Vasectomy
Simcock, B.W.
Medical Journal of Australia 1(5): 183-184
1979
ISSN/ISBN: 0025-729X PMID: 449769 Document Number: 144435
Dr. Selvey's assertions regarding vasectomy (Journal, January 13) should not be allowed to go unchallenged, unsupported as they are by published data or the experience of many Australian vasectomists. In Australia most vasectomies are at present being performed by doctors other than specialist surgeons so that any escalation of demand will not change the situation or provide any great problems. The use of non-absorbable sutures does not reduce the failure rate. Many ligatures (for example, nylon and Dexon) may slip off the vas after a time, often by loosening at the knot. Occlusion of the vas lumen is achieved by fibrosis and the greater the length of lumen which is so fibrosed the less the likelihood of a "blow-out" and subsequent sperm granuloma formation which is often the forerunner of recanalization. Dr. Selvey states that surgical reanastomosis of the vas is a simple procedure and that it is not necessary to suture the luminal endothelium. This is at variance with other work. Dr. Selvey seems unreasonably apprehensive regarding recanalization and his suggestion that in all cases 5 cm of each vas be removed, will make it almost impossible to rejoin the vas at a subsequent date. If he knows of any sure way to identify which man will, within five years of operation, lose a child or a wife, whether by death or divorce, and so realize the need for a restoration of his fertility then I should be very glad to hear of it. His major concern seems to be the failure rate and, excluding those pregnancies associated with repeated and confirmed azoospermia (which are hardly likely to be operative failures) the Schmidt's technique is more effective than any doubling back or different suture materials and equally as good as excising the 5 cm Dr. Selvey suggested. During more than six years of working in vasectomy clinics in Sydney I have performed almost 3000 vasectomies using a variety of methods. These have included black silk and Dexon ligatures, the use of cautery to the stump, and the introduction of fascial barrier sheath and with all these methods there were five failures in 1395 cases (0.35%). With the intravasal bipolar cautery to the lumen (Schmidt VaSeal technique) there have been no failures in 533 consecutive cases. All the failures were apparent within three months of operation at the time of the first semen analysis.