Adult urologySterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? a prospective randomized trial
Section snippets
Material and methods
The local ethics committee approved the study before we began. Between February 1998 and November 1999, 200 consecutive patients undergoing vasectomy were recruited. The control group received a “standard” vasectomy and the flush group had irrigation of the distal vas deferens incorporated into the procedure. Randomization was by drawing lots.
Although the operations were performed by a number of surgeons, the same basic technique was used. Small bilateral incisions were made, and each vas
Results
Of the 200 patients recruited for the study, 22 (11%) failed to send any, or sufficient, samples to be included, with 1 man undergoing transurethral resection of the prostate 3 months after vasectomy. An additional 15 (7.5%) had to be excluded for sending samples after a long delay. This left 163, of whom 76 had received vas deferens irrigation and 87 a standard vasectomy. No cannulation failed in the flush group, and no significant adverse effects were reported in this group. A transient
Comment
The clearance of spermatozoa after vasectomy has received a great deal of attention in published reports. Factors that affect the rate of clearance have been identified, in particular, patient age and frequency of ejaculation.5, 6 There is a great deal of variation in clearance of spermatozoa between reported series. Esho and Cass7 reported 95% azoospermia at 16 weeks, and Barnes et al.8 found that 143 (14.3%) of 1000 men had lingering sperm between 6 and 18 months after vasectomy. Our own
Conclusions
Our results, which represent the largest reported randomized controlled trial of the effect of irrigation of the distal vas deferens with sterile water, did not show any benefit over a standard vasectomy with respect to the mean time to clearance or proportion of men with lingering sperm. In the absence of any benefit from vas deferens irrigation, “special clearance” remains the only alternative recommendation in cases of persistent lingering sperm. Although local policies for the declaration
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Cited by (25)
Outpatient Vasectomy: Safe, Reliable, and Cost-effective
2021, Primary Care - Clinics in Office PracticeCitation Excerpt :Irrigation of the vas with saline or spermicidal agents does not have any documented benefit. Three randomized trials failed to show any acceleration of sperm clearance and sterility by irrigation of the prostatic end during vasectomy.4,23–25 Fascial interposition is the technique of burying 1 vasal end within the internal spermatic fascia to separate the anatomic plane between the 2 vasal ends, minimizing the risk of recanalization.6
Male Contraception
2015, Endocrinology: Adult and PediatricVasectomy
2013, Urologic Clinics of North AmericaCitation Excerpt :The authors prefer obtaining the PVSA at 12 weeks, but any time from 8 to 16 weeks after vasectomy is appropriate as per the most recent AUA guidelines.45 Some have tried irrigation of the vas deferens with saline or water to decrease time to azoospermia, but only 1 of 4 randomized studies showed a benefit with vas irrigation.69,71–73 Some physicians base the timing of the PVSA on the number of ejaculations (eg, 20 ejaculations) since vasectomy.
Intraoperative distal vasal flushingDoes it improve the rate of early azoospermia following no-scalpel vasectomy? A prospective, randomized, controlled study
2010, UrologyCitation Excerpt :Roshani et al, in a study of 126 patients, also reported significantly higher azoospermic rates of 100% at 12 weeks and 88.1% at 16 weeks in patients who underwent distal vasal flushing with 40 mL of sterile water and saline solution, respectively, when compared with patients in whom vasal flushing was not used (26.2% azoospermic at 16 weeks).5 In contrast, studies by Mason et al (200 men undergoing vasectomy with or without vasal lavage using 10 mL of sterile water) and Eisner et al (106 men undergoing vasectomy with or without vasal flush using 10 mL of normal saline) failed to demonstrate any benefit of distal vasal flushing insofar as hastening azoospermia was concerned.2,6 Although it may be argued that these 2 studies may not have been able to demonstrate a significant difference in outcomes because the quantity of fluid used to flush the vas was suboptimal in both (10 mL), a nonrandomized, controlled study of 72 patients by Pearce et al, in which 50 mL of normal saline was used for vasal flushing, also did not demonstrate any benefit in terms of hastening azoospermia.7
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2010, UrologyEditorial comment
2010, Urology