Are evidence-based vasectomy surgical techniques performed in low-resource countries?

Background: Research evidence published 10 to 15 years ago has shown that the type of vasectomy surgical technique performed can influence the effectiveness and the safety of the procedure. The objective of this study was to determine if evidence-based vasectomy surgical techniques are integrated in the vasectomy programs of selected low-resource countries. Methods: The surgical techniques recommended to perform the two steps of the vasectomy procedure (isolation/exposition and occlusion of the vas deferens) were extracted from current evidence-based clinical practice guidelines. Documents describing male sterilisation standards and practice from Kenya, Rwanda, India, Nepal, Mexico, Honduras, Colombia and Haiti were reviewed to assess adequacy with international guideline recommendations. Results: Best recommended techniques are 1) a minimally invasive technique including the no-scalpel technique (known as the no-scalpel vasectomy (NSV)) to isolate and expose the vas deferens, and 2) cautery of the mucosa of the vas preferably combined with interposition of the fascia (FI) to occlude the vas deferens. The NSV is largely adopted and performed to isolate the vas in selected low-resources countries. Ligation and excision (LE) of a small segment of the vas deferens combined with FI is the most common vas occlusion technique mentioned in the country standards. Cautery as recommended in the guidelines is seldom used in selected countries. Conclusions: Effective and adapted vasectomy vas occlusion techniques are available, but are still underused in many low-resource countries. Providing the most effective vasectomy surgical techniques increases users' confidence and satisfaction regarding male sterilization and may lead to higher acceptability and uptake.

Background: No scalpel vasectomy (NSV) is a novel modern innovation technique wherein vas deferens is delivered, ligated, and excised without use of a scalpel. It is a permanent sterilization option for male with low complication rate and greater patient compliance and low morbidity. Aims and Objectives: The objective of this study was to analyze the effectiveness, safety, complications, and acceptability of NSV. Materials and Methods: A total of 140 vasectomies were performed using NSV technique in Government Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu, India. during December 2020–November 2022 (24 months). Results: A study of operative time, effectiveness, and complications of the procedure were analyzed. The mean age of patients was 34 with 2 Nos of children on an average. The average operative time was 10 min with a range of 8–30 min. No cases required for conversion into standard incisional vasectomy. Complication of NSV included bleeding – in 3 cases (2%), hematoma – in 2 cases (1.4%), wound infections – in 3 cases (2%), and scrotal pain – in 4 cases (2.8%) which were managed conservatively. There was no failure of NSV reported during follow-up of these cases. Conclusion: NSV is an effective, safe, cost-effective, and permanent male contraceptive procedure, with very minimal manageable complications. India is fighting population explosion and does need this technique to be popularized among the people.

Introduction Patients who desire concomitant sterilization and treatment for medically refractory erectile dysfunction may benefit from a combined surgical approach involving vasectomy and inflatable penile prosthesis (IPP) placement. Traditional surgical methods often require separate incisions for each procedure, which increases overall patient recovery time and introduces potential complications associated with multiple incisions. This video details a minimally invasive no-scalpel vasectomy technique performed concurrently with 3-piece IPP placement through a single incision. Objective We demonstrate a surgical method that combines the no-scalpel vasectomy and 3-piece IPP placement through a single midline infrapubic incision. This approach aims to reduce the number of incision points, minimize surgical trauma, and optimize the recovery process for patients who undergo both procedures. Methods A 50 year-old male patient with a history of medically refractory erectile dysfunction and penile vascular disease requested sterilization and IPP implantation. Preoperative preparations included a detailed discussion of risks and benefits, home oral antibiotics, and a Hibiclens shower. The patient was placed under IV sedation and prepped in a sterile fashion. A Foley catheter was not needed as the patient voided his bladder to completion prior to the procedure. Local anesthesia was first administered via a pudendal nerve block through Alcock’s canal with 5 cc’s of mixed ropivacaine and lidocaine solution on either side. This was followed by a neurovascular bundle block and incisional block, followed by a fan block at the site of reservoir placement. A small midline infrapubic incision was made superior to the penopubic junction, only wide enough to accommodate the IPP pump. The spermatic cord and vas deferens were identified and delivered through the incision using a ring vasal clamp. The vas deferens on either side was transected and the ligated ends were secured in different fascial planes. Following the completion of the vasectomy, implantation of the IPP was performed through the same midline incision. Results The patient tolerated the procedure well with minimal blood loss. Postoperative pain was managed effectively, and the patient was able to ambulate without issues. The patient was discharged the following day and experienced no complications at the two week follow up visit. A post-vasectomy semen analysis performed at eight weeks confirmed complete sterility with non-motile sperm count under 100,000 per mL, meeting the American Urological Association guidelines. Conclusions The combined no-scalpel vasectomy and 3-piece IPP placement using a single midline infrapubic incision is a viable and effective approach for patients desiring both sterilization and treatment for erectile dysfunction. This method minimizes the number of surgical incisions required, reduces cumulative recovery time, and offers a convenient and streamlined surgical approach for these consecutive procedures, to the benefit of both patients and urologists. Disclosure No.

A systematic Medline/PubMed and Cochrane Library review of the literature was carried out with regard to technique, effectiveness, safety and complications of male sterilisation. Vasectomy is an outpatient procedure which can be performed under local anaesthesia. The vas deferens is accessed by means of either a conventional incision with a scalpel or by using the ‘no-scalpel technique’. A closed-ended vasectomy (by means of suture ligature, surgical clips or electrocautery) or the open-ended alternative is then carried out. Each of these techniques has both advantages and drawbacks. Fascial interposition has been shown to reduce the risk of failure. A promising alternative for occluding the vas consists of placing an intra-vas device. Haematoma and pain are the most common complications. Non-steroidal anti-inflammatory drugs, narcotic analgesics and neuroleptic drugs are effective for treatment of pain. The success of vasectomy reversal ranges from 30–60%. The data on record convincingly demonstrate that vasectomy is a safe and cost-effective intervention for permanent male contraception. The no-scalpel vasectomy under local anaesthesia is recommended. Occlusion of the vas is most successful when performed by means of an electrocautery; fascial interposition should complete the procedure.

Current status of Kampo (Japanese herbal) medicines in Japanese clinical practice guidelines

HOW LITTLE IS ENOUGH? THE EVIDENCE FOR POST-VASECTOMY TESTING

Objective Perform a systematic critical appraisal of current clinical practice guidelines (CPGs) for frozen shoulder. Literature Survey Systematic review of CPGs (PROSPERO number CRD42022368775). Inclusion criteria- CPGs written in English providing guidance on the evaluation and or treatment for frozen shoulder, traumatic injury and neurologic CPGs were excluded.Relevant studies were assessed for inclusion and selected studies were identified from PubMed, EMBASE, Scopus and CINAHL databases. The search strategy was developed by a biomedical librarian, performed on October 9, 2024. Methodology Data were extracted from the selected CPGs and underwent quality assessment using the Appraisal of Guidelines for Research and Evaluation (AGREE) II. Synthesis The search resulted in 38,428 studies and 2 CPGs were retained for appraisal. The mean overall AGREE II score was 75% (SD = 5.7). Lowest mean scores were found in the applicability (27% SD = 24.0) and editorial independence (48% SD = 14.1) domains. The highest domain scores were found in scope and purpose (92% SD = 7.8) and clarity and presentation (79% SD = 9.9). One CPG was rated as low quality based on a priori criteria and ultimately one higher quality CPG was recommended. Conclusion Given the advances in research that have developed over the last decade pertaining to the evaluation and treatment of frozen shoulder there is a critical need for an up to date, evidence informed, high quality CPG in order to identify gaps in our knowledge that the global research community should address.

The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.

COMPARATIVE EVALUATION OF NO-SCALPEL VASECTOMY AND STANDARD INCISIONAL VASECTOMY

Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy

The prospective study was carried out to evaluate the success rates of combining a check tug and fascial interposition while performing a no-scalpel vasectomy.A total of 2150 male acceptors visiting...

Background Diabetes is a major global health challenge, impacting millions and disproportionately affecting low- and middle-income countries (LMICs), where approximately three-quarters of affected individuals reside. Despite abundant guidance on diabetes management, most evidence is derived from high-resource settings, potentially impeding effective application in low-resource settings. This study explored issues related to the application of the current clinical practice guidelines (CPG) for diabetes management in Ecuador, from the perspective of local health professionals. Methods We developed 5 focus groups in Quito, the capital of Ecuador, in a low-income district. The groups included doctors, nurses, and health promoters; they discussed four sections of the CPG concerning their daily practice. Qualitative results are contrasted with quantitative research based on patient records. Results The Ecuadorian health system considers patients with diabetes a priority group, yet a patient may wait up to 4 months to receive their first appointments and once they receive their diagnosis several criteria set out in the CPG are not followed due to lack of time and resources, particularly the delivery of multidisciplinary attention. Access to specialized consultations, such as an ophthalmological assessment is severely restricted, and it can take up to a year to get an appointment. Clinicians expressed difficulties in adapting the nonpharmacological recommendations to different socioeconomic backgrounds, while at times, prescription choices are determined by medicine stock regardless of the patient’s actual needs. Conclusions Healthcare professionals have developed a series of ad-hoc strategies to ensure healthcare for their patients, pointing out the difficulties of applying CPG within a health system that lacks basic resources. Healthcare is intertwined with social inequalities among the Ecuadorian population that have worsened since the covid19 pandemic. Key messages • We identified significant challenges in applying the CPG in low resource settings. Clinicians adapt by introducing novel ways to overcome limitations at times to the detriment of the patient’s health. • CPGs need to be tailored to the context considering socioeconomic realities of the population and limited resources in the health setting.

Physicians are not adherent to clinical practice guidelines for acute otitis media

Prepubertal vasal injury: its effect on postpubertal: vas deferens

Current state of imaging for lung cancer staging