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      Prospective comparison of ligation and bipolar cautery technique in non-scalpel vasectomy

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          ABSTRACT

          Objectives:

          There is no trial comparing bipolar cautery and ligation for occlusion of vas in non-scalpel vasectomy. This study aimed to compare the effectiveness of these vasectomy occlusion techniques.

          Materials and Methods:

          Between January 2002-June 2009, patients were allocated in alternate order. We recruited 100 cases in cautery group and 100 cases in ligation group. Non-scalpel approach was performed during vasectomy and fascial interposition was performed in all cases. First semen analysis was done 3 months after vasectomy. Vasectomy success was defined as azoospermia or non-motile sperm lower than 100.000/mL.

          Results:

          Four patients from the cautery group were switched to the ligation group due to technical problem of cautery device. Thus, data of 96 patients as cautery group and 104 patients as ligation group were evaluated. After vasectomy, semen analyses were obtained from 59 of 96 (61.5%) patients in cautery group and to 66 of 104 (63.5%) patients in ligation group. There was no statistical significant difference between the two groups in terms of the success of vasectomy (p=0.863).

          Conclusion:

          Although bipolar cautery technique is safe, effective and feasible in non-scalpel vasectomy, it has no superiority to ligation. There was no statistically significant difference in terms of the success and complications between the two groups.

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          Most cited references19

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          Vasectomy: AUA guideline.

          The purpose of this guideline is to provide guidance to clinicians who offer vasectomy services.
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            The no-scalpel vasectomy.

            A refined method of delivering the vas deferens for vasectomy has been developed and used in China since 1974. This method eliminates the scalpel, results in fewer hematomas and infections, and leaves a smaller wound than conventional techniques. An extracutaneous fixation ring clamp encircles and firmly secures the vas without penetrating the skin. A sharp curved hemostat punctures and dilates the scrotal skin and vas sheath. The vas is delivered, cleaned and occluded by the surgeon's preferred technique. The contralateral vas is delivered through the same opening. The puncture wound contracts to about 2 mm., is not visible to the man and requires no sutures for closure. The reported incidence of hematoma in 179,741 men followed in China was 0.09%. No hematomas or infections were identified in the first 273 procedures performed by a surgeon in the United States. The operating time in China and for the last 50 United States procedures has ranged from 5 to 11 minutes. The disadvantage of the technique is the hand-on training and number of cases necessary to gain proficiency. However, the advantages for surgeons and patients should enhance the popularity of vasectomy.
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              Vasectomy surgical techniques: a systematic review

              Background A wide variety of surgical techniques are used to perform vasectomy. The purpose of this systematic review was to assess if any surgical techniques to isolate or occlude the vas are associated with better outcomes in terms of occlusive and contraceptive effectiveness, and complications. Methods We searched MEDLINE (1966-June 2003), EMBASE (1980-June 2003), reference lists of retrieved articles, urology textbooks, and our own files looking for studies comparing two or more vasectomy surgical techniques and reporting on effectiveness and complications. From 2,058 titles or abstracts, two independent reviewers identified 224 as potentially relevant. Full reports of 219 articles were retrieved and final selection was made by the same two independent reviewers using the same criteria as for the initial selection. Discrepancies were resolved by involving a third reviewer. Data were extracted and methodological quality of selected studies was assessed by two independent reviewers. Studies were divided in broad categories (isolation, occlusion, and combined isolation and occlusion techniques) and sub-categories of specific surgical techniques performed. Qualitative analyses and syntheses were done. Results Of 31 comparative studies (37 articles), only four were randomized clinical trials, most studies were observational and retrospective. Overall methodological quality was low. From nine studies on vas isolation, there is good evidence that the no-scalpel vasectomy approach decreases the risk of surgical complications, namely hematoma/bleeding and infection, compared with incisional techniques. Five comparative studies including one high quality randomized clinical trial provided good evidence that fascial interposition (FI) increases the occlusive effectiveness of ligation and excision. Results of 11 comparative studies suggest that FI with cautery of the vas lumen provides the highest level of occlusive effectiveness, even when leaving the testicular end open. Otherwise, firm evidence to support any occlusion technique in terms of increased effectiveness or decreased risk of complications is lacking. Conclusions Current evidence supports no-scalpel vasectomy as the safest surgical approach to isolate the vas when performing vasectomy. Adding FI increases effectiveness beyond ligation and excision alone. Occlusive effectiveness appears to be further improved by combining FI with cautery. Methodologically sound prospective controlled studies should be conducted to evaluate specific occlusion techniques further.
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                Author and article information

                Journal
                Int Braz J Urol
                Int Braz J Urol
                ibju
                International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Sociedade Brasileira de Urologia
                1677-5538
                1677-6119
                Nov-Dec 2015
                Nov-Dec 2015
                : 41
                : 6
                : 1172-1177
                Affiliations
                [1 ]Department of Urology, Süleyman Demirel University, Faculty of Medicine, Isparta, Turkey
                [2 ]Department of Urology, Şifa University, Faculty of Medicine, Izmir, Turkey
                [3 ]Department of Urology, Gazi Hospital, Izmir, Turkey
                [4 ]Department of Urology, M.H. Tepecik Research and Education Hospital, Izmir, Turkey
                Author notes
                Correspondence address: Muammer Altok, MD, Department of Urology, Assistant Professor of Urology, Suleyman Demirel University, Faculty of Medicine, 32260, Isparta, Turkey, Fax: + 90 246 211-2830, E-mail: muammeraltok@ 123456sdu.edu.tr

                CONFLICT OF INTEREST

                None declared.

                Article
                S1677-5538.IBJU.2014.0356
                10.1590/S1677-5538.IBJU.2014.0356
                4756945
                26742977
                8ef45629-54d2-4c2b-a8df-ee64a2c56510

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 July 2014
                : 27 January 2014
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 16, Pages: 6
                Categories
                Original Article

                cautery,ligation,vasectomy
                cautery, ligation, vasectomy

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