Use of Cautery Improves Vasectomy Outcomes -- October 27, 2004

Research Triangle Park, NC — Vasectomy results can be improved by the use of cautery, according to an analysis published today in the journal BioMed Central Urology. Vasectomy procedures that included cautery significantly reduced vasectomy failure rates compared to procedures that involved ligation and excision with fascial interposition.

The analysis compared post-vasectomy sperm count data from two previously published studies of vasectomy technique efficacy that were conducted by researchers at Family Health International (FHI), based in Research Triangle Park, NC, and EngenderHealth, based in New York, NY. Men in both studies had sperm concentration analyses two weeks after vasectomy and then about monthly for some 22 additional weeks.

In the comparative analysis, use of cautery was associated with a significantly quicker drop to a low sperm count (less than 100,000 sperm per milliliter of semen) after vasectomy.  It was also associated with significantly fewer early vasectomy failures. Failures were defined as a sperm count of more than 10 million sperm per milliliter at three months post-vasectomy or later. Early vasectomy failures were 1 percent (4/389) for vasectomy involving cautery, compared with 5 percent (20/410) for vasectomy involving ligation and excision with fascial interposition. 

This analysis was based on sperm counts rather than pregnancy outcomes because pregnancy after vasectomy is rare and difficult to study. For various reasons, pregnancy rates are likely to be lower than the early failures rates found in this analysis.
 
"Vasectomy is a well-established, highly effective contraceptive method," says Dr. David Sokal, lead author of the comparative analysis and an associate medical director at FHI. "But this research indicates that physicians now practicing simple ligation and excision alone or with fascial interposition might improve their vasectomy results by adopting the use of cautery."

Hand-held, thermal cautery devices powered by two AA-alkaline batteries are available and affordable in the developed world, and appear to be feasible for use by surgeons in low-resource settings, Dr. Sokal adds.

In the United States, about 70 percent of physicians use cautery as part of the vasectomy procedure. "Worldwide, however, ligation and excision — with or without fascial interposition — is the most common method of vasectomy," says Dr. Mark Barone, co-author of the comparative analysis and a senior medical manager at EngenderHealth.

During simple ligation and excision vasectomy, a short piece of the vas deferens (each of two tubes that carry sperm from the testicles to the penis) is cut and removed, and the remaining two ends are tied. Fascial interposition involves pulling the sheath covering the vas deferens over one severed end, then sewing it shut to create a natural tissue barrier.

"Adding fascial interposition appears to help prevent a phenomenon known as recanalization, in which sperm can temporarily or permanently find a way through the healing vasectomy site, causing sperm to persist in the semen," says Dr. Sokal. "Results from the previously published study of fascial interposition that provided data for this comparative analysis suggest that most vasectomy failures after fascial interposition were due to early recanalizations within the first two to three months after vasectomy."

If cautery is used, fascial interposition might still be recommended. A number of reports suggest that combining the two techniques is an ideal method of vasectomy.  Furthermore, even if providers in low-resource settings adopt a cautery technique, cautery instruments may occasionally become unavailable there.  In such cases, providers would want to be able to perform fascial interposition as part of the ligation and excision procedure.
 
More information about vasectomy is available here and at  http://www.engenderhealth.org/wh/fp/cvas2.html.

Published Sources:

Sokal DC, Irsula B, Chen-Mok M, Labrecque M, Barone MA. A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition. BMC Urology 2004;4:12. Full text available online.

Sokal DC, Irsula B, Hays M, et al. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Medicine 2004;2:6. Full text available online.

Barone MA, Irsula B, Chen-Mok, et al. Effectiveness of vasectomy using cautery. BMC Urology 2004;4:10. Full text available online.

Family Health International is dedicated to improving lives, knowledge, and understanding worldwide through a highly diversified program of research, education, and services in family health and HIV/AIDS prevention and care. Since its inception in 1971, FHI has formed partnerships with national governments and local communities in countries throughout the developing world to support lasting improvements in the health of individuals and the effectiveness of entire health systems.
Founded in 1943, EngenderHealth is a nonprofit organization that has been working internationally for more than 30 years to support and strengthen reproductive health services for women and men worldwide. Since its inception, its work has improved the health and lives of more than 100 million individuals in 90 countries.