Vasectomy

输精管切除术
  • 文章类型: Journal Article
    背景:先前的报道显示了输精管结扎术对前列腺癌(PCa)的潜在因果影响。这项研究的目的是调查输精管结扎术和PCa之间的关系,同时评估前列腺特异性抗原(PSA)筛查和体重指数(BMI)等混杂因素的影响。
    方法:孟德尔随机化(MR)研究使用全基因组输精管切除术协会的汇总统计(462,933欧洲血统),曾经进行过PSA测试(200,410欧洲血统),自上次PSA测试以来的时间(46,104欧洲血统),BMI(152,893欧洲男性)和PCa(79,148例,61,106个控件,欧洲血统)。这项研究是使用来自大型的汇总统计数据进行的,先前描述的队列。数据分析于2022年11月至2023年6月进行。
    结果:输精管结扎的遗传责任与PCa无关(OR=0.07,95%CI:2.95×$\乘以$10-3,1.54,p=0.09)。输精管结扎的遗传倾向与曾经进行过PSA测试(OR=1.08,95%CI:0.49-2.39,p=0.83)和自上次PSA测试以来的时间(OR=2.49,95%CI:0.71-8.79,p=0.16)无关。在控制PSA测试和BMI后,输精管结扎术与PCa风险之间没有因果关系(OR=5.56×$乘以$10-4,95%CI:7.29×$乘以$10-8,4.24,p=0.10)。反向MR结果显示PCa和输精管切除术患者之间的相关性较弱(OR=1.00,95%CI:1.0003-1.0033,p=0.02)。
    结论:根据MR分析的现有证据,目前的研究结果不支持输精管结扎术是PCa的危险因素.需要进一步的工作来提供对潜在链接的额外确认和验证。
    BACKGROUND: Previous reports have shown a potential causal impact of vasectomy on prostate cancer (PCa). The objective of this study was to investigate the association between vasectomy and PCa, while evaluating the influence of confounding factors such as prostate-specific antigen (PSA) screening and body mass index (BMI).
    METHODS: Mendelian randomization (MR) study using summary statistics from genome-wide associations of vasectomy (462,933 European ancestry), ever had PSA test (200,410 European ancestry), time since last PSA test (46,104 European ancestry), BMI (152,893 European males) and PCa (79,148 cases, 61,106 controls, European ancestry). This study was conducted using summary statistic data from large, previously described cohorts. Data analyses were conducted from November 2022 to June 2023.
    RESULTS: Genetic liability to vasectomy was not associated with PCa (OR = 0.07, 95% CI: 2.95  × \\unicode{x000D7}  10-3 , 1.54, p = 0.09). Genetic liability to vasectomy was not associated with ever had PSA test (OR = 1.08, 95% CI: 0.49-2.39, p = 0.83) and time since last PSA test (OR = 2.49, 95% CI: 0.71-8.79, p = 0.16). After controlling for PSA test and BMI, there remains no causal relationship between vasectomy and PCa risk (OR = 5.56  × \\unicode{x000D7}  10-4 , 95% CI: 7.29  × \\unicode{x000D7}  10-8 , 4.24, p = 0.10). The reverse MR results showed a weak association between PCa and vasectomy patients (OR = 1.00, 95% CI: 1.0003-1.0033, p = 0.02).
    CONCLUSIONS: Based on the available evidence from MR analysis, the current findings did not support vasectomy being a risk factor for PCa. Further work is required to provide additional confirmation and validation of the potential link.
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  • 文章类型: Journal Article
    防止意外怀孕是全球公共卫生政策的目标之一,以尽量减少对个人的影响。家庭,和社会。各种避孕制剂具有很高的有效性和接受度,包括宫内节育器,女性的荷尔蒙补丁,男性的避孕套和输精管切除术,在过去的几十年中被开发和采用。然而,避孕技术尚未取得重大突破,虽然相关的长期不利影响是无法克服的,如内分泌系统紊乱和激素给药,侵入性结扎,并在取出宫内节育器后缓慢恢复生育能力。受到纳米材料和生物技术发展的刺激,先进的避孕药可以通过更安全,更可控和有效的方法来满足不同生殖阶段男女的各种特殊需求。纳米医学技术已经扩展到开发避孕方法,例如女性使用纳米载体的靶向药物递送和激素的控制释放,以及男性通过光热治疗或磁性热疗使用功能性纳米材料的物理刺激辅助输精管切除术。用于高级避孕药的纳米材料解决方案提供了显着改善的生物安全性,非侵入性管理,和可控的可逆性。这篇综述总结了女性和男性避孕药的纳米材料解决方案,包括工作机制,临床关注,以及他们的优点和缺点。这项工作还回顾了在避孕应用中采用的纳米材料。此外,我们进一步讨论了纳米材料在下一代避孕药的纳米策略开发中的安全性考虑因素和未来前景.我们预计在不久的将来,纳米材料可能会取代传统的避孕材料。
    Preventing unintentional pregnancy is one of the goals of a global public health policy to minimize effects on individuals, families, and society. Various contraceptive formulations with high effectiveness and acceptance, including intrauterine devices, hormonal patches for females, and condoms and vasectomy for males, have been developed and adopted over the last decades. However, distinct breakthroughs of contraceptive techniques have not yet been achieved, while the associated long-term adverse effects are insurmountable, such as endocrine system disorder along with hormone administration, invasive ligation, and slowly restored fertility after removal of intrauterine devices. Spurred by developments of nanomaterials and bionanotechnologies, advanced contraceptives could be fulfilled via nanomaterial solutions with much safer and more controllable and effective approaches to meet various and specific needs for women and men at different reproductive stages. Nanomedicine techniques have been extended to develop contraceptive methods, such as the targeted drug delivery and controlled release of hormone using nanocarriers for females and physical stimulation assisted vasectomy using functional nanomaterials via photothermal treatment or magnetic hyperthermia for males. Nanomaterial solutions for advanced contraceptives offer significantly improved biosafety, noninvasive administration, and controllable reversibility. This review summarizes the nanomaterial solutions to female and male contraceptives including the working mechanisms, clinical concerns, and their merits and demerits. This work also reviewed the nanomaterials that have been adopted in contraceptive applications. In addition, we further discuss safety considerations and future perspectives of nanomaterials in nanostrategy development for next-generation contraceptives. We expect that nanomaterials would potentially replace conventional materials for contraception in the near future.
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    文章类型: English Abstract
    目的:定量评估新机器人可视化系统的性能(蔡司,KINEVO900)在视觉成像效果方面,并评估其在显微输精管切除术逆转中的潜在应用。
    方法:我们在KINEVO900的平面和立体视觉图像与光学外科显微镜的效果之间进行了平行比较(蔡司,S7),并使用KINEVO900对大鼠模型进行显微输精管切除术逆转。
    结果:与S7相比,KINEVO900提供了更长的工作距离(200-625毫米),在200mm的相同工作距离下,有效场面积大3-4倍,前场深度深1.5-2倍。两平台间平均吻合时间和即刻通畅率差异无统计学意义(P>0.05)。
    结论:由KINEVO900输出的4K3D视频图像流并不逊色于由S7代表的光学外科显微镜,并且足以用于泌尿科和男科的显微手术。需要更多的前瞻性随机临床动物实验来进一步评估其在男科的应用价值。
    OBJECTIVE: To quantitatively assess the performance of the new robotic visualization system (Zeiss, KINEVO 900) in terms of visual imaging effect and evaluate its potential application in microscopic vasectomy reversal.
    METHODS: We made a parallel comparison between the effects of the plane and stereo visual images of KINEVO 900 and optical surgical microscopy (Zeiss, S7), and performed microscopic vasectomy reversal on the rat model using KINEVO 900.
    RESULTS: Compared with S7, KINEVO 900 provided an even longer working distance (200-625 mm), a 3-4 times larger effective field area and a 1.5-2 times deeper front depth of field with the same working distance of 200 mm. No statistically significant difference was observed in the average anastomosis time and immediate patency rate between the two platforms (P > 0.05).
    CONCLUSIONS: The 4K3D video image stream outputted by KINEVO 900 is not inferior to that of the optical surgical microscope represented by S7 and is sufficient for microsurgeries in urology and andrology. More prospective randomized clinical animal experiments are needed to further evaluate its application value in andrology.
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  • 文章类型: Multicenter Study
    迄今为止,关于输精管切除术逆转(VR)患者的人口统计学或目前影响VR有效性的因素的信息很少,特别是在2015年全面二胎政策发布之后。在这项研究中,从中国不同省市的7家主要医院提取VR患者的人口统计学数据和围手术期病历。同时,我们对患者进行了电话调查,以收集随访信息.最终,纳入了过去13年的448例VR病例。对结果进行分层对比分析,探讨影响术后输精管通畅率和妊娠率的因素。采用适当的统计方法,在这项研究中,所有方案都得到了研究所伦理委员会的批准。结果表明,实施二胎政策后,VR年手术量翻了两番。非显微外科手术和长时间的输精管切除术与较低的通畅率显着相关。随访调查显示,术后一般妊娠率为27.2%。对于35岁以上的女性伴侣,术后妊娠率下降更严重,但只有35.5%的人在丈夫接受VR手术前接受过生育检查。我们的工作表明,近年来中国越来越多的患者要求VR。高质量的显微外科手术和短时间的输精管切除术对于通过VR恢复通畅至关重要。临床男科医师应对患者的女性伴侣进行术前生育评估。
    To date, there is little information about the demography of vasectomy reversal (VR) patients or the factors currently influencing VR effectiveness in China, especially after the universal two-child policy was released in 2015. In this research, demographic data and perioperative medical records of VR patients were extracted from seven major hospitals in different provinces or municipalities of China. Meanwhile, a telephone survey of the patients was conducted to collect follow-up information. Eventually, 448 VR cases from the past 13 years were included. The results were analyzed by stratified comparison to investigate factors that can influence postoperative vas deferens patency and pregnancy rate. Appropriately statistical methods were used, and all of the protocols were approved by the Ethics Committees of the institutes in this research. The results showed that the annual operation volume of VR quadrupled after the two-child policy was implemented. Nonmicrosurgery and a long duration of vasectomy were significantly associated with a lower patency rate. A follow-up survey showed that the general postoperative pregnancy rate was 27.2%. For female partners over the age of 35 years, the postoperative pregnancy rate showed a more severe decline, but only 35.5% of them had been given a fertility examination before their husbands\' VR surgery. Our work revealed that more patients in China have been demanding VR in recent years. High-quality microsurgery and a short duration of vasectomy are crucial for restoring patency by VR. Clinical andrologists should perform a preoperative fertility evaluation of the patients\' female partners.
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  • 文章类型: Journal Article
    关于输精管结扎术和前列腺癌之间关联的争论已经持续了大约40年,并且没有停止的迹象。在本研究中,我们旨在基于现有最全面和最新的证据评估输精管结扎术是否与前列腺癌相关.
    PubMed,科克伦图书馆,和EMBASE数据库从2021年3月14日开始进行了系统搜索,没有年份或语言限制。使用多变量调整风险比(RR)来评估每个终点。使用纽卡斯尔-渥太华量表评估偏倚风险。
    共有58项研究,涉及16,989,237名参与者,符合纳入标准。输精管结扎术与任何前列腺癌的风险有显著关联(风险比,1.18,95%CI,1.07-1.31)。输精管结扎术与晚期前列腺癌之间的关联(风险比,1.06,95%CI,1.01-1.12),低级别前列腺癌(风险比,1.06,95%CI,1.02-1.10),和中度前列腺癌(风险比,1.12,95%CI,1.03-1.22)显著。输精管结扎术和前列腺癌特异性死亡率之间没有显著关联(风险比,1.01,95%CI,0.93-1.10)。
    这项研究发现,输精管结扎术与任何前列腺癌和晚期前列腺癌的风险有关。从目前的证据来看,患者在输精管结扎术前应充分了解前列腺癌的风险.
    The debate over the association between vasectomy and prostate cancer has been lasted about 40 years and there is no sign of stopping. In the present study, we aimed to evaluate whether vasectomy is associated with prostate cancer based on the most comprehensive and up-to-date evidence available.
    The PubMed, Cochrane Library, and EMBASE databases were systematically searched inception to March 14, 2021 without year or language restriction. Multivariable adjusted risk ratios (RRs) were used to assess each endpoint. Risk of bias was assessed using the Newcastle-Ottawa scale.
    A total of 58 studies involving 16,989,237 participants fulfilled inclusion criteria. There was significant association of vasectomy with risk of any prostate cancer (risk ratio, 1.18, 95% CI, 1.07-1.31). Association between vasectomy and advanced prostate cancer (risk ratio, 1.06, 95% CI, 1.01-1.12), low-grade prostate cancer (risk ratio, 1.06, 95% CI, 1.02-1.10), and intermediate-grade prostate cancer (risk ratio, 1.12, 95% CI, 1.03-1.22) were significant. There was no significant association between vasectomy and prostate cancer-specific mortality (risk ratio, 1.01, 95% CI, 0.93-1.10).
    This study found that vasectomy was associated with the risk of any prostate cancer and advanced prostate cancer. From the current evidence, patients should be fully informed of the risk of prostate cancer before vasectomy.
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  • 文章类型: Case Reports
    Arteriovenous haemangioma of the vas deferens is an extremely rare entity in clinical practice. To date, there have been no clinical or pathological cases reported in Medline, Embase or other published English literature. Herein, a 50-year-old male who presented with right scrotal pain for 4 years after vasectomy was admitted to our hospital. One painful nodule was palpable in the right scrotum on physical examination. Color Doppler ultrasound merely showed dilation of the epididymis and no additional information concerning the painful nodule in the right scrotum. Moreover, the laboratory test results were all within normal limits. Ibuprofen was administered to the patient for 2 months with a poor effect, and then spermatic cord block significantly relieved his symptoms. This patient underwent resection of the right painful nodule of the vas deferens under medical advice. Postoperative pathological examinations showed arteriovenous haemangioma of the vas deferens. There were no obvious complications after arteriovenous haemangioma excision, and the right scrotal pain was significantly relieved 1 month later. This article reminds urologists and oncologists that haemangioma can involve the vas deferens and, in addition to spermatic granuloma, might be a cause of post-vasectomy pain syndrome. Cauterization of the vas deferens might have a potential relationship with haemangioma.
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  • 文章类型: Journal Article
    BACKGROUND: Unintended pregnancy is popular all over the world, accounting for 40% to 50% of all pregnancies. The condition not only exerts pressure on the relationship of couples and severely impacts the quality of life, but also imposes a heavy burden on the health of women and child. Recently, more than 220 million couples have chosen to be sterilized to obtain contraception, 47.3% of married couples select sterilization, of which vasectomy accounts for 17.1%. Vasectomy is currently the most convenient and effective method of male contraception. We will perform the systematic review and meta-analysis to assess the correlation between vasectomy and male sex dysfunction and provide evidence-based evidence for the couple METHODS:: The electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, Clinicaltrials.org., China National Knowledge Infrastructure Database (CNKI), Wan fang Database, China Biology Medicine Database (CBM), VIP Science Technology Periodical Database, Chinese Clinical Trial Registry, and Cochrane Library will be retrieved before November 20, 2021. We will search English literature and Chinese literature with proper Medical Subject Heading or text key words. RevMan 5.3 and Stata 14.0 will be used for Systematic review and Meta-analysis. This protocol reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement, and we will report the systematic review by following the PRISMA statement.
    UNASSIGNED: The aim of this study was to evaluate the effect of vasectomy on the sexual function of patients after operation. The results will be published in a public issue journal to provide evidence-based medical evidence for urologists and andrologists to make clinical decisions.
    UNASSIGNED: INPLASY202080014.
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  • 文章类型: Journal Article
    输精管切除术是一种简单的,安全,有效,和世界范围内用于长期男性避孕的经济方法。作为一个外科手术,它有短期和长期的并发症,如血肿形成,感染,灭菌失败,精子肉芽肿,术后短期疼痛(淋巴结疼痛,阴囊疼痛,和射精疼痛),和慢性疼痛综合征。是否会增加自身免疫性疾病的风险,心血管疾病,睾丸癌,或前列腺癌仍有争议。血浆促黄体生成素浓度的变化,促卵泡激素,输精管切除术后的睾酮也被研究过,以及输精管结扎术与性功能的关系。输精管结扎后精子质量下降非常缓慢,如果一对夫妇在任何时候改变主意,血管血管造口术和卵胞浆内单精子注射可以帮助他们怀孕。在本综述结束时,我们包括了后续策略和后续护理建议。
    Vasectomy is a simple, safe, effective, and economical method used worldwide for long-term male contraception. As a surgical operation, it has short-term and long-term complications such as hematoma formation, infection, sterilization failure, sperm granulomas, short-term postoperative pain (nodal pain, scrotal pain, and ejaculation pain), and chronic pain syndrome. Whether it increases the risk of autoimmune disease, cardiovascular disease, testicular cancer, or prostate cancer is still controversial. Changes in plasma concentrations of luteinizing hormone, follicle-stimulating hormone, and testosterone after vasectomy have also been studied, as well as the relation between vasectomy and sexual function. Sperm quality decreases very slowly after vasectomy, and vasovasostomy and intracytoplasmic sperm injection could help a couple achieve a pregnancy if they change their minds at any point. We include a follow-up strategy and suggestions for follow-up care at the end of this review.
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  • 文章类型: Journal Article
    Epidemiological cohort studies investigating the association between vasectomy and prostate cancer risk have yielded inconsistent results. The aim of the present meta-analysis is to update the evidence on the association between vasectomy and prostate cancer. A comprehensively literature search of relevant studies was performed in December 2019 using PubMed. A DerSimonian and Laird random-effects model was used to calculate the summary relative risk (RR) and its 95% confidence interval (CI). A total of 15 eligible cohort studies (16 data sets) with more than four million of participants were eventually included in this meta-analysis. There was a statistically significant higher risk of prostate cancer among men who underwent vasectomy (RR: 1.09, 95% CI: 1.04-1.13) with obvious heterogeneity among included studies (P < 0.001, I2 = 64.2%). Vasectomy was also associated with the risk of advanced prostate cancer (RR: 1.07, 95% CI: 1.02-1.13), which is less likely to be affected from detection bias. In conclusion, findings from this meta-analysis of prospective studies indicate that vasectomy may be positively associated with the risk of prostate cancer. Further large prospective studies with long follow-up are warranted to verify the findings from this meta-analysis. In addition, the potential underlying molecular mechanism needed further exploration with in vitro and animal studies.
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  • 文章类型: Comparative Study
    This study aimed to evaluate a simplified vasovasostomy procedure that shortens the operative time. This was a retrospective (non-randomized) study of men who underwent bilateral vasectomy and consulted for vasovasostomy (02/2014-08/2016). Eight interrupted sutures were used for one-layer full-thickness vasal anastomosis over a 20 or 22 G catheter temporarily inserted in the lumen of the anastomotic site as a stent. Control patients underwent double-layer vasovasostomy. The surgery was significantly shorter in the one-layer group (n = 23) (62 ± 8 vs. 133 ± 15 min, P < 0.001 vs. the two-layer group, (n = 19)). There was no difference in patency between the two groups (95.7 vs. 94.7%, P > 0.999). There was one case of epididymitis in each group. There were no complications like bleeding, scrotal hematoma, hydrocele, or infection. Low-power microscopic one-layer vasovasostomy with stent was simple and had a short operation time. The patency could be similar to that of two-layer vasovasostomy, but prospective studies are necessary for confirmation.
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