Saturday, June 16, 2012

No Scalpel Vasectomy (part 1)


Overview

Vasectomy is the most popular form of permanent surgical birth control for men. In 2002, an estimated 526,501 vasectomies were performed in the United States, which is a rate of 10.2/1,000 in men aged 25-49 years. The no-scalpel vasectomy (NSV), originally developed in China in 1974 and first introduced in the United States in 1984, is an innovative approach to exposing the vas deferens using 2 specialized surgical instruments. A recent Cochrane Review concluded that the NSV, as compared to traditional incisional technique, resulted in less bleeding, hematoma, infection, and pain, and a shorter operative time. According to one study, 37.8% of physicians, including urologists, family practitioners, and general surgeons, were using the NSV technique by 2002.
Indications
·         Vasectomy is indicated for any fully informed man who does not want to father any children (or any additional children) and who desires an inexpensive outpatient method of voluntary permanent surgical sterilization.
·         Although less popular than other forms of sterilization, such as tubal ligation for the man’s sexual partner, the procedure offers the advantages of lower expense, lower level of invasiveness (ie, does not require general anesthesia or hospitalization), and quicker recovery time. Also, future checks of fertility are possible at any time with semen analysis, unlike with women who have undergone tubal ligation.

Contraindications
·         Contraindications to no-scalpel vasectomy (NSV) include the following:
·         Anatomic abnormalities, such as the inability to palpate and mobilize both vas deferens or large hydroceles or varicoceles
·         Past trauma and scarring of the scrotum
·         Acute local scrotal skin infections
·         Extreme care and consideration must be taken with patients who are taking anticoagulants or antiplatelet medications.
·         Provision and review of both written and verbal informed consent is paramount. Men and their spouses must understand that vasectomy should be considered a permanent sterilization procedure. Belief that reanastomosis microsurgery provides a good backup plan for fathering future children should be strongly discouraged.
·         Surgical complications, failure rates, alternative methods of birth control, and possible chronic postoperative pain should also be discussed, and all questions should be answered.
·         Emotional instability or equivocal feelings about permanent sterilization are contraindications to vasectomy.
·         Compliance with postoperative follow-up and postprocedure semen analysis is of utmost importance.

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