Recent developments in vasectomy
http://www.100md.com
《英国医生杂志》
1 Field, Information and Training Services Department, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA, 2 Clinical Research Department, Family Health International
Correspondence to: D C Sokal dsokal@fhi.org
Introduction
Family Health International, EngenderHealth, and EngenderHealth's ACQUIRE Project organised an expert consultation on vasectomy to review the literature and share new research findings on vas occlusion techniques, discuss programmatic implications, prioritise future research, and develop guidelines for using vasectomy techniques in diverse healthcare settings. More than 50 representatives from 24 universities and reproductive health research, service delivery, training, advocacy, and donor organisations attended the consultation. We focus here on the new clinical findings and evidence based "points of consensus" on the effectiveness of techniques agreed on at the meeting. These points of consensus were based on recent research results, described below; input from independent experts; and results of a formal, systematic literature review that was presented at the meeting and has since been published.2
Recent research results
Overall, the recent research suggests a hierarchy of increasing contraceptive effectiveness with the following techniques: ligation and excision alone, ligation and excision with fascial interposition, and cautery with fascial interposition. The position of cautery alone in this hierarchy is unclear. On this basis, the experts at the meeting developed points of consensus in the form of a brief document for vasectomy providers and programme managers, to inform them of the latest research and to provide practical recommendations for the use of various techniques (box).
These points of consensus are meant to provide guidance to vasectomy providers and programme managers but should not be considered a mandate for change, for several reasons. Firstly, data are still limited on the effectiveness of cautery alone compared with ligation and excision plus fascial interposition. Secondly, some vasectomy providers might be encouraged to abandon ligation and excision prematurely because of the notion that cautery is a superior technique. However, vasectomy with ligation and excision alone is still very effective compared with most other contraceptive options, and cautery may be difficult to implement and sustain in some settings. Thirdly, training is advisable before adopting any new surgical technique, as the details of a particular cautery technique are important in determining efficacy.
Future research priorities
Labrecque M. Review of other evidence (abstract). In: Expert consultation on vasectomy: an interagency workshop organized by Family Health International, EngenderHealth and the ACQUIRE Project, Washington DC, Dec 3-5, 2003. Durham, NC: Family Health International, 2004. www.fhi.org/en/RH/Pubs/booksReports/vasconrpt.htm (accessed 10 Dec 2004).
Labrecque M, Dufresne C, Barone MA, St-Hilaire K. Vasectomy surgical techniques: a systematic review. BMC Med 2004;2: 21.
Pollack A. Prevalence of occlusion techniques, vasectomy follow-up protocols and compliance with follow-up (abstract). In: Sokal DC, ed. Proceedings of an expert consultation on vasectomy effectiveness co-sponsored by Family Health International and EngenderHealth, Apr 18-19, 2001, Durham, NC. Durham, NC: Family Health International, 2001. www.fhi.org/en/RH/Pubs/booksReports/vasec_effective.htm (accessed 10 Dec 2004).
Haws JM, Morgan GT, Pollack AE, Koonin LM, Magnani RJ, Gargiullo PM. Clinical aspects of vasectomies performed in the United States in 1995. Urology 1998;52: 685-91.
Schmidt SS. Vasectomy. Urol Clin North Am 1987;14: 149-54.
Liskin L, Pile JM, Quillin WF. Vasectomy—safe and simple. Popul Rep D 1983;4: 61-100.
Trussell J, Kowal D. The essentials of contraception: efficacy, safety, and personal considerations. In: Hatcher RA, Trussel J, Stewart F, Cates W Jr, Stewart GK, Guest F, et al, eds. Contraceptive Technology. 17th ed. New York: Ardent Media, 1998: 211-47.
Barone M, Nazerali H, Cortes M, Chen-Mok M, Pollack A, Sokal D. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol 2003;170: 892-6.
Nazerali H, Thapa S, Hays M, Pathak LR, Pandey KR, Sokal DC. Vasectomy effectiveness in Nepal: a retrospective study. Contraception 2003;67: 397-401.
Wang D. Contraceptive failure in China. Contraception 2002;66: 173-8.
Sokal D, Irsula B, Hays M, Chen-Mok M, Barone MA, Investigator Study Group. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Med 2004;2: 6.
Chen-Mok M, Bangdiwala SI, Dominik R, Hays M, Irsula B, Sokal DC. Termination of a randomized controlled trial of two vasectomy techniques. Control Clin Trials 2003;24: 78-84.
EngenderHealth. No-scalpel vasectomy: an illustrated guide for surgeons. 3rd ed. New York: EngenderHealth, 2003.
Marquette CM, Koonin LM, Antarsh L, Gargiullo PM, Smith JC. Vasectomy in the United States, 1991. Am J Public Health 1995;85: 644-9.
Barone MA, Irsula B, Chen-Mok M, Sokal DC, Investigator Study Group. Effectiveness of vasectomy using cautery. BMC Urol 2004;4: 10.
Schmidt SS, Minckler TM. The vas after vasectomy: comparison of cauterization methods. Urology 1992;40: 468-70.
Seamans Y. Recent research results (abstract). In: Expert consultation on vasectomy: an interagency workshop organized by Family Health International, EngenderHealth and the ACQUIRE Project, Washington DC, Dec 3-5, 2003. Durham, NC: Family Health International, 2004. www.fhi.org/en/RH/Pubs/booksReports/vasconrpt.htm (accessed 10 Dec 2004).
Sokal D, 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 Urol 2004;4: 12.
Christiansen CG, Sandlow JI. Testicular pain following vasectomy: a review of postvasectomy pain syndrome. J Androl 2003;24: 293-8.
EngenderHealth. No-scalpel vasectomy: an illustrated guide for surgeons. 3rd ed. New York: EngenderHealth, 2003.(Kerry Wright Aradhya, senior science wri)
Correspondence to: D C Sokal dsokal@fhi.org
Introduction
Family Health International, EngenderHealth, and EngenderHealth's ACQUIRE Project organised an expert consultation on vasectomy to review the literature and share new research findings on vas occlusion techniques, discuss programmatic implications, prioritise future research, and develop guidelines for using vasectomy techniques in diverse healthcare settings. More than 50 representatives from 24 universities and reproductive health research, service delivery, training, advocacy, and donor organisations attended the consultation. We focus here on the new clinical findings and evidence based "points of consensus" on the effectiveness of techniques agreed on at the meeting. These points of consensus were based on recent research results, described below; input from independent experts; and results of a formal, systematic literature review that was presented at the meeting and has since been published.2
Recent research results
Overall, the recent research suggests a hierarchy of increasing contraceptive effectiveness with the following techniques: ligation and excision alone, ligation and excision with fascial interposition, and cautery with fascial interposition. The position of cautery alone in this hierarchy is unclear. On this basis, the experts at the meeting developed points of consensus in the form of a brief document for vasectomy providers and programme managers, to inform them of the latest research and to provide practical recommendations for the use of various techniques (box).
These points of consensus are meant to provide guidance to vasectomy providers and programme managers but should not be considered a mandate for change, for several reasons. Firstly, data are still limited on the effectiveness of cautery alone compared with ligation and excision plus fascial interposition. Secondly, some vasectomy providers might be encouraged to abandon ligation and excision prematurely because of the notion that cautery is a superior technique. However, vasectomy with ligation and excision alone is still very effective compared with most other contraceptive options, and cautery may be difficult to implement and sustain in some settings. Thirdly, training is advisable before adopting any new surgical technique, as the details of a particular cautery technique are important in determining efficacy.
Future research priorities
Labrecque M. Review of other evidence (abstract). In: Expert consultation on vasectomy: an interagency workshop organized by Family Health International, EngenderHealth and the ACQUIRE Project, Washington DC, Dec 3-5, 2003. Durham, NC: Family Health International, 2004. www.fhi.org/en/RH/Pubs/booksReports/vasconrpt.htm (accessed 10 Dec 2004).
Labrecque M, Dufresne C, Barone MA, St-Hilaire K. Vasectomy surgical techniques: a systematic review. BMC Med 2004;2: 21.
Pollack A. Prevalence of occlusion techniques, vasectomy follow-up protocols and compliance with follow-up (abstract). In: Sokal DC, ed. Proceedings of an expert consultation on vasectomy effectiveness co-sponsored by Family Health International and EngenderHealth, Apr 18-19, 2001, Durham, NC. Durham, NC: Family Health International, 2001. www.fhi.org/en/RH/Pubs/booksReports/vasec_effective.htm (accessed 10 Dec 2004).
Haws JM, Morgan GT, Pollack AE, Koonin LM, Magnani RJ, Gargiullo PM. Clinical aspects of vasectomies performed in the United States in 1995. Urology 1998;52: 685-91.
Schmidt SS. Vasectomy. Urol Clin North Am 1987;14: 149-54.
Liskin L, Pile JM, Quillin WF. Vasectomy—safe and simple. Popul Rep D 1983;4: 61-100.
Trussell J, Kowal D. The essentials of contraception: efficacy, safety, and personal considerations. In: Hatcher RA, Trussel J, Stewart F, Cates W Jr, Stewart GK, Guest F, et al, eds. Contraceptive Technology. 17th ed. New York: Ardent Media, 1998: 211-47.
Barone M, Nazerali H, Cortes M, Chen-Mok M, Pollack A, Sokal D. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol 2003;170: 892-6.
Nazerali H, Thapa S, Hays M, Pathak LR, Pandey KR, Sokal DC. Vasectomy effectiveness in Nepal: a retrospective study. Contraception 2003;67: 397-401.
Wang D. Contraceptive failure in China. Contraception 2002;66: 173-8.
Sokal D, Irsula B, Hays M, Chen-Mok M, Barone MA, Investigator Study Group. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Med 2004;2: 6.
Chen-Mok M, Bangdiwala SI, Dominik R, Hays M, Irsula B, Sokal DC. Termination of a randomized controlled trial of two vasectomy techniques. Control Clin Trials 2003;24: 78-84.
EngenderHealth. No-scalpel vasectomy: an illustrated guide for surgeons. 3rd ed. New York: EngenderHealth, 2003.
Marquette CM, Koonin LM, Antarsh L, Gargiullo PM, Smith JC. Vasectomy in the United States, 1991. Am J Public Health 1995;85: 644-9.
Barone MA, Irsula B, Chen-Mok M, Sokal DC, Investigator Study Group. Effectiveness of vasectomy using cautery. BMC Urol 2004;4: 10.
Schmidt SS, Minckler TM. The vas after vasectomy: comparison of cauterization methods. Urology 1992;40: 468-70.
Seamans Y. Recent research results (abstract). In: Expert consultation on vasectomy: an interagency workshop organized by Family Health International, EngenderHealth and the ACQUIRE Project, Washington DC, Dec 3-5, 2003. Durham, NC: Family Health International, 2004. www.fhi.org/en/RH/Pubs/booksReports/vasconrpt.htm (accessed 10 Dec 2004).
Sokal D, 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 Urol 2004;4: 12.
Christiansen CG, Sandlow JI. Testicular pain following vasectomy: a review of postvasectomy pain syndrome. J Androl 2003;24: 293-8.
EngenderHealth. No-scalpel vasectomy: an illustrated guide for surgeons. 3rd ed. New York: EngenderHealth, 2003.(Kerry Wright Aradhya, senior science wri)