Vasectomy: AUA Guideline (2026) Part I.

Patient and OBGYN Perspectives on Considering Long-Acting Reversible Contraception for Postpartum Patients Who Desire Permanent Contraception

IntroductionIn many developing countries like Ethiopia, access and the utilization of long acting and permanent contraceptive methods (LAPCMs) is very low and it is also difficult to find them from many reproductive health programs. The aim of this study was to assess factors associated with non-utilization of long-acting and permanent contraceptive methods among married women in the reproductive age (15-49 years).MethodsA community based unmatched case-control study was conducted in Chencha district, Southern Ethiopia from November 2015 to December 2015. Cases were those women who used contraceptive methods other than LAPCMs and women who were not using contraceptive methods. Controls were women who used LAPCMs in their lifetime. Study participants were selected by simple random sampling technique and records were reviewed and then by tracing their address, the selected samples were interviewed. We analyzed data using SPSS version 20.0 and logistic regression models to identify associated factors.ResultsWe enrolled 328 women: factors such as partner’s lower level of education (p = 0.003), less number of live children (p = 0.04), preference to have children in the future (p = 0.042), husband’s approval to LAPCMs (p = 0.002), not informed to use contraception (p = 0.006), started using contraceptives during campaign (p = 0.021) and discussion with health professionals (p = 0.039) were predictors of non-utilization of LAPCMs.ConclusionNon-utilization of LAPCMs in the district is associated with knowledge about LAPCMs and quality of health service. Interventions should focus on couple’s knowledge, training of service providers in quality care, and the rights of clients, informed choice to contraceptive methods.

This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed. This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case-control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity. A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS. The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion. I.

BackgroundGlobally, unintended pregnancy has been very high accounting for 27% of maternal deaths. Different studies noted that nearly half of HIV positive women who gave unintended birth were using contraceptive methods prior to their unintended pregnancy. This implies that contraceptive failure contributes to unintended pregnancy. Long-term and permanent contraceptive methods are safe and effective contraceptive options. In women who are using long acting and permanent methods, the unintended pregnancy rate is very low and it is almost the same both in typical and perfect users. However, there is limited information on factors that affect long acting and permanent contraceptive methods utilization among Human Immuno-deficiency Virus (HIV) positive women in Ethiopia. Therefore, the purpose of this study was to assess long acting and permanent contraceptive utilization and its associated factors.MethodsAn institution-based cross-sectional study was conducted among 505 married women attending care at Anti Retroviral Therapy (ART) clinics in Bahir Dar from March 16, 2014 to April 15, 2014. The data were collected using a structured and interviewer administered questionnaire. Both bivariate and multivariate logistic regressions were used to identify associated factors.ResultsA total of 505 married women participated in the study with a response rate of 99.6%. The utilization of long acting and permanent contraceptive methods (LAPMs) was 27.5% [95% CI, 23.8–31.5]. The multivariate analyses showed that women who were getting pre- anti retroviral therapy (Pre-ART) services [Adjusted Odds Ratio = 2.65, 95% confidence interval: 1.44, 4.86], had spousal discussion on family planning sometimes [Adjusted Odds Ratio = 6.03, 95% CI:2.42–15.01] and frequently [Adjusted Odds Ratio = 6.61, 95% confidence interval: 2.49–17.47], had previous experience on long acting contraceptive methods [Adjusted Odds Ratio = 9.06, 95% confidence interval: 5.38–15.26], no exposure to myths about LAPMs [Adjusted Odds Ratio = 2.07, 95% confidence interval: 1.24–3.45], had birth intention after 2 years [Adjusted Odds Ratio = 6.95, 95% confidence interval: 3.35–14.42], and no such intention [Adjusted Odds Ratio = 7.60, 95% confidence interval: 3.77–15.34] were factors significantly associated with utilization of long acting and permanent contraceptive methods.ConclusionThe utilization of long acting and permanent contraceptive methods was relatively high. Discussion with partners on family planning, previous experiences of LAPMs, not hearing myths about LAPMs, women not started ART, and no birth intention were positively associated with LAPMs utilization. It is therefore recommended that health service providers need to make couples counseling on FP, undergo behavioral change communication (BCC) to avoid misconceptions/myths regarding LAPMs. Further research is also recommended to address the gaps mentioned in the limitation section and to explore the reason/s for not using LAPMs (qualitative study).

Background: In 1996, the U.S. Collaborative Review of Sterilization (CREST) reported permanent contraception failure rates by method, but did not include the Filshie clip. Subsequent research provides data for Filshie clip failure rates up to 24 months, but rigorously designed and executed studies examining failure rates beyond 2 years are lacking.Objectives: To describe non-Filshie and Filshie procedures, identify failures, and calculate 10-year pregnancy rates among patients who have undergone interval permanent contraception procedures with Filshie clips.Study Design: We performed chart review for patients who underwent interval permanent contraception procedures between 2000 and 2014 at our institution. We identified births after permanent contraception by utilizing both chart review and the Utah Population Database. We report results from life table analysis, with censoring at failure, 49 years of age, or last observed date of service.Results: In this cohort of 693 patients, surgeons most commonly used Filshie clips for interval permanent contraception (N = 547, 78.8%). We classified pregnancies after Filshie clip procedures as verified (n = 4) or self-reported (n = 3). We obtained 5 years of data for 411 patients (59.3% of all permanent contraception procedures), and more than 10 years of data for 257 patients (37.1%). We calculated a cumulative 5- and 10-year pregnancy rate to be the same, including both verified and self-reported pregnancies, of 9.8 (95% confidence interval [CI] 4.1–23.3)/1000 women using Filshie clips. The 10-year rate of verified pregnancy is 2.8 (95% CI 1.0–15.7)/1000 women.Conclusion: Overall, long-term failure of Filshie clip interval permanent contraception procedures is infrequent, with a 10-year cumulative probability of failure of 4.1–23.3/1000 procedures performed. Filshie clips compare favorably with other methods of permanent contraception included in the CREST study, where the 10-year cumulative probability of failure ranged from 7.5 to 36.5/1000 procedures performed.

Background: Contraceptive use including short acting, long acting and permanent methods positively influence the socio-economic development of a nation by allowing families to space and limit their family size to their economic capacity. Demand for Long acting and permanent methods (LAPM) of contraception as determined by utilization and unmet need for LAPMs provide reliable information for providers. Objective: To assess factors associated with utilization level of long acting contraceptive methods and associated factors among married women of reproductive age in Jigjiga town, Somali region, Eastern Ethiopia Feb.2016. Methods: A community based cross sectional study supplemented with qualitative inquiry was conducted among randomly selected married women of reproductive age in Jijiga town from Feb to March 2014. A structured and pretested, interview administered questionnaire was used to collect data which was entered to computer by using EpiData version 3.1 and exported to SPSS version 16.0. Bivariate and multivariate logistic regression was employed to determine independent predictors of long acting and permanent contraceptive utilization level and associated factors. Result: Three hundred eighty three women of reproductive age group participated in the quantitative survey making a response rate of 97.2%. The overall prevalence of long acting and permanent contraception was 34 [8.8%]. Educational level AOR=1.53; 95% CI [0.25-9.62] Occupation AOR=2.0; 95% CI [1.00-4.50] and support from husband AOR=0.09; 95% CI [0.01-0.57] were significantly associated with long acting and permanent contraceptive utilization. Conclusion: The overall prevalence of long acting and permanent contraceptive method was low. Knowledge of contraceptive and occupation of women have significant association with use of long acting and permanent contraceptive. Extensive health information should be provided for both husband and women.

Background: Long-acting and permanent contraceptive methods (LAPMs) are highly effective, safe, convenient, and cost effective. Many women in Ethiopia rely on short acting contraceptives. Hence, this study was conducted to assess determinants of long acting and permanent contraceptive methods utilization among married women in Hossana town, Southern Ethiopia. Methods: A community based unmatched case control study was conducted in Hossana town among married women. Census was done to know the number of cases and controls in the study area before data collection. A total of 420 respondents (140 cases and 280 controls) were selected by using simple random sampling technique. Cases were married women who were using long acting and permanent contraceptive methods whereas controls were married women who were using short acting contraceptive methods. Data entry and cleaning were done by Epi-info version 3.5.3 and exported to SPSS version 20 for analysis. Result: A total of 414 married women of reproductive age group were interviewed with response rate of 99%. Women with moderate and good level of knowledge about LAPM [AOR=13.9, 95% CI: 6.16, 31.56] and [AOR=8.74, 95% CI: 3.78, 20.2] respectively, discussion about modern contraceptives with their partners [AOR=3, 95%CI: 1.37, 7.11], plan or intention to give birth in the future [AOR=0.5, 95% CI: 0.25,0.98], source of modern contraceptives from non-governmental health facilities [AOR=7.4 95% CI: 2.62, 20.8] and women who had 3-4 children versus children[AOR = 0.42 95% CI: 0.20, 0.90] were determinant factors of LAPM utilization. Conclusion: More actions should be done in order to increase the utilization of LAPM by promoting discussion between partners about modern contraceptives, women’s knowledge about LAPM and provision of adequate LAPM in public health facilities.

Aims: Introduction: Bangladesh has impressive gains in indicators related to population and family planning. Therefore, the unmet need for family planning should be addressed with utmost importance.
 Materials and Methods: A descriptive type of cross sectional study was conducted at four villages of Saturia Upazilla of Manikganj district to find out unmet need of family planning among married women of reproductive age including the status of contraceptive use and obstacles toward using family planning methods. The duration of study was from November 2017 to March 2018. The sample size was 480 in number.
 Results: In the study, 87.5% respondents were Muslims. Regarding level of education 18.75% of the respondents was illiterate, 22.19% of the respondents completed their primary education and 31.35% passed the secondary school certificate Examination. Most of the respondents (92.92%) were housewives. Out of 480 families, 51% belongs to nuclear family. 23.13% of the respondents had income below 10,000 Tk. and about 27.50% had an income more than 20,000 Tk. Among 480 respondents, 42.06% had 2 living children and about 33.78% had a single child. 89.17% of the respondents knew about contraceptive method. OCP was the most preferred method among 57.62% respondents. 61% respondents were using contraceptive method. The reason for not using any contraceptive method were fear of side effects (28.03%), eager to conceive (13.63%), and non-co-operative attitude of the husband (7.58%). In this study 58.13% respondents had the knowledge about permanent method of contraception.
 Conclusion: Family planning is more of a health necessity than an option. Though family planning program has remarkable success over the past decade, but still there is unmet need.
 Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 23-27

Background: Population explosion has been India's major problem since independence. It is a major obstacle to the overall progress of the nation. Adoption of family planning methods is one of the best solutions to tackle this problem. The present study was planned to determine the factors for non-acceptance of different contraceptive methods among married women of reproductive age group in rural areas of Patna.Methods: Study design: a community based cross sectional study. Study population: married women of reproductive age group (15-45 years). Study period: January 2012- July 2013. Study area: field practice area of PHC Sampatchak, Patna. Sample size: 705 using formula n =4p* q/d2. Study tool: pre tested semi-structured proforma. Collected data was analysed using latest version of SPSS. Results: 705 married women of reproductive age group were surveyed and it was found that out of 705 women only 230 (32.65%) were using contraceptive methods. Amongst the users 70.87% were using permanent method of contraception and that too female sterilization. Of the temporary method users (29.13%) 2.60% were using condom, 15.21% were using OCP (oral contraceptive pills) and 11.30% were using IUCD (Intra Uterine Contraceptive Device). Choice of contraceptive method was mostly OCP (71.4%) when duration of marriage was <5 years. Greater the duration of married life more was the acceptance of Tubectomy. The main reasons for non-acceptance of contraceptives method was desire for child (31.17%) followed by fear of side effects (21.05%). Want of male child and opposition by husband accounted for 8.45% &12% respectively. Conclusions: There is tremendous need to increase use of temporary contraceptives for spacing after one or two children. Male involvement in RCH care is essential. It is important to increase their participation as husbands often influence their wife’s decision regarding reproductive health.

BackgroundEthiopia is the second most populous country in sub Saharan Africa with high total fertility rate, and high maternal and child mortality rates. In sub Saharan African countries, including Ethiopia, even though studies show that demand for contraception is high, the practice is low. Particularly, in Ethiopia, despite the fact that practices on long acting and permanent methods are believed to be low, there are limited evidences on the real magnitude of demand for the methods.MethodsTo assess demand for long acting and permanent contraceptive methods and associated factors among married women of reproductive age group in Debre Markos town, Amhara Regional State, North West Ethiopia, A community based cross sectional study was conducted, from April 08–19, 2012. Systematic sampling technique was used to select 523 study participants. Pre tested structured Amharic version questionnaire was used to collect the data through interview. Both bivariate and multiple logistic regressions were used to identify associated factors.ResultsAmong 519 respondents, 323 (62.2%) were using modern family planning (FP) methods in which 101 (19.5%) were using long acting and permanent contraceptive methods (LAPMs). Among all respondents, 171 (32.9%) had unmet need for LAPMs. The total demand for LAPMs was 272 (52.4%) of which 37.1% were satisfied and 62.9% unsatisfied demand. Being in the older age group (40-44 years) [AOR = 2.8; 95% CI:1.12, 9.55], having no desire for more child [AOR = 20.37; 95% CI:9.28, 44.72], desire to have a child after 2 years [AOR = 6.4; 95%CI:3.04,13.47], not ever heard of modern FP [AOR = 5.73; 95% CI:1.26, 25.91], not ever using of modern FP [AOR = 1.89; 95% CI:1.01, 3.55] and having no spousal discussion in the last six month [AOR = 1.642, 95% CI: 1.049, 2.57) were some of the factors significantly associated with demand for LAPMs.ConclusionsDemand and unmet need for LAPMs were high in the study area. Therefore raising awareness of the community, counseling/discussion about the methods with all clients, encouraging spousal involvement are fundamental areas of intervention. Moreover, increasing the availability and accessibility of LAPMs is required to meet the unmet needs.

Introduction Sterilization is a permanent and an effective method of contraception. However, fertility rates increased in Egypt, lately; sterilization is rarely utilized. Psychosocial factors and religious issues are considered in all societies. Objective To find out physicians' perception of vasectomy as a permanent contraceptive method and factors that might influence recommending vasectomy in Egypt. Design A cross- sectional questionnaire based study. Setting and methods The study included 181 physicians practicing, as gynecologist and family planning doctors, in Egypt. The questionnaire was designed to explore the physicians' perception of vasectomy and their attitudes to advise Egyptian men to undergo the procedure. Results 94/181 (52%) physicians positively perceived vasectomy as the best method of permanent contraception but only 45/181 (24.9%) advised the procedure. Positive perception was associated with advice of vasectomy (P = 0.001). The majority, 119/136 (87.5%) physicians, did not recommend vasectomy for: a possible post vasectomy sexual dysfunction, anticipation of non-acceptance of vasectomy by Egyptian men, religious issues and concerns regarding regaining future fertility when needed. The majority, 43/45 (95.5%) physicians recommended vasectomy when female contraception was contraindicated or when couples completed their families. Conclusion However more than half of physicians had a positive perception of vasectomy, only 24.9% advised Egyptian men to undergo the procedure. Sociocultural factors and religious issues hindered physicians to recommend vasectomy in Egypt. Vasectomy was recommended when it was absolutely needed.

ObjectiveOur aim was to describe the reliance on female permanent contraception among women with demand for family planning satisfied with modern methods (mDFPS) in low- and middle-income countries (LMICs) and to describe socio-economic and demographic patterns of permanent contraception in countries with high use. Study DesignUsing data from the latest national health survey carried out in LMICs, we estimated mDFPS and the share of each contraceptive method used. Countries with a share of more than 25% of female permanent contraception were further explored for differences by wealth, number of living children, woman's age, and by the intersection of woman's age and number of living children. ResultsIn the 20 countries studied, between 6% and 94% of the contracepting population used modern methods. Female permanent contraception accounted for more than half of women using modern contraceptives in India, Dominican Republic, El Salvador, Mexico, and Colombia. In India and Tonga, more than 20% of women using contraceptives with fewer than 2 living children were using female permanent contraception. Among women with 2 living children, countries with the highest reliance on permanent contraception were India (79%), El Salvador (61%), Cuba (55%), Colombia (52%), and Thailand (51%). Dominican Republic, El Salvador, India, and Mexico presented high levels of permanent contraception among younger women, with reliance higher than 30% among women aged 25 to 29 and 50% or more among women aged 30 to 34. ConclusionsReliance on permanent contraception was high in several countries and among women aged less than 35 years. ImplicationsOur results may help policymakers and health managers improve family planning services in low- and middle-income settings. We identified high use of female permanent contraception among modern contraceptive users in several countries, even among young women with fewer children.

Consideration of vasectomy among patients desiring postpartum permanent contraception and their obstetrician-gynecologists: A United States-based study.

Short-notice cancellations of laparoscopic permanent contraception

Background: Despite decreased fertility rate, East Kalimantan Province still facing unmet needs. Moreover, almost all contraceptive use in East Kalimantan depends on short-acting contraceptive methods. Only a few studies have ever been conducted on women's autonomy in relation to Long-Acting Permanent Contraception Methods (LAPMs) choices. It is, therefore, essential to find the associated factors affecting LAPMs uptake. This study aimed to analyze the influence of sociodemographic, knowledge, women's autonomy and fertility on LAPMs uptake at the household level. Methods: The data derived from the Indonesian Demographic and Health Survey (IDHS) 2017 of East Kalimantan Province. As much as 570 women of childbearing age (10–49 years) with marital status who still using contraception in any method was included as samples. Results: Factors correlate with the uptake of LAPMs in the bivariate analysis were age, insurance ownership, family planning knowledge and women's autonomy (p value<0.05). While in the multivariate analysis only women autonomy and insurance ownership were related to the uptake of LAPMs. Conclusion: This finding provides evidence for including women empowerment programs in the family planning program. Keywords: Family planning, women autonomy, long acting contraceptive methods