Levine Laurence A, Abern Michael R, Lux Matthew M
Department of Urology, Rush University Medical Center, Chicago, Illinois 60612, USA.
J Urol. 2006 Nov;176(5):2146-8. doi: 10.1016/j.juro.2006.07.028.
We evaluated the efficacy and mechanism of failure in a small case series of VasClip vasectomies.
Between September 2003 and March 2004, 8 patients underwent elective vasectomy using the VasClip ligation band. Microscopic semen analysis was done a minimum of 4 weeks postoperatively and after at least 15 ejaculations. The number of sperm and motility were quantified in 15 or more high power fields. Successful vasectomy was defined as 2 consecutive postoperative unspun semen analyses containing no sperm. Patients with failed vasectomy underwent bilateral surgical removal of the vas deferens segments containing the ligation band for gross and histological analysis.
Six of 8 patients (75%) were deemed azoospermic after 2 semen analyses at a mean followup of 7 and 11 weeks postoperatively, respectively. Two of 8 patients (25%) had semen analyses containing multiple motile sperm after vasectomy. In the 2 failed cases 1 side was patent, as demonstrated by vasal cannulation and irrigation with dilute methylene blue despite a well positioned, intact and secure ligation band. Histological analysis showed extravasation and sperm granuloma on the patent side.
The VasClip was found to fail at an unexpectedly high rate. Pathological analysis suggests sperm extravasation and fistula tract formation as the mechanism. One failure resulted in an unwanted pregnancy, which demonstrates the need for patient counseling regarding postoperative followup.
我们在一个小型病例系列中评估了VasClip输精管切除术的疗效及失败机制。
2003年9月至2004年3月期间，8例患者接受了使用VasClip结扎带的择期输精管切除术。术后至少4周且至少射精15次后进行显微镜下精液分析。在15个或更多高倍视野中对精子数量和活力进行定量。成功的输精管切除术定义为术后连续2次未离心精液分析均未发现精子。输精管切除术失败的患者接受双侧手术切除包含结扎带的输精管段，进行大体和组织学分析。
8例患者中有6例（75%）在术后分别平均随访7周和11周时进行2次精液分析后被判定为无精子症。8例患者中有2例（25%）在输精管切除术后的精液分析中含有多个活动精子。在2例失败病例中，尽管结扎带位置良好、完整且牢固，但经输精管插管并用稀释美蓝冲洗显示1侧输精管通畅。组织学分析显示通畅侧有精子外渗和精子肉芽肿形成。
发现VasClip失败率出乎意料地高。病理分析提示精子外渗和瘘管形成是其机制。1例失败导致意外妊娠，这表明需要对患者进行关于术后随访的咨询。
