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Outside the People's Republic of China transcutaneous methods of male sterilization are not widely used, even though there are advantages of these methods over surgical vasectomy procedures. Methods of transcutaneous sterilization (intratesticular, intraepididymal, and intravasal) that have been evaluated in men are reviewed.

Vasectomy was performed in 90 men in Department of Surgery II of the University Central Hospital of Helsinki during the period January 1st, 1972 to December 31st, 1973. Operation was performed on an ambulatory basis under local anesthesia. After resection and ligation of vas deferens the cut ends were placed in different fascial planes in order to avoid recanalisation. The patients were mainly in the age group 31-40 years. Seven patients had postoperative complications, scrotal hematoma being the most common. Recanalisation was found in one patient, in whom a new operation was performed. The author stresses the importance of a correct vasectomy method, histological verification of the divided vasa and most of all the postoperative sperm analysis. Two negative sperm analyses with an interval of at least 1 month must be recorded before sterility can be confirmed.

Phenyl mercuric nitrate as an injection, in a dilution of 0-02% and buffered to pH 7, is a potent spermicidal agent which has been demonstrated to have no harmful side effects. It produces rapid death of all spermatozoa on contact. The injection of 2-5 ml of the solution into the lumen of each vas at the time of vasectomy is a simple procedure and adds no significant time and no complications to the operation. Studies have shown that no viable spermatozoa were present at seminal counts carried out one or two weeks after operation.

In two sexually mature boars subjected to bilateral vasectomy the content of testosterone was followed in the semen and blood plasma prior to the operation and in the course of 26 days after the operation. In the third boar only the operation without actual vasectomy as the control was made to eliminate the possible effect of narcosis and of the surgical stress. Bilateral vasectomy induced an average decrease in the initial levels of testosterone in the semen plasma of the first and second animal by 63.24% and 47.67% respectively, and 47.17% and 56.46% respectively in the blood plasma. In the control boar no analogous post-operation drop of testosterone concentration in the semen plasma was observed, the content of testosterone in the blood plasma decreased over the followed period on an average only by 14.38%. The results imply that bilateral vasectomy in boars results, in the first followed month after the surgical procedure, in a decrease of semen and plasma testosterone, which proves that the operation under investigation affects testicular incretion.

In a randomized, double-blind investigation 36 men undergoing sterilization had irrigation of the vas deferens with either sterile water or the spermicide, euflavine, to reduce the lag to sterility. Semen samples were vital stained by the patients shortly after ejaculation and the smears were mailed to the laboratory. Irrigation with the spermicide was significantly more effective than sterile water. However, even in the group irrigated with euflavine 6 to 35 days elapsed before the semen samples were without potentially fertile spermatozoa.

The moral justification for substitutive sterilization presupposes a critical verification of the sterilization wishes and an exact explanation to both partners. With the acquisition of the proper consent, the explanation of the absolute necessity of the postoperative spermiogram check-up cannot be neglected. Comparison of the spermiograms of unalterably vasectomized men with findings from additional rinsings with physiological saline solution and nitrofurantoin showed that the instillation of the vas deferens leads to a swift, mechanically dependent, emptying of the distal sperm depot. Through instillation of the spermicidal substance nitrofurantoin and the resulting spermatozoa immobilization, this effect can be considerably increased.

An analysis was made of the 26 unsuccessful operations from the 2,197 vasectomies performed in a non-profit medical facility. Hhe operations were performed by 6 physicians and significant differences were found in the failure rates. In all instances the tissue removed proved to be vas deferens when examined histologically. Two factors seem to account for the differences of failure rates amoung the physicians; 1) the lenght of vas excised and 2) the character of thechnique. Phsicians with a high rate of success removed a significantly longer section of vas than physicians exhibiting higher failure rates. At least 15 mm. of vas should be excised to maximize the success of the procedure. Excised vas segments less than 15 mm. had up to a 25-fold greater incidence of failure. Although considered of secondary importance, good surgical technique subjectively measured by the minimal amount of accessory tissue attached to the excised vasa was also considered to aid in reducing the number of vasectomy failures.

Fifty-one patients with obstructive azoospermia caused by blockage at the caput epididymidis have been followed for 4 years after undergoing "specific tubule" vasoepididymostomy, bypassing the corpus and cauda. The patency rate was 73%, and the pregnancy rate was 31%. There was no correlation between sperm count and pregnancy rate, but there was a strong correlation with sperm motility. With less than 20% motility, only 15% of the patients became pregnant, but with greater than 20% motility postoperatively, 58% became pregnant. If the wife was over 30 years old, only 21% got pregnant. If the wife was under 30, 67% got pregnant. "Redo" cases were just as likely to succeed as "first-time" attempts. In the "patent" cases, 43% of patients with spermatozoa that never reached or traversed the corpus or cauda epididymidis produced a pregnancy. Spermatozoa from the proximal caput produced a 33% pregnancy rate, whereas spermatozoa from the distal caput produced a 50% pregnancy rate. One-half of the pregnancies occurred more than 2 years postoperatively.

As the ideal contraceptive has not been found after a quarter century of global contraception research, this is an attempt to assess the advantages and drawbacks of the so-called "safe" methods of contraception currently in use. The most persuasive arguments in favour of oral contraceptives which other reversible methods cannot claim are their unsurpassed safety as well as the simplicity of their application. The disadvantage of potential damages through the perennial intake of hormones can be minimized with the low dosages of modern compounds. Recommendations are made concerning the controlled use of the various kinds of ovulation-inhibitors. Likewise, the use of ovulation-inhibitors with adolescents, at the end of reproductive age, and with women afflicted with diabetes mellitus are discussed. Advantages and drawbacks of contraception through the exclusive use of progestagen are briefly stated. Despite good applicability in single cases, intrauterine contraception should rather be viewed as a second choice only. Yet the standard problems, such as menstrual disturbances, increased tendency toward inflammations and individual incompatibility remain unsolved. Moreover, the rate of failure of 3% is ten times as high as with the ovulation-inhibitors. In their instructions some producers recommend too short a period of placement of the device in the uterus. Most IUD's can stay in place for a longer period of time. Repeated references to the possible complications of the use of IUD's with nulliparous women are made. As an emergency method to prevent a pregnancy after intercourse without contraceptives a hormonal method as well as the post-coital insertion of an IUD are discussed. After completed family planning the definitive sterilization presents itself as the ideal method of contraception, either through tubal sterilization in case of the woman, or vasectomy in case of the man. Rates of complications, failure rates, and chances of reversibility of both methods are specified.

In summary, a vasectomy is a safe, simple, and effective method of male contraception without any known long-term health hazards. Because of its simplicity, it is performed in more than 500,000 patients per year, mainly in a physician's office, making it a very cost-effective contraceptive method. With the introduction of the microscope into the operating suite of the urologist, this procedure that was once considered permanent is amenable to reversal at a later date.

A material is presented of 66 males who were treated with Rivanol injection during vasectomy in order to obtain immediate sterility. The fertility control was established using vital eosin staining on seminal fluid at home. One case of recanalization occurred. All patients had infertile spermatozoa or aspermia 10 days after surgery. Increased frequency of complications was not observed. Vital staining with eosin is found to be practical and easily used.

Whether antisperm antibodies develop after vasectomy probably depends on several variables, 1 of which may be the surgical technique. The levels of serum antisperm antibodies were compared in men vasectomized by 1 techniques: vasoligation and fulguration. No difference in the incidence of spermagglutinating antibody was found in the 2 groups. However, immobilizing antibodies were observed in 43 per cent of the men undergoing vasoligation but in only 29 per cent of the men vasectomized by fulguration.

One-hundred-and-one men requesting vasectomy in 1985 for the purpose of limiting family size were admitted to a study of standard incision and monopolar diathermy, and a new percutaneous electrocoagulation vasectomy procedure. Semen specimens were tested at 10 and 12 weeks after surgery. Men were telephoned at 2, 12 and 24 weeks post-surgery to elicit complications and complaints. Half of the men having the standard incision procedure and about one-third of the men undergoing the percutaneous procedure complained of discomfort during the surgery. At the two-week telephone contact, 23% of those having the standard incision and 66% of those having the percutaneous procedure reported complications. There were few complications or complaints reported at the long-term follow-up contacts with either method; although twice as many men in the percutaneous group were not declared sterile by the end of the study period. Failure rates were 2.0% for the standard incision procedure and 7.8% for the percutaneous approach.

Thirteen hundred bilateral, partial vasectomies have been performed for sterilization, without a failure. The procedure utilizes (1) a small, single incision; (2) no sutures; (3) cautery of each vas deferens lumen with a hand-held, battery-operated, disposable, hot-wire cautery; and (4) sealing of the proximal vas deferens in its sheath with a single tantalum clip. No spermatic granulomas were noted using this technique.

According to new trends and terms in microsurgery, the intra-serous proximal hemideferentectomy is compared to the classical vasectomy in rat. The effects of these surgical models are evaluated on morphological and functional bases. The anatomo-pathological parameters considered (stenosis and leakage of the anastomosis of the epididymal tubule conseguent on local ischemia) have been correlated with functional parameters "in vitro" (spontaneous motility and field stimulation) in order to plan the best microsurgical procedure in the experimental tubulo-vasostomy.

Vasectomy and vaso-occlusion techniques were used in 47 male rhesus monkeys to maximize and minimize the amount of sperm allowed to escape from the vas into surrounding tissues for up to seventy-two weeks postoperatively. Body weight changes and blood clinical data indicated that the general health of all the monkeys remained good. Normal seasonal changes in body weights and testicular volumes suggested that there were no disturbances to the endocrine system and that the monkeys remained responsive to seasonal environmental stimuli. Vasectomy appears to cause no short-term deleterious effects in the rhesus monkeys, based on observations made during the seventy-two weeks that these monkeys were study after vasectomy. This conclusion agrees with the findings of other investigators.

Vasectomy has become a popular method of family planning in recent years in Australia. The relatively simple procedure is effective, has few complications and usually does not require hospitalisation.

The results of 355 questionnaires are reported, returned one or more years after vasectomy from 1,000 consecutive patients undergoing vasectomies performed by the author from 1959 to 1972. A majority claimed either unchanged or improved health, satisfaction with sexual relations, and frequency of sexual intercourse; 99.5 per cent were satisfied with the operation and in retrospect 96.7 per cent would have the operation again.

A limited free vasectomy service providing for the needs of a rural area, with the counselling and operation conducted by a specially trained general practitioner is reported. The development of vasectomy as a contraceptive measure and some practical aspects of technique are reviewed and some characteristics of 100 patients operated on are recorded.

Different types of rigid, reversible, vas deferens occlusive devices were developed and evaluated in 14 unilaterally vasectomized dogs. All prosthetic devices had molded silicone rubber bodies, and rigid inflow and outflow tubes. Various techniques for the removal of the vas luminal epithelium, and for the preparation of porous ceramic and etched stainless steel surfaces to encourage tissue ingrowth into the prosthetic device end tubues were attempted. The devices differed in their methods of achieving occlusion. One device used a "rotary stem valve" which had a C-section rotating mechanism; the others used the "shuttle stem valve" which possessed an occlusive element that moved transverse to the axis of flow in the device, thus occluding the device when the stem was depressed. The rotarystem valve was implanted by means of a longitudinal incision. The remaining 13 shuttle stem devices were placed in the vas using either a longitudinal or a transverse implantation. Inno case was sperm transport through the prosthetic devices obtained for more than a few ejaculations.