs of vasectomy techniques for male sterilization.‘
Let’s translate the question as simply ‘which is the best way to perform vasectomy?’
The Cochrane group ‘research the research’ and conclude ‘For vas occlusion with clips or vasectomy with vas irrigation, no conclusions can be made as those studies were of low quality and underpowered. Fascial interposition reduced vasectomy failure.’
Many leading vasectomists in The US, Canada and Australia practice Fascial Interposition (FI). The research tenatively points to a lower failure rate of vasectomy after FI.
Is Open Vasectomy Truly Open?
Does the tube remain open after an open vasectomy?
Open vasectomy is considered by many vasectomy experts to be superior to closed vasectomy. Open Vasectomy involves cutting the tube & leaving the lower end alone (no cautery or closure to the lower end). The open tube allows for drainage of sperm away from the testicle which is thought to reduce the risk of back-pressure that might cause swelling or pain.
But does the tube actually stay open after an open vasectomy?
You can’t randomly biopsy men a few weeks after their vasectomy. Rats, however, have a very similar Tube (Vas Deferens) to humans.
A study was performed in rats that underwent either an open or a closed vasectomy. The tubes were examined microscopically some weeks later.
Surprisingly, 2 out of 5 rats that had an open vasectomy revealed obstruction of the tube by a ‘fibromuscular cap.’
The study concluded that ‘by 8 weeks after surgery both vasectomy procedures are equally effective in preventing further damage in the epididymis caused by elevated intraluminal pressures.’
Open vasectomy is considered to reduce back-pressure caused by sudden blockage of the tube that drains the testicle of sperm. In all likelihood, the tubes will close over several weeks.
Closed Vasectomy will immediately close the tube draining the testicle, whereas any closure after open vasectomy is expected to be gradual.
A COMPARISON OF METHODS OF PERFORMING VASECTOMY – WITH OR WITHOUT CAUTERY?
Men in the study had one of two methods of Vasectomy Occlusion:
- Cautery of the Tubes (Intraluminal Cautery), or
- Without Cautery (the tubes were cut & tied) – with or without fascial interposition.
Vasectomy with Cautery had fewer failures (1% versus 5%).
Results: Vasectomy with cautery was associated with a significantly more rapid progression to
severe oligozoospermia and with significantly fewer early failures (1% versus 5%).
This study suggests that methods of blocking the tube that do not involve Cautery may be risky. Cautery used ‘on its own’ is common in The UK. Cautery used alongside Fascial Interposition is common The US & Australia.
As always with research like this, the devil is in the detail & there may well be successful vasectomists who do not utilise cautery.
EFFECTIVENESS OF VASECTOMY USING CAUTERY
Effectiveness of vasectomy using cautery was published in 2004. This study researched the effectiveness of vasectomy following different methods of occlusion. All 4 methods of occlusion included Cautery of the lumen of the tube.
378 men were included in the study. The overall failure rate was 0.8%.
However, it was not possible to conclude which method is ‘best,’ with the investigators stating that that ‘Our study was not designed to analyze the efficacy of the various occlusion procedures used at the study sites, but rather to estimate effectiveness of occlusion techniques that include use of cautery.’
We don’t know from this study which method of occlusion is ‘best’ but simply that the overall failure rate is around 1 failure in 120 Vasectomies, and emphasizes the need for the post-vasectomy sample.