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Human Reproduction 2004 19(11):2431-2438; doi:10.1093/humrep/deh484
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Human Reproduction vol. 19 no. 11 © European Society of Human Reproduction and Embryology 2004; all rights reserved

Cochrane review

Vasectomy techniques for male sterilization: systematic Cochrane review of randomized controlled trials and controlled clinical trials

L.A. Cook1, H.A.A.M. Van Vliet2, A. Pun3 and M.F. Gallo3,4

1 Department of Public Health and General Practice, Christchurch School of Health Sciences, University of Otago, Christchurch 8002, New Zealand, 2 Department of Gynaecology and Reproductive Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands and 3 Clinical Research Department, Family Health International, Durham, NC 27713, USA

4 To whom correspondence should be addressed. Email: mgallo{at}fhi.org

BACKGROUND: The review aimed to compare the effectiveness, safety and acceptability of vasectomy techniques for male sterilization. METHODS: We searched five computerized databases and reference lists of relevant articles and book chapters for randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing vasectomy techniques. Two reviewers independently extracted data from eligible articles. RESULTS: Two poor-quality trials compared vas occlusion with clips versus a conventional technique, and four poor-quality trials examined vas irrigation with water versus no irrigation or irrigation with euflavine. No significant differences regarding the primary outcome of time to azoospermia were found. However, one trial reported fewer median number of ejaculations to azoospermia with euflavine rather than water irrigation. An interim report of a high-quality trial comparing vasectomy with and without fascial interposition found more azoospermia with fascial interposition but also more surgical difficulties. CONCLUSIONS: No conclusions can be reached regarding the effectiveness, safety and acceptability of vas occlusion techniques or vas irrigation since only low-quality, underpowered studies were available. Fascial interposition had improved vasectomy success but also increased surgical difficulty. High-quality, adequately reported RCTs are required. More work is also needed in the standardization of follow-up protocols, evaluation of vasectomy success and failure, recanalization and analytical methods.

Key words: controlled clinical trials/randomized controlled trials/review/vasectomy


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