RESEARCH TRIANGLE PARK, NC — Research published by Family Health International (FHI), Laval University in Quebec City, Canada, and EngenderHealth in New York, New York, in the open-access journal BMC Urology shows that early recanalization ― the most frequent cause of vasectomy failure ― is more common than previously recognized. It also confirms that certain vasectomy techniques are associated with lower risk of recanalization, and that wider use of these techniques could reduce vasectomy failure rates.
“Vasectomy is a highly effective contraceptive method,” says Dr. David Sokal, an investigator for the study and a medical scientist at FHI, “but these findings tell us that there is room for improvement. The study gives us a better understanding of how frequently recanalization occurs, and clearly identifies a key focus for future vasectomy research: how to reduce the rate of early recanalization.”
The researchers described patterns of early recanalization (a spontaneous reconnection of the two ends of the severed vas deferens) by charting data from semen analyses beginning two weeks post-vasectomy from two of the most rigorous studies of vasectomy techniques to date. One of these studies tested the effectiveness of a technique known as fascial interposition among 826 men in seven countries, while the other examined the effectiveness of cautery among 389 men in four countries.
The researchers estimated that early recanalization occurred in 13 percent of study participants overall – a surprisingly high percent for a method commonly considered to be at least 99 percent effective – and caused more than four-fifths of vasectomy failures overall. The findings also suggest, however, that in many cases of recanalization the vas eventually closes off, resulting in a successful vasectomy.
Large differences in recanalization risk were observed for the different vasectomy techniques, as follows:
• One-fourth for men with ligation and excision alone
• One-eighth for men with ligation and excision plus fascial interposition
• Zero for men with thermal cautery and fascial interposition
These findings reinforce recent recommendations from several medical groups to avoid ligation and excision as the sole method for occluding the vas. They also support the use of cautery with fascial interposition as probably the most effective way of occluding the vas.
FHI’s Dr. Sokal cautions that further research is needed to clarify the full implications of these results for clinical practice, because what seem like small differences in surgical technique may lead to significant differences in effectiveness.
Labrecque M, Hays M, Chen-Mok M, Barone MA, Sokal D. Frequency and patterns of early recanalization after vasectomy. BMC Urol 2006;6:25. Available at: http://www.biomedcentral.com/1471-2490/6/25
Family Health International (www.fhi.org) is dedicated to improving lives, knowledge, and understanding worldwide through a highly diversified program of research, education, and services in family health and HIV/AIDS prevention, care, and treatment. Since its inception in 1971, FHI has formed partnerships with national governments and local communities in countries throughout the developing world to support lasting improvements in the health of individuals and the effectiveness of entire health systems. FHI has a staff of 1,600 and offices in 40 countries.
EngenderHealth (www.engenderhealth.org) works to improve the health and well being of people in the poorest communities of the world by sharing expertise in sexual and reproductive health and transforming the quality of health care. The not-for-profit organization promotes gender equity, advocates for sound practices and policies, and inspires people to assert their rights to better, healthier lives. Working in partnership with local organizations, EngenderHealth adapts its work in response to local needs. With more than 60 years of experience in the field of international sexual and reproductive health, projects are supported in 40 countries through 19 offices worldwide.
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