Diabate Souleymane, Arellano Marco, Cloutier Jonathan, Dallaire Michel, Plourde Simon, Labrecque Michel
Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec G1V 0A6, Canada.
Research Center of the Quebec City University Hospital Center, Laval University, Quebec City, Quebec G1S 4L8, Canada.
Asian J Androl. 2025 Sep 1;27(5):592-597. doi: 10.4103/aja202517. Epub 2025 Apr 25.
We aimed to assess the occlusive effectiveness of open-ended vasectomy with mucosal cautery and fascial interposition and to determine the factors associated with occlusion failure. We studied all vasectomies performed between September 1, 2020, and August 31, 2021, by four vasectomy surgeons from Quebec City, Quebec, Canada. Sociodemographic and clinical characteristics were extracted from the electronic medical records. Occlusive effectiveness was assessed in all men with at least one postvasectomy semen analysis (PVSA). The effectiveness criteria were adapted from those of the American Urological Association (AUA) vasectomy guideline. Among the 4000 eligible vasectomies, 2242 (56.1%) were followed by at least one PVSA, with 99 (4.4%) requiring more than one PVSA. Occlusive effectiveness was achieved in 2233 vasectomies (99.6%; 95% confidence interval [CI]: 99.3%-99.8%), with 2199 (98.1%) and 34 (1.5%) classified as confirmed and probable success, respectively. The final status of the three vasectomies (0.1%) was indeterminate. Occlusive failure was observed in six vasectomies (0.3%; 95% CI: 0.1%-0.6%). The four surgeons had a similar risk of failure. The only significant factor associated with failure was the difficulty in performing the vas occlusion reported by the surgeon (7.4% [2/27] vs 0.2% [4/2212]; relative risk = 41.0; 95% CI: 7.8-214.2). The high occlusive effectiveness observed in our study validates AUA recommendations, supporting the use of this technique. Difficulty in occlusion of the vas deferens, as reported by surgeons, was the only factor associated with vasectomy failure. This finding highlights the need for PVSA in such cases.
我们旨在评估开放式输精管切除术联合黏膜烧灼和筋膜间置术的闭塞效果，并确定与闭塞失败相关的因素。我们研究了2020年9月1日至2021年8月31日期间，加拿大魁北克市的四位输精管切除术外科医生所进行的所有输精管切除术。社会人口统计学和临床特征从电子病历中提取。对所有至少进行过一次输精管切除术后精液分析（PVSA）的男性评估闭塞效果。有效性标准改编自美国泌尿外科学会（AUA）输精管切除术指南。在4000例符合条件的输精管切除术中，2242例（56.1%）至少进行了一次PVSA，其中99例（4.4%）需要进行不止一次PVSA。2233例输精管切除术实现了闭塞效果（99.6%；95%置信区间[CI]：99.3%-99.8%），其中2199例（98.1%）和34例（1.5%）分别被归类为确诊成功和可能成功。三例输精管切除术（0.1%）的最终状态不确定。六例输精管切除术（0.3%；95%CI：0.1%-0.6%）观察到闭塞失败。四位外科医生的失败风险相似。与失败相关的唯一显著因素是外科医生报告的输精管闭塞困难（7.4%[2/27]对0.2%[4/2212]；相对风险=41.0；95%CI：7.8-214.2）。我们研究中观察到的高闭塞效果验证了AUA的建议，支持该技术的使用。外科医生报告的输精管闭塞困难是与输精管切除术失败相关的唯一因素。这一发现凸显了在此类情况下进行PVSA的必要性。
