VASECTOMY RESEARCH

NO NEEDLE VASECTOMY

Introduction to The Madajet

The Madajet is used in North America and Canada for No Needle Vasectomy. The device is not approved by The TGA for use in Australia.

The No Needle device is a specialised instrument that sprays rather than injects local anaesthetic through the skin.

The instrument has a specific fitting that is designed to be used only for No Scalpel Vasectomy. The fitting is a curved shape that is designed to gently sit on top of the tube before releasing the anaesthetic.

The high tech mechanical device works by spraying local anaesthetic through the skin to the underlying tube. The objective is to numb both the skin and the underlying tube. This is performed with meticulous attention to detail.

Guys report the following with the no needle anaesthesia device:

• ‘That’s different’ (laugh)
• ‘like a a flick’
• like an elastic band snap

The jury is really out as to whether the experience of a no needle anaesthesia is superior to that of invisible needle anaesthesia.

What does the research say?

Needle-free jet versus conventional needle injection for local anesthesia in men undergoing surgical sperm retrieval.

Their conclusion is that ‘for local anesthesia in patients undergoing surgical sperm retrieval, MadaJet produces less pain and discomfort with quicker time to onset and offset of anesthesia compared with conventional needle injection.’

OFFSPRING SEX RATIO AND VASECTOMY!

The Relationship Between Offspring Sex Ratio and Vasectomy Utilization was published in the Journal of Urology in 2017.

The study looked at a large health database from the USA.

30,927 men underwent Vasectomy. They reported that ‘For men with at least 2 children, each additional son increased the likelihood of vasectomy by 4%, whereas each additional daughter led to a 2% decrease in vasectomy utilization.’

In other words, fathers undergoing vasectomy have a higher proportion of sons compared with fathers who have not had a vasectomy.

COMMENT

A quirky & somewhat controversial study! Men with sons are more likely to say ‘enough is enough’ – and to get a Vasectomy – than men with daughters!

ROUTINE USE OF STRONG PAINKILLERS AFTER VASECTOMY

Routine use of opioids after vasectomy was published in The Journal of Urology in 2019.

This paper attempted to answer the question as to whether strong painkillers need to be described regularly after vasectomy. Vasectomists have in the past prescribed strong painkillers routinely after vasectomy – for example panadeine forte, Endone or tramadol.

102 patients received a prescription for strong painkillers for use after their vasectomy and 126 received no prescription. The results were:

• There was no difference between the two groups in the experience of scrotal pain following the vasectomy
• Men who received a prescription for strong painkillers were more likely to get addicted to them afterwards.

A further American study published in 2020 concludes that ‘Patients that are not prescribed opioids after vasectomy do not generate additional phone calls, clinic or
ED visits compared to those that were routinely prescribed prior to our institutional change. We have permanently discontinued the routine use of opioids for post-vasectomy analgesia. Other physicians performing vasectomy should consider making this change as well.’

COMMENTS

Prescriptions for strong painkillers are simply not required after vasectomy. There is an epidemic of people who are addicted to prescribed opiates in The US where these studies were performed. There is no place for routine prescribing of strong painkillers after a vasectomy because single script has the potential to convert a ‘patient’ into a long term addict.

USE OF CONTRACEPTION BEFORE THE ‘ALL CLEAR’

Vasectomy should not be considered a reliable form of contraception until the post-vasectomy sample confirms that the vasectomy has worked.

Use of secondary contraception following vasectomy: insights from the Pregnancy Risk Assessment Monitoring System, was an American study that investigated the use of contraception in the period between the Vasectomy and the post-vasectomy test.

1004 couples were investigated who:

• Had recently had a baby, and
• The male partner had a vasectomy after the baby was born

An astonishing 57.8% of couples reported NOT using additional contraception after the vasectomy (before the post vasectomy sample). The 43% of couples who DID use additional contraception mainly used condoms (50%).

COMMENTS

This study looked at couples who had a vasectomy after having a baby. Mothers who breastfeed and have no periods are unlikely to conceive. The couples may not have used contraception because they believed that breast feeding is a good form of contraception. Nevertheless, there is concern that over half of couples in this study did not use contraception in between the vasectomy and the post vasectomy test.

Vasectomy providers emphasise that Vasectomy is only reliable after the confirmatory post vasectomy test.

CONTRACEPTION USE IN COUPLES BEFORE UNINTENDED PREGNANCY

The goal of contraception is to effectively prevent pregnancy. However, all forms of contraception can fail, particularly condoms and the pill. Vasectomy is least likely to fail.

Which type of contraception, if any, is used before an unintended pregnancy?

326 Australian women were interviewed about unexpected pregnancy in a 2018 study.

Just 41% were using contraception at the time of the pregnancy, and of these:

• 64% were using the contraceptive pill
• 27% of couples were using condoms
• 9% were using ‘the rod’ (hormonal device that is inserted in the upper arm)

POSTAL .V. FRESH POST VASECTOMY SAMPLE

The 12-14 week Post vasectomy testing requires a ‘fresh sample’ in most countries, but also available as a postal sample in The USA and The UK.  The fresh sample requires taking the sample to the local laboratory for analysis of sperm concentration and motility (movement) within 2 hrs, whereas the postal sample simply requires dropping the sample into your local post box to test for zero sperm a few days later.

How does the postal sample perform against the gold standard fresh semen analysis?

This study analysed data from 58,800 vasectomies performed in The UK over 11 years. The postal method was used in 59% of vasectomies, and the fresh sample in 44% of vasectomies.

They found that ‘Compliance with postal (79.5%) was significantly greater than with non-postal strategy (59.1%), the difference being 20.4%.’

There was no significant difference in the rate of failure between postal and fresh samples.

COMMENTS

This research informs us that 20% more men offered the postal test, compared with men required to do a fresh sample, will do a post vasectomy test. The postal test is more than convenient – it can make the difference between doing the test and not doing the test.

It’s worth noting, however, that postal samples are more likely to require a further test than an initial fresh sample, and that a further test would require a fresh sample – somewhat offsetting the convenience of an initial postal sample. The reason is that the postal sample needs to be entirely clear of sperm, whereas a few non-motile sperm in the fresh sample allows for clearance from the one sample.

Perhaps the most interesting observation is the relatively high failure rate in this UK study where closed vasectomy is standard. Whilst the failure rates of 0.94% and 0.73% did not differ significantly between the two groups, these failure rates are high compared with < 0.3% failure rate of open-ended vasectomy. Many vasectomists practicing open ended vasectomy will achieve a failure rate of < 0.2% (1 in 500).