Table 27. Characteristics of studies combining isolation and occlusion of the vas

Authors and Year of Publication / Type of Study / Subject’s Eligibility Criteria / Sample Size / Setting / Study Period / Interventions / Type and Number of Surgeons
Isolation Method / Occlusion
Method

Percutaneous ligation or section (PL) vs incision and ligation (IL)

Sekhon
1970 [29] / Cases series with concurrent controls / 70 vasectomies performed between February 1969 to January 1970
Excluded: 28 cases that could not be contacted / PL1: 10
PL2: 10
PL3: 2
IL: 10 / Unspecified,
India / February 1969 to January 1970 / PL: use of a device (‘vasectome’) to insert a metal wire in the scrotum
Il: 1-2 cm
(one midline opening?) / PL: vas divided by a diathermy snare wire in 1, 2 or 3 places 5mm apart
IL: Ligation + Standard division / PL: One surgeon
IL: Unspecified number of different surgeons
Agarwal et al.
1986 [49] / Prospective cohort study / Included: volunteers
Excluded: unspecified / PL: 56
IL: 18 / Unspecified / Unspecified / PL: no isolation
IL: Standard / PL: Percutaneous ligation with suture material (12=non absorbable 44=absorbable)
IL: Ligation + Excision? (not clearly specified) / Unspecified
Percutaneous cautery (PC) vs intraluminal cautery (IC)
Black et al.
1989 [3] / Non-randomized parallel group trial / Volunteers requesting a vasectomy in 1985 at the Marie Stopes clinic / PC: 51
IC: 50 / Office,
United Kingdom / March to November 1985 / One midline opening (1 cm in both group) / PC: Percutaneous peri vas electro-cautery
IC: Intraluminal electro-cautery on both ends + Vas uncut / One surgeon for each technique

PL: Percutaneous ligation or section, PL1: Percutaneous section one cut, PL2: Percutaneous section two cuts, PL3: Percutaneous section three cuts, IL: incision and ligation, PC: Percutaneous cautery, IC: Intraluminal cautery.

Table 28. Outcome measures of studies combining isolation and occlusion of the vas

Authors and Year of Publication / Effectiveness / Complications
Data Collection / Length of Follow-up / Post-vasectomy Semen Analysis (SA) / Data Collection / Length of Follow-up / Method of Follow-up / Main Outcome Measures
Timing of SA / Definition of Failure

Percutaneous ligation(PL) vs incision and ligation (SL)

Sekhon
1970 [29] / PL: prospective
IL: retrospective / PL: 6 to 10 months
IL: 6 to 12 months / PL: 3 and 6 months. Repeat at 10 months if presence of sperm
SL: between 6 to 12 months / Presence of sperm at 10 months. No number, nor motility specified / PL: Prospective
IL: Retrospective / PL: 6 months
IL: 6 months to one year / Phone or exam
PL: 1 week, 3 and 6 months
IL: once 6-12 months / Pain, swelling, infection
Agarwal et al.
1986 [49] / Prospective / 3 months / Sperm count at 2,4,6,8, and 12 week post vasectomy / No number, motility, nor time specified / Prospective / 7 days / Phone at 2,5, and days / Hematoma, infection, sinus formation
Percutaneous cautery (PC) vs intraluminal cautery (IC)
Black et al.
1989 [3] / Prospective / 12 weeks / 10 and 12 weeks sent to the lab by mail / Motile or numerous (number?) dead sperm in two consecutive SA / Prospective / 24 weeks / Phone at 2, 12 and 24 weeks / Early complications: serous discharge, incision infection, hematoma, fever wound slow to heal, pain
Late complications: scrotal problem, granuloma, wound infection, wound discharge, adhesions, pain)

PL: Percutaneous ligation or section, IL: incision and ligation, PC: Percutaneous cautery, IC: Intraluminal cautery, SA: semen analysis.

Table 29. Quality assessment of studies combining isolation and occlusion of the vas

Authors and Year of Publication / Study Design* / Sample Size / Comparability / Effectiveness Assessment / Complication Assessment / Global Assessment
Total / Power* / Participants / Study Period / Setting / Provider / Follow-up / Sample Size / Compliance/ Follow-up rate / Adequate Comparability* / Explicit Criteria / Blinded / Systematically Performed in All Men / At the Same Time / Adequate Assessment* / Follow-up Rate* / Explicit Criteria / Blinded / Systematically Performed in All Men / At the Same Time / Adequate Assessment* / Follow-up Rate*
PL vs IL / Sekhon
1970 [29] / 3 / 32 / 0.07 / ? / Yes / ? / No / No / Yes / ? / No / No / ? / Yes / No / No / 60% / No / No / Yes / No / No / 60% / Very Low
Agarwal et al.
1986 [49] / 2 / 74 / 0.10 / ? / ? / ? / ? / Yes / No / Yes / No / Yes / ? / Yes / Yes / Yes / 100% / No / ? / Yes / Yes / No / 100% / Low
PC vs IC / Black et al.
1989 [3] / 2 / 101 / 0.14 / Yes / Yes / Yes / No / Yes / Yes / Yes / Yes / Yes / ? / Yes / Yes / Yes / 100% / No / ? / Yes / Yes / No / PC: 96%
IC: 96% / Moderate

*criteria used for global assessment (see Table 1, Additional file 1).

PL: Percutaneous ligation or section, IL: incision and ligation, PC: Percutaneous cautery, IC: Intraluminal cautery.

Table 30. Results of studies combining isolation and occlusion of the vas

Authors and Year of publication / Effectiveness / Complications
Based on SA / Based on Pregnancy / Comments / Hematoma /

Infections

/ Pain / Granuloma / Epididymitis / Others / Total / Comments

Percutaneous ligation(PL) vs incision and ligation (SL)

Sekhon
1970 [29] / PL1: 4 (40%)
PL2: 0 (0%)
PL3: 0 (0%)
IL: 0 (0%) / Higher failure risk with PL1 than other groups. Very small sample size / PL1: 0 (0%)
PL2: 0 (0%)
PL3: 0 (0%)
IL: 1 (10%) / PL1: 1 (10%)
PL2: 2 (20%)
PL3: 2(100%)
IL: 2 (20%) / Swelling
PL1: 2 (20%)
PL2: 2 (20%)
PL3: 2(100%)
IL: 3 (30%) / Similar risk of complications in all groups except PL3 but only 2 cases. Very small sample size
Agarwal et al.
1986 [49] / PL: 17.8%
IL: 0 / Unspecified / High failure risk with percutaneous ligation but very small sample size. / PL: 0%
IL: 0% / PL: 1.8%
IL: 11.2% / Sinus formation
PL: 0%
IL: 11.2% / Lower risk of infection with percutaneous ligation than with incision and ligation. Very small sample size
Percutaneous cautery (PC) vs intraluminal cautery (IC)
Black et al.
1989 [3] / PC: 4 (7.8%)
IC: 1 (2%) / Unspecified / Higher failure risk with percutaneous cautery than with intraluminal cautery / PC: 9 (18.4%)
IC: 5 (10.4%) / PC: 6 (12.2%)
IC: 3 (6.3%) / Early
PC: 39 (79.6%)
IC: 40 (83.3%
Late
PC: 2 (4.0%)
IC: 3 (6.0%) / PC: 1 (2%)
IC: 0 (0%) / Early
PC: 32 (65.3%)
IC: 11 (23%)
P<0.05
Late
PC: 3 (6.0%)
IC: 2 (4.0%) / Higher risk of complications with percutaneous cautery. Small sample size

SA: semen analysis, PL: Percutaneous ligation or section, PL1: Percutaneous section one cut, PL2: Percutaneous section two cuts, PL3: Percutaneous section three cuts, IL: incision and ligation, PC: Percutaneous cautery, IC: Intraluminal cautery.