==VASECTOMY - SIDE EFFECTS== [Entrez medline Query] Fortschr Med 1997 Oct 30;115(30):38-41 [Contraception for the man]. [Article in German] Schramm P Androloge, Oberarzt an der Hautklinik, Johannes-Gutenberg-Klinikum, Universitat Mainz. Current possibilities of contraception that can be practiced by the male continue to be based on the barrier concept. Methods that have an action on the spermatozoa, whether toxic, immunologic or hormonal have not become established in Germany, although the latter is still being researched, and even practiced (gestagen implant), in some countries. The two barrier methods--the condom and vasectomy--both have a permanent place in contraception: the condom is by far the more popular of the two, additionally providing protection against infection and free of side effects. The invasive procedure of vasectomy is not widely practiced, although, on the basis of risk-benefit considerations, it is the method of choice vis-a-vis the pill when a couple definitively want no more children. Fertil Steril 1998 Aug;70(2):191-200 Br J Urol 1997 Feb;79(2):269-70 The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management. Ahmed I, Rasheed S, White C, Shaikh NA Airedale General Hospital, Keighley, UK. OBJECTIVE: To assess the incidence of chronic postvasectomy testicular pain (CPTP) and evaluate the use of denervation of the spermatic cord in its management. PATIENTS AND METHODS: A retrospective postal survey of 560 patients (mean age 36 years, range 25-55; mean time since vasectomy 19 months, range 8-39) who underwent vasectomy between July 1992 and December 1994 was carried out to determine the incidence of CPTP. A prospective study was conducted in a further group of 17 patients (mean age 43 years, range 34-60), who had had CPTP for at least one year, to evaluate the effectiveness of nerve stripping of the spermatic cord in relieving pain. RESULTS: Of 396 replies, 108 (27.2%) patients complained of some testicular pain following their vasectomy operation. In 88 (82%) of these 108 patients the pain was brief and was not defined as CPTP, while 20 (19%) patients had pain for > 3 months; 33 (31%) patients required analgesics to control the pain. Of the 17 patients who underwent spermatic cord denervation, 13 reported complete relief of pain at their first follow-up visit and were discharged. Four patients had a significant improvement in the symptom score and were satisfied with the results. CONCLUSIONS: There is a small but significant incidence of CPTP and patients should be warned of this possibility when counselled before operation. Denervation of the spermatic cord seems to be a viable surgical option for patients with CPTP who fail to respond to conservative measures. Ugeskr Laeger 1997 Dec 8;159(50):7500-2 [Vasectomy by the Li method]. [Article in Danish] Dorfelt A Urologisk/karkirurgisk afdeling H, Amtssygehuset i Gentofte. The vasectomies were performed by the residents of the department without prior training in this surgical procedure. Four and a half months after the operation, a questionnaire was sent to the patients, posing questions about discomfort, pain, swelling, discolouration and infection as well as pain and bleeding following ejaculation. Eighty-five percent of the patients returned the questionnaire. We found a low rate of primary surgical complications: seven cases of infection (including antibiotic treatment on the suspicion of infection; one was verified as epididymitis) and one granuloma. Sixty-four, 39 and 45% respectively complained about postoperative pain, swelling and discolouration, but only half of the patients in each of these groups indicated discomfort. We see this as an indication that the method has a low rate of complications and, that this may be further reduced if the surgeon achieves sufficient routine in the procedures. The association between vasectomy and prostate cancer: a systematic review of the literature. Bernal-Delgado E, Latour-Perez J, Pradas-Arnal F, Gomez-Lopez LI Department of Preventive and Social Medicine, Faculty of Medicine, University of Zaragoza, Spain. APT@OMC.TELPROF.ES OBJECTIVE: To evaluate the possible association between vasectomy and prostate cancer. DESIGN: Systematic review of the literature. PATIENT(S): Fourteen original studies published between January 1985 and December 1996 that addressed the association between vasectomy and prostate cancer. MAIN OUTCOME MEASURE(S): The strength of the association was estimated with the use of a meta-analysis (DerSimonian and Laird method). A sensitivity analysis was conducted to assess the impact of different sources of heterogeneity. RESULT(S): Fourteen original papers were reviewed (5 cohort and 9 case-control studies). Relative risks ranged between 0.44 (95% confidence interval [CI] = 0.1-4.0) and 6.70 (95% CI = 2.1-21.6). The overall relative risk (DerSimonian and Laird estimate) was 1.23 (95% CI = 1.01-1.49). The sensitivity analysis showed that this measure was very sensitive to the study base, the type of design used, and the possibility of bias. Further, the funnel plot demonstrated the probable existence of publication bias. CONCLUSION(S): No causal association was found between vasectomy and prostate cancer. Individuals who have undergone vasectomy are not at high risk for the development of prostate cancer. Eur J Contracept Reprod Health Care 1996 Sep;1(3):231-5 No-scalpel technique for vasectomy. Filshie M Department of Obstetrics and Gynaecology, University of Nottingham, Queen's Medical Centre, UK. This review aims to describe the development of the no-scalpel technique and to summarize the available results. An attempt is made to simplify the training of surgeons in the no-scalpel vasectomy technique. This technique uses the method described by Dr Li Shunqiang, utilizing a dedicated vas-grasping forceps; a sharp dedicated dissecting forceps, scissors and sutures are all that are required in addition. In a simple comparative study in Bangkok involving 1203 patients, it was found that the no-scalpel technique was faster. In the 19 cases of complications of symphysis and hemorrhage, 16 occurred using the standard technique (3.1 per 100 patients) and three from the no-scalpel technique (0.4 per 100 patients). The no-scalpel technique is probably more difficult to learn but requires fewer resources. The operation is nearly twice as fast as the standard technique with approximately one-eighth of its complications. Actas Urol Esp 1997 Jun;21(6):609-13 [Vasectomy and arteriosclerosis: are they related]? [Article in Spanish] Puyol M, Menendez V, Gomez J Servicio de Urologia, Hospital Sant Joan de Deu, Martorell (Barcelona). There has been a remarkable increase in recent years in the demand by the male population of vasectomy procedures as a sterilization technique. Several recent studies have questioned its safety. We have evaluated in 103 healthy males the effect of vasectomy on plasma lipoprotein concentration, blood pressure and body mass index, all acknowledged risk factors for arteriosclerosis. No statistically significant change was found either in plasma lipoprotein concentration or blood pressure. The only statistically significant (p < 0.05) change was in terms of body mass index, which experiences a mean increase of 1.22%. Our results cannot confirm that vasectomy plays a role as risk factor for arteriosclerosis. Int J Epidemiol 1997 Oct;26(5):933-8 Vasectomy and prostate cancer: a case-control study in India. Platz EA, Yeole BB, Cho E, Jussawalla DJ, Giovannucci E, Ascherio A Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA. BACKGROUND: The role of vasectomy in the development of prostate cancer remains controversial. In particular, there has been concern about detection bias and confounding in the previously published epidemiological studies examining this hypothesis. With the goal of minimizing detection bias, we have evaluated the relation between vasectomy and prostate cancer in a population without routine prostate cancer screening. METHODS: A case-control study consisting of 175 prostate cancer cases and 978 controls with cancer diagnoses other than prostate cancer was conducted at hospitals covered by the Bombay Cancer Registry in Bombay, India. History of vasectomy, demographic, and lifestyle factors were obtained by structured interview. Multiple logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Standardizing by age, 8.7% of cases and 8.3% of controls had had a vasectomy. The OR for prostate cancer comparing men who had had a vasectomy to those who did not was 1.48 (95% CI: 0.80-2.72) controlling for age at diagnosis, smoking status, alcohol drinking, and other demographic and lifestyle factors. Risk of prostate cancer associated with vasectomy appeared to be higher among men who underwent vasectomy at least two decades prior to cancer diagnosis or who were at least 40 years old at vasectomy. CONCLUSIONS: Although not statistically significant, the results of this hospital-based case-control study are consistent with the hypothesis of a positive association between vasectomy and prostate cancer. Because routine prostate cancer screening is not common in this population, detection bias was unlikely to account for this association. Br J Gen Pract 1997 Jun;47(419):381-6 Is vasectomy harmful to health? McDonald SW University of Glasgow. Since the late 1960s, vasectomy has been a popular and widely used form of contraceptive in Britain for couples who do not want to have any more children. However, throughout the past decade there has been considerable concern about the safety of this procedure. This paper reviews the current opinion on the possible health considerations associated with this operation and shows that the latest news is mostly reassuring. Prim Care 1997 Jun;24(2):433-61 Office procedures. No-scalpel vasectomy. Davis LE, Stockton MD Department of Family Medicine, University of Tennessee Graduate School of Medicine at Knoxville, Knoxville, Tennessee 37920, USA. Vasectomy is a safe, permanent, and inexpensive method of surgical sterilization for men. No-scalpel vasectomy is an innovative approach for exposing the vas deferens that is associated with fewer complications than the standard technique of vasectomy (incisional). It has been used in this country since 1986. The no-scalpel vasectomy, preoperative counseling, management of complications, and evaluation of the postvasectomy semen specimen are described. Br J Urol 1997 Apr;79(4):599-601 Does vasectomy predispose to osteoporosis? Byrne PA, Evans WD, Rajan KT East Glamorgan NHS Trust, Pontypridd, UK. OBJECTIVE: To investigate whether vasectomy, which causes immunological and histological changes to the testes and changes to the hypothalamo-pituitary axis, could influence bone mineral density (BMD) and predispose to osteoporosis. PATIENTS AND METHODS: From patients referred to the Bone Densitometry Clinic, the BMD of L1-L4 and of the hip was analysed in 25 vasectomized men and compared with that in age-matched controls, ensuring that both groups had no secondary causes which might predispose to osteoporosis. RESULTS: In the spine, the mean (standard deviation) BMD was 1.00 (0.19) g/cm2 for the vasectomized men and 0.96 (0.14) g/cm2 for the controls. In the hip (femoral neck and total, respectively) the means were 0.79 g/cm2 and 0.90 g/cm2 for the vasectomized men and 0.72 g/cm2 and 0.96 g/cm2 for the controls. None of the differences were statistically significant. CONCLUSION: This study does not support the hypothesis that vasectomy may be a risk factor for osteoporosis. Am J Epidemiol 1996 Oct 15;144(8):717-22 Vasectomy and prostate cancer: a case-control study in a health maintenance organization. Zhu K, Stanford JL, Daling JR, McKnight B, Stergachis A, Brawer MK, Weiss NS Department of Epidemiology, University of Washington, Seattle, USA. A case-control study was conducted within Group Health Cooperative of Puget Sound to evaluate the relation between prior vasectomy and the risk of prostate cancer. Cases consisted of 175 men newly diagnosed with histologically confirmed prostate cancer during 1989-1991. A total of 258 controls, matched to cases on birth year and membership status, were randomly selected from the general membership of the plan. Information was collected from mailed questionnaires and medical records on medical history, including prior vasectomy, anthropometric measures, family history of prostate cancer, personal habits, and medical care utilization, and demographic factors. Conditional logistic regression analyses showed that the odds ratio for prostate cancer associated with vasectomy was 0.86 (95% confidence interval 0.57-1.32) after adjustment for confounders. The odds ratio estimate did not differ substantially by age at vasectomy or time since vasectomy. However, the odds ratio estimate for prostate cancer associated with vasectomy tended to be increased among men who had a father or brother with prostate cancer. Nevertheless, the increased risk may be related to detection bias or differential participation rates due to both vasectomy status and a family history of prostate cancer. These results suggest no overall association between vasectomy and prostate cancer.