Elsevier

Urology

Volume 59, Issue 3, March 2002, Pages 424-427
Urology

Adult urology
Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? a prospective randomized trial

https://doi.org/10.1016/S0090-4295(01)01566-7Get rights and content

Abstract

Objectives. To assess the effect of irrigation of the distal vas deferens with sterile water at the time of vasectomy on sperm clearance. Is it possible to accelerate clearance and avoid the problem of lingering sperm?

Methods. Two hundred men undergoing vasectomy were randomized to receive either a standard vasectomy or vasectomy plus irrigation of each vas deferens with sterile water. The interval between vasectomy and the production of two azoospermic semen samples was recorded.

Results. Overall, 37 patients were excluded for failing to follow the postvasectomy protocol for semen analysis, leaving 87 in the control group and 76 who received vasal irrigation. No statistically significant differences existed between the two groups with regard to the mean time to clearance (26.4 weeks, control group versus 28.6 weeks, flush group), proportion clear at 16 weeks (29% versus 21%), or proportion with lingering sperm at 40 weeks (22% versus 26%).

Conclusions. Irrigation of the vas deferens with sterile water does not accelerate the clearance of spermatozoa after vasectomy. Men wishing to undergo vasectomy must be counseled about the possibility of lingering sperm.

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

References (18)

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    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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