Chapter 49
Long-Term Risks of Vasectomy
Amy E. Pollack and Mark A. Barone
Main Menu   Table Of Contents

Search

Amy E. Pollack, MD, MPH
President, AVSC International, New York, New York (Vol 6, Chaps 47, 48, 49)

Mark A. Barone, DVM, MS
AVSC International, New York, New York (Vol 6, Chaps 47, 48, 49)

INTRODUCTION
EFFECTS ON SEXUALITY AND SEXUAL FUNCTION
ENDOCRINE/HORMONAL EFFECTS
CHANGES IN TESTES
EFFECTS ON THE EPIDIDYMIS
EFFECTS ON PROSTATIC FUNCTION
HUMAN IMMUNODEFICIENCY VIRUS AND VASECTOMY
COMPREHENSIVE STUDIES OF DISEASE INCIDENCE
COMPREHENSIVE STUDIES OF DISEASE PREVALENCE
EFFECTS ON CARDIOVASCULAR SYSTEM
VARIOUS PHYSIOLOGIC EFFECTS
IMMUNOLOGIC EFFECTS
PROSTATE CANCER
TESTICULAR CANCER
UROLITHIASIS
POSTVASECTOMY PAIN SYNDROME
OVERALL MORTALITY RATES
CONCLUSIONS
REFERENCES

INTRODUCTION

Because vasectomies are usually performed on men who are in their thirties and forties at the time of the procedure, several decades of life remain after vasectomy during which long-term effects on health might manifest themselves. Because large numbers of men are exposed to such a risk for a long period of time, an adverse effect of vasectomy on health would have far-reaching negative consequences for public as well as individual health.

Concern about the possibility of long-term risks of vasectomy was fueled by findings that vasectomy may accelerate development of atherosclerosis in monkeys,1,2 but it originated in observations that a high proportion of men with vasectomy develop anti-sperm antibodies.3,4,5,6,7,8,9 Results of studies conducted over the past few decades provide little evidence of any significant long-term side effects of vasectomy. Nonetheless, the topic remains of considerable interest.

Back to Top
EFFECTS ON SEXUALITY AND SEXUAL FUNCTION

After vasectomy, male sexual and reproductive physiology remains unaffected, aside from the desired change in fertility. The nerves involved in erectile function and ejaculation are not affected, and vasectomy does not lead to impotence or other sexual difficulties. In a large cohort study,10,11 incidence of impotence was 1.9/1000 man-years (MY) of observation in men with vasectomy and 1.7/1000 MY in men without vasectomy, a difference that was not statistically significant.

As with female sterilization, vasectomy has sometimes been reported to have a positive effect on sexuality, possibly because the chance of unintended pregnancy has been reduced.12,13,14 In one large study, the number of men reporting loss of sexual interest was identical in vasectomized versus nonvasectomized men.15

Production of seminal fluid, the major component of semen, by the accessory sex glands is unaffected by vasectomy. Thus, the client will not notice any reduction in the amount of semen ejaculated after vasectomy has been performed. Sperm production continues, even though the sperm's passage through the reproductive tract has been blocked, and sperm are broken down by macrophages in the lumen of the epididymal tubule.3,16 Sometimes the blockage in the reproductive tract after vasectomy causes pressure to build up in the epididymis, which causes the tubules to distend and, in time, rupture. Ruptures are usually asymptomatic and not problematic. Sperm granulomas that can form at the site of the rupture do not usually require treatment. Although some vasectomists believe that this buildup can be avoided by leaving open the testicular end of the vas, the effect of this “open-ended” technique on failure rates has not been adequately studied.

Back to Top
ENDOCRINE/HORMONAL EFFECTS

Although some early prospective endocrine studies suggested that mean plasma levels of testosterone, luteinizing hormone (LH), and estradiol increased after vasectomy when compared with mean hormone levels measured before vasectomy, the changes were found to be inside the normal range for adults.17 Studies in animals suggesting an effect of vasectomy on testicular weight and Leydig cell morphology, which were never confirmed,18,19,20 generated sufficient concern that a large number of studies regarding endocrine function in man have been done. The results of these studies are summarized in Table 1.

In nearly all longitudinal studies and all of the cross-sectional studies (with the exception of that of Mo and colleagues, who reported significantly higher testosterone levels in men >20 years postvasectomy compared with age-matched controls), no significant association of vasectomy with changes in the concentrations of testosterone, LH, or follicle-stimulating hormone (FSH) was found. Thus, despite isolated findings of a significant association of vasectomy with changes in some hormones, the bulk of the extensive research on the subject provides strong evidence that vasectomy has no effect on testosterone or the pituitary gonadotropins at least up to 25 years after the operation.

Back to Top
CHANGES IN TESTES

Although the testes maintain some of the normal ultrastructure following vasectomy,44 several studies have demonstrated that some histologic changes occur in the testes following vasectomy.20,45,46,47,48,49,50,51

Electron microscopic examination of sections of the seminiferous tubules from the testes of vasectomized men showed that some of the normal ultrastructure was maintained:

  The blood supply to the tubules was intact.
  The lumen of each tubule examined was patent.
  The Sertoli cells appeared to be intact.
  The germinal epithelium was present and showed normal stages of spermatogenesis.
  The spermatids were seen in the usual clusters of four to five.44

Histologic abnormalities noted, however, include sperm abutting the basal portion of the Sertoli cells, instead of being observed in their typical location close to the lumen,44 increased thickness of the seminiferous tubular walls,20,49,51 reduced mean number of Sertoli cells and spermatids per tubular cross-section,49 and increased focal interstitial fibrosis.20,49,51

How these changes occur and their significance remain unclear. Some men with these changes have been able to produce offspring following vasectomy reversal.47,49,50 In the one study in which fertility was examined in relation to histologic changes, interstitial fibrosis was significantly correlated with infertility in patients who had a successful vasectomy reversal determined by sperm in the ejaculate. None of the other vasectomy-associated histologic abnormalities were associated with infertility after vasectomy reversal.49

Back to Top
EFFECTS ON THE EPIDIDYMIS

Although numerous studies have examined the effects of vasectomy on the epididymis in various laboratory animals, similar studies in men are lacking.52 Epididymitis, because of continued passage of sperm from the testis into the epididymis following vasectomy, is uncommon, being reported in up to 6% of men who have had a vasectomy.53 This condition has been referred to as “congestive” epididymitis and is only rarely due to infection.

Some degree of epididymal dilatation or distension has been reported in 70% to 100% of the men undergoing vasectomy reversal, but most men do not have any symptoms.54,55,56 Ultrasound studies have found that epididymal enlargement is common and may not be associated with any pain or discomfort.57,58 The mechanism whereby sperm can be accommodated in the human epididymis is still not known, but at least clinicopathologically, it does not resemble the events that occur in the rabbit, rat, and hamster, where despite species' variation in the ability of the proximal vas and epididymis to distend following vasectomy, the epididymis may ultimately rupture.52

Back to Top
EFFECTS ON PROSTATIC FUNCTION

Thakur and colleagues studied maltase activity in semen, which reflects the secretory activity of the prostate, in 35 men vasectomized for 1 to 2 years and a comparison group of 24 nonvasectomized men.59 They found that maltase activity in the semen of vasectomized men was significantly lower than in nonvasectomized men and concluded that prostatic function was diminished by vasectomy. These findings were confirmed by Naik and associates who demonstrated that, in 78 men vasectomized for 1 to 8 years, seminal concentrations of maltase, in addition to prolactin, zinc, and magnesium, were significantly lower than in 22 nonvasectomized men of normal fertility.60

However, total prostatic volume and growth rate do not appear to be affected by vasectomy.61 More recently, Lassen and colleagues62 demonstrated that postvasectomy prostate-specific antigen levels were significantly lower than preoperative levels for up to 6 months after vasectomy.

Implications of these findings on changes in the secretory function of the prostate after vasectomy remain unknown. Further epidemiologic research on noncancerous prostatic disease in vasectomized men, in particular the relationship of the changes noted already to benign prostatic hypertrophy would be of interest.

Back to Top
HUMAN IMMUNODEFICIENCY VIRUS AND VASECTOMY

Human immunodeficiency virus (HIV) can be found in seminal white blood cells (WBC), and these cells may play a role in the sexual transmission of HIV.63,64 Because semen from vasectomized men contains significantly fewer WBCs than nonvasectomized men,65,66 some have questioned whether vasectomy may be used to decrease sexual transmission of HIV.67,68

Preliminary data from Anderson and coworkers indicated that infectious HIV could be found in semen from some HIV seropositive vasectomized men.66 More recently, 46 HIV-seropositive men were studied before vasectomy and for 3 months afterward; although levels of cell-free virus in the semen remained stable after vasectomy, cell-associated HIV was detected in significantly more men after vasectomy.69 Taken together, these results provide good evidence that vasectomy provides no protection against HIV transmission. This underscores the importance of counseling vasectomized men that vasectomy does not provide any protection against transmission or acquisition of HIV and other sexually transmitted diseases (STDs) and that men need to use condoms consistently and correctly if they are at risk of transmitting or acquiring HIV/STDs.

Back to Top
COMPREHENSIVE STUDIES OF DISEASE INCIDENCE

Four large-scale, retrospective cohort studies have examined comprehensively the incidence of a number of diseases in vasectomized men and a comparison group of nonvasectomized men.70,71,72,73,74 In each, investigators identified retrospectively by computer a group of men who were known to have vasectomies and a comparison group of men not known to have had a vasectomy. The occurrence of hospitalizations after identification for the study was determined by computer-record linkage. The comparison groups were men hospitalized in the same years for an operation other than vasectomy;70,71 men with the same prepaid medical care program;72 men having routine health checkups who did not indicate on questionnaires that they had had a vasectomy previously;73 and men admitted to the hospital for elective operations, appendicitis, or injury.74 The designs of these four studies are summarized in Table 2, and the results of their comparison of disease incidence in vasectomized and nonvasectomized men are summarized in Tables 3 and Table 4.

Of greatest importance, in all four studies, vasectomy was not significantly associated with increased risk of hospitalization for most disease categories. The total number of cases of disease in men in these studies is large for all categories and taken together, the studies are reassuring that vasectomy does not increase the risk of adverse health outcomes.

In the study by Walker and associates,72 vasectomy was associated with a significantly higher risk of diseases of the genitourinary system, including orchitis and epididymitis. The increase in risk was confined to the first years after vasectomy, and the authors attributed the findings to the occurrence of minor complications of vasectomy and to the possibility that men who had recently undergone vasectomy might be more likely to seek medical attention for nonvasectomy-related genitourinary conditions.

In three of the studies,70,71,72,73 the risk of hospitalization for mental disorders was lower in vasectomized men than in the comparison group. The most likely explanation is that men who elect to have a vasectomy are mentally more stable, because a causal relationship of vasectomy to better mental health is unlikely.

Walker72 and Petitti 73 and respective coworkers studied the risk of hospitalization separately in men with vasectomies of long duration—9 or more years in the Walker study and 10 or more years in the Petitti study. In both, there was no significant association of vasectomy of long duration with an increased risk of hospitalization for any of the categories of disease shown in Table 3.

Massey and colleagues reported the results of the fifth large retrospective cohort study, which examined the incidence of 98 diseases or conditions in 10,590 paired vasectomized men and neighborhood controls matched for age, race, and marital status.10 Additional data on this cohort were later reported by Schuman and associates.11 Of particular interest to those authors were diseases or conditions that could have been the immunopathologic consequences of anti-sperm antibodies. The median time of follow-up postvasectomy was over 8 years, ranging from 1 to 41 years. With the exception of epidid-ymitis/orchitis, the occurrence of all other diseases examined was similar or lower in vasectomized men compared with controls. This included diseases or conditions in which a vasectomy-related immunopathologic mechanism may have played a role. The number of cases of epididymitis/orchitis was relatively low (33 per 10,000 MY in vasectomized men), and the major difference in occurrence between the vasectomized men and controls was during the first 12 months after vasectomy.

Back to Top
COMPREHENSIVE STUDIES OF DISEASE PREVALENCE

Petitti and colleagues15 also did a cross-sectional analysis in which they examined the prevalence of a large number of diseases and the existence of current symptoms of illness in 4,385 vasectomized and 13,155 nonvasectomized men enrolled in the Kaiser-Permanente Medical Care Plan. Of 45 diseases and symptoms that were examined, vasectomy was significantly, independently associated with joint pain or swelling, back trouble, and a history of kidney or bladder infection. The latter finding is consistent with the findings of Walker and associates72: that is, a higher risk of diseases of the genitourinary system in vasectomized men, although details on whether risk of kidney or bladder infection was elevated are not provided by Walker's group. No other studies have examined specifically the possibility of an association of vasectomy with joint pain or swelling and back trouble, although the occurrence of arthritis15 or the risk of hospitalization for arthritis10,11,72,74 have not been shown to be higher in vasectomized than in nonvasectomized men.

Back to Top
EFFECTS ON CARDIOVASCULAR SYSTEM

Intense research efforts examining the association between vasectomy and cardiovascular disease in men were touched off by studies reporting that vasectomized monkeys had atherosclerosis of greater extent and severity than nonvasectomized monkeys.1,75 It was postulated that vasectomy could increase the risk of atherosclerosis if anti-sperm antibodies that form as a consequence of vasectomy resulted in the production of circulating immune complexes that injure the vascular wall. Concern about the possibility that vasectomy might increase the risk of atherosclerotic cardiovascular disease in men has waned since publication of a large number of studies showing no association of vasectomy with various disease endpoints in men. In addition, two experimental studies, which attempted to replicate the original studies that showed an effect of vasectomy on atherosclerosis in monkeys, included larger numbers of monkeys and found no adverse effect of vasectomy on atherosclerosis.76,77

Since the early 1980s, numerous cohort, case-control, and cross-sectional studies have been conducted to examine potential associations between vasectomy and various cardiovascular disease endpoints, including acute myocardial infarction, other ischemic heart disease, stroke, nonsyphilitic aortic aneurysm, peripheral vascular disease, hypertension, coronary artery disease, and hypertensive and atherosclerotic retinal vascular changes. Table 5 provides a summary of studies on vasectomy and cardiovascular disease. These epidemiologic studies of cardiovascular disease in vasectomized men have, with few exceptions, shown no association of vasectomy with any manifestation of atherosclerosis or cardiovascular disease. Even in men with vasectomies of long duration (20 years or longer), no association of vasectomy with an increased risk of cardiovascular disease has been found.73,78,79,80 Taken together, the newer experimental studies in monkeys76,77 and accumulated epidemiologic studies in men provide strong reassurance that vasectomy has no adverse effect on the cardiovascular system nor does it increase the risk of atherosclerosis in man.

Back to Top
VARIOUS PHYSIOLOGIC EFFECTS

In the late 1960s and the early 1970s, Roberts91,92 suggested that the risk of thrombophlebitis might be increased following vasectomy. Results of a large-scale epidemiologic study, however, did not find increased risk of thrombophlebitis in vasectomized men.10,11 In a prospective study, various measures of blood coagulation function were examined in 38 men before vasectomy and for 12 months following vasectomy and at the same timepoints in an age-matched, nonvasectomized comparison group.93 No differences were found between the vasectomized and the nonvasectomized men in any measures examined including prothrombin time, partial thromboplastin time, spontaneous platelet aggregation, circulating platelet aggregation ratios, or levels of fibrinogen, Factor V, Factor VII, fibrin monomer, and fibrin digestion products.

Petitti and coworkers94 used information from comprehensive multiphasic health checkups in 4,385 vasectomized and 13,155 age- and race-matched, nonvasectomized men to study the association of vasectomy with a large number of physiologic measures. In this group, vasectomy was not significantly associated with alterations in any of the following: diastolic blood pressure, white blood cell count, hemoglobin, hematocrit, mean corpuscular hemoglobin, mean cell volume, mean corpuscular hemoglobin concentration, sodium, calcium, cholesterol, glucose, uric acid, blood urea nitrogen, creatine, total bilirubin, alkaline phosphatase, lactic dehydrogenase, and glutamic-oxaloacetic transaminase. The vasectomized men had a significantly higher mean serum potassium concentration (4.6 versus 4.5 mEq/L) and significantly lower systolic blood pressure (128.9 versus 130.4 mm Hg) than nonvasectomized men. The overall differences in these measures, although statistically significant, were considered unlikely to be biologically important even if they were causally associated with vasectomy. In three additional studies that examined the effect of vasectomy on systolic and diastolic blood pressure, two found that the mean systolic and diastolic blood pressures were not significantly different between vasectomized and nonvasectomized men;83,95 the other found that both were lower in vasectomized men than in nonvasectomized men.96 Verheught and associates measured serum cholesterol before and 3 months after vasectomy in 24 men and in a control group of 23 men of similar age.97 No significant differences in cholesterol concentration were measurable between the two groups at baseline, nor was a significant change in cholesterol found after vasectomy.

Taken together, these studies indicate that vasectomy is not associated with changes in the physiologic functions measured by these tests.

Back to Top
IMMUNOLOGIC EFFECTS

An increased occurrence of circulating sperm-agglutinating antibodies in vasectomized men was first reported by Phadke and Padukone in 1964.3 Subsequently, numerous investigators have confirmed the presence of anti-sperm antibodies in association with vasectomy.4,5,6,7,8,9,98,99,100

The clinical significance of anti-sperm antibodies in men after vasectomy has been the subject of many investigations, and a number of potential mechanisms whereby they might lead to disease have been suggested including anti-sperm antibodies might trigger production of antibodies to other cells which might lead to disease; sperm antigens may combine with the anti-sperm antibodies to produce circulating immune complexes that could cause tissue damage and inflammation;1 and vasectomized men may have immunity to tumor-associated antigen that could affect directly the development of tumors.101

However, numerous studies conducted over the past few decades have shown no evidence of any immunologic or other diseases related to development of anti-sperm antibodies following vasectomy.5,10,72,80,82,102,103 Anti-sperm antibodies have been associated with decreased fertility following vasectomy reversal (see Chapter 48, Reversing Vasectomy).

Antisperm Antibodies

Because sperm first form at puberty, they are autoantigenic. Normally, sperm antigens are not exposed to the immune system because of the blood-testis barrier and other epithelial barriers along the reproductive tract. Development of anti-sperm antibodies after vasectomy is thought to be related to breakdown of the blood-testis barrier104 and leakage of sperm antigens from the epididymis.96 Sperm antigens have been found in the serum of men as early as 2 weeks after vasectomy.105

Antisperm antibodies are found in between 8% and 21% of men in the general population and in 9% and 36% of infertility patients.104 In contrast, circulating sperm agglutinating antibodies are found in 50% to 80% of men in the first year after following vasectomy.3,4,5,6,7,8,9,106 Approximately 3% of nonvasectomized men have sperm-immobilizing antibodies96 whereas anywhere from 25% to 60% of men develop sperm-immobilizing antibodies in the first year after vasectomy.6,7,8,9 A small percentage of men who do not develop anti-sperm antibodies in the first year after vasectomy develops them in the second or third year after the procedure.5,107

Although serum anti-sperm antibodies are common following vasectomy, fewer men have these antibodies in their seminal plasma.108 Following surgery for vasectomy reversal, however, anti-sperm antibodies are more commonly found in seminal plasma104 and are found on the surface of sperm as well.104,109

Antibodies to protamines, proteins found in the nucleus of the sperm, are detectable in between 20% and 40% of vasectomized men but are virtually undetectable in nonvasectomized men.98,99,100,110 The presence of antiprotamine antibodies has been of special concern because of fear that vasectomy might lead to formation of anti-deoxyribonucleic acid (DNA) antibodies, because DNA is the other main constituent of the sperm nucleus. To date, however, anti-DNA antibodies have not been detected in vasectomized men.98,100

Large variations occur in the titers of both sperm-agglutinating and sperm-immobilizing antibodies in men following vasectomy.8,96 Few studies have examined what happens to anti-sperm antibody titers over time. The results of those that have examined the issue are conflicting, with some investigators111,112 reporting no change and others7,96 reporting an increase over time.

Little is known about the factors that affect either the development of anti-sperm antibodies or the titer of the antibodies in the men who do develop them. Some evidence suggests that age at vasectomy plays a role, with younger men being more likely than those older to develop anti-sperm antibodies.96,100 A family history of autoimmune disease is not associated with development of anti-sperm antibodies.100

Other Autoantibodies

If development of anti-sperm antibodies caused or was accompanied by the development of other antibodies, particularly other autoantibodies, a mechanism linking vasectomy with disease in men would be established, because many diseases in humans are associated with increases in autoantibody levels.

Several investigators have studied this possibility by examining the presence of various autoantibodies including rheumatoid factor and anti-thyroid, anti-nuclear, anti-mitochondrial, anti-parietal cell, anti-thyroid, anti-thyroglobulin, anti-liver, antikidney, and anti-smooth-muscle antibodies in men before and after vasectomy or in vasectomized compared with findings in nonvasectomized men.9,99,100,113,114,115,116,117,118 Results of these studies indicate that vasectomy is not associated with clinically significantly increased levels of autoantibodies other than anti-sperm antibodies.

Although two studies reported that vasectomized men developed cytotoxic antibodies,119,120 results of larger, well-designed studies using before-and-after measures of cytotoxic antibodies were unable to demonstrate any change in the level of cytotoxic antibodies after vasectomy.9,121,122

Finally, results of several large-scale epidemiologic studies have not shown an increased incidence or prevalence of autoimmune disease in vasectomized compared with findings in nonvasectomized men. 10,11,70,71,72,73,74

Thus, taken together, these studies provide convincing evidence that vasectomy does not lead to development of autoantibodies in man other than anti-sperm antibodies.

Circulating Immune Complexes

Immune complexes form when an antibody combines with its antigen, and in some circumstances, immune complexes may be deposited in tissues such as the renal glomerulus, joints, and arterial walls, leading to inflammation and tissue necrosis. It has been suggested that continuous production of anti-sperm antibodies after vasectomy could lead to the formation of circulating immune complexes with subsequent development of various diseases. Some investigators have hypothesized or demonstrated this is to be the case in laboratory animals following vasectomy, including atherosclerosis in monkeys1 and orchitis and glomerulonephritis in rabbits.123

Studies to detect circulating immune complexes in vasectomized men have produced conflicting results. Several investigators have demonstrated the presence of circulating immune complexes in small percentages of men following vasectomy.113,124,125 One study demonstrated a higher incidence and higher levels of circulating immune complexes in men who were vasectomized for a mean of nearly 8 years compared with those in age-matched controls.126 Numerous others, however, have reported no association of vasectomy with circulating immune complexes or have demonstrated only a transient increase in circulating immune complexes following vasectomy, which disappear by 3 months to 1 year after vasectomy.86,99,100,105,118 In the study with the longest follow-up after vasectomy, no differences were found in the level of circulating immune complexes in vasectomized men (mean time since vasectomy nearly 16 years) compared with those in nonvasectomized men.96

Although the evidence indicates that at least in some men and for some time, circulating immune complexes occur following vasectomy, they do not appear to be clinically relevant. Results of a number of large-scale epidemiologic studies have not shown increased incidence or prevalence of various diseases that could be related to immune complex deposition, including atherosclerosis and glomerulonephritis in vasectomized compared with nonvasectomized men.10,11,71,73,74,87

Back to Top
PROSTATE CANCER

Incidence of prostate cancer is rising, and in the United States it is the most commonly diagnosed cancer among men.127,128 Although this may be due at least in part to enhanced screening and detection, these are unlikely to be the only factors involved.127 Little is known about the etiology and pathogenesis of prostate cancer, and few risk factors have been identified. Family history of prostate cancer appears to be an important risk129,130 and incidence increases with age, varies with ethnicity, and shows wide geographic variation.131 Black Americans have the highest incidence of prostate cancer in the world, nearly twice that of white Americans. Asians have a low incidence of prostate cancer. Geographic variation is not solely explained by ethnicity; for example: American blacks have twice the incidence of prostate cancer that Zimbabwean blacks have,132 American whites have twice the incidence of prostate cancer that European whites have,131 and incidence of prostate cancer among Japanese immigrants in the United States is higher than among Japanese in Japan.133 Dietary fat intake may be an important risk factor.134,135,136

Over a dozen epidemiologic studies of vasectomy and the risk of prostate cancer have been reported in the literature since the mid-1980s (Table 6). Results of these studies have been difficult to interpret for several reasons: research findings have been found in conflict; a convincing biologic mechanism for a causal relationship has been lacking; when associations have been found, they have been generally weak; and some studies have had the potential for bias (detection, misclassification, recall and/or confounding bias).

In 1990, there was a report of a case-control study showing a threefold to sixfold increased risk of prostate cancer in vasectomized men.140 The methodology used in this study was to screen data gathered from hospital interviews to look for associations between risk factors and diseases. Associations identified in studies using this methodology often appear more highly significant than they actually are.152 In a subsequent report of another case-control study by the same authors using additional data from the same surveillance system, a lower and nonsignificant association between vasectomy and prostate cancer was described.146

There were four other case-control studies and one cohort study published in the late 1980s and early 1990s. Two of the five studies reported a moderate but significant elevated risk of prostate cancer in vasectomized men,139,142 one reported a nonsignificantly increased risk,138 and the other two reported no increased risk.137,153 Limitations, including detection and misclassification bias, were possible in all of these studies.154

Two cohort studies published in 1993 by Giovannucci and coworkers reported weak positive associations between vasectomy and prostate cancer and relative risks that increased over time.143,144 These studies provided the best evidence for a causal link between vasectomy and prostate cancer and prompted the U.S. National Institutes of Health (NIH) to convene a panel of experts to review the data available at that time. The panel concluded that the associations that had been reported to date were weak and that there was a strong potential for detection bias in the studies because much prostate cancer is undetected and underreported, and because vasectomized men may be more likely than other men to be screened for prostate cancer or seek health care services, leading to the appearance of an elevated risk of prostate cancer in vasectomized men.155

Since that time, there have been eight additional studies on vasectomy and prostate cancer published.11,145,146,147,148,149,150,151 Seven showed no increased relative risk of prostate cancer in vasectomized men, although one study reported a nonsignificant increased risk in vasectomized black men in the United States.146 In the one study that demonstrated a significant elevation of risk of prostate cancer in vasectomized men, the patients also had very high rates of prostatitis and benign prostatic hypertrophy compared with controls, indicating a high likelihood of detection bias.148 These more recent studies confirm the probability that some of the earlier studies were subject to bias.

Epidemiologic studies of relatively weak associations between a procedure such as vasectomy and a chronic disease such as prostate cancer are difficult because of the potential for bias.128 Authors of a recent metaanalysis of published studies on vasectomy and prostate cancer concluded that numerous sources of bias have likely led to an overestimation of any effect of vasectomy on prostate cancer.156 Taken as a whole, these studies provide little evidence for a causal association between vasectomy and prostate cancer, especially given that results of studies have been inconsistent, associations when found have been mostly weak and potential for biases large, and there is no plausible biologic mechanism.157 More recent studies support the conclusions of the NIH panel of experts that no change in current practice of vasectomy is warranted, that providers should continue to offer vasectomy, that vasectomy reversal is not warranted to prevent prostate cancer, and that screening for prostate cancer should not be any different in men who have had a vasectomy than in those who have not.155

Back to Top
TESTICULAR CANCER

Table 7 summarizes results of epidemiologic studies of vasectomy and testicular cancer. With one exception,162 the studies conducted between the 1970s and early 1990s that showed an increased risk of testicular cancer following vasectomy were not statistically significant.70,159,160,161 These studies included only small numbers of vasectomized men with testicular cancer and were subject to confounding and/or misclassification bias. Three other studies reported no increased risk,74,146,158 and Giovannucci and coworkers80 found no cases of testicular cancer among nearly 15,000 vasectomized men. Two addi-tional studies included the largest numbers of cases of testicular cancer among vasectomized men and found no increased risk.147,163 Taken together, results of these epidemiologic studies provide convincing evidence that vasectomy is not associated with an increased risk of testicular cancer.

Back to Top
UROLITHIASIS

Information on the risk of urolithiasis in vasectomized men is available from five studies (Table 8). No significant increase in risk was reported in three of these five studies.11,15,74 Kronmal and associates,164 examining data from the Coronary Artery Surgery Study registry, first reported a significantly increased risk of urolithiasis in vasectomized men in the late 1980s. More recently, the same investigators found a similar increased risk of urolithiasis in vasectomized men under 46 years of age, but not in those men who were 46 or over at the time of the study.165 The mechanism by which vasectomy might increase the risk of urolithiasis is obscure. The public health impact of an increase in the risk of urolithiasis of the magnitude suggested in the accumulated studies to date is small.

Back to Top
POSTVASECTOMY PAIN SYNDROME

Chronic testicular pain has been reported by a small percentage of men after vasectomy and has been called postvasectomy pain syndrome.58,166,167 In one study that included 172 patients surveyed four years after vasectomy,58 56 patients (33%) reported some type of chronic testicular discomfort following vasectomy. Twenty-six (15%) considered this pain to be troublesome, nine (5%) sought medical care, and only three patients (<2%) regretted having had the vasectomy because of chronic pain. Likewise, in another study, 34 of 182 (18.7%) reported some postvasectomy pain 2 to 7 years after vasectomy.166 However, 71% said the discomfort was only occasional and was not troublesome or was only a minor nuisance. Just over 2% reported that the pain had a negative impact on their life. In rare instances, in which conservative therapy such as nonsteroidal anti-inflammatory drugs, sitz baths, antibiotics, or spermatic cord blocks fails, vasectomy reversal or denervation of the spermatic cord may be useful options.168,169 The cause of postvasectomy pain syndrome is poorly understood and may be related to infection, epididymal engorgement with sperm, sperm granuloma formation resulting from back pressure-induced rupture of epididymal tubules, or nerve entrapment.168,170,171 There is, however, no convincing evidence that postvasectomy pain arises from the testes.53

Back to Top
OVERALL MORTALITY RATES

Overall mortality rates in vasectomized and nonvasectomized men has been examined in three large cohort studies10,11,80,81, and was found to be lower in vasectomized men in all three studies (Table 9). The most likely explanation for the lower mortality rates in vasectomized men is selection bias: that men who have had a vasectomy represent a self-selected group who may be healthier or seek health care more readily than nonvasectomized men. Authors of two of the studies suggested that the most appropriate interpretation of these data was that no evidence suggested that vasectomy leads to an overall increase in mortality rates.10,80

Back to Top
CONCLUSIONS

There have now been over 2 decades of intense research on potential long-term health effects of vasectomy. This research provides reassurance that vasectomy does not have any significant long-term negative effects and does not increase the risk of cardiovascular disease, which is the major cause of morbidity and mortality in men in developed and most developing countries. Vasectomy appears to be a largely safe and highly effective method of fertility control with a risk profile that compares favorably with that of methods of fertility control used by women.

TABLE 1. Studies of the Effects of Vasectomy on Testosterone, Luteinizing Hormone (LH), and Follicle-Stimulating Hormone (FSH)


 

Time Between

 

 

 

 

 

Vasectomy and

No. of

Results

Study

Last Measure

Study Subjects

Testosterone

LH

FSH

Longitudinal

 

 

 

 

 

Bunge (1972)21

1 mo

50

0

NM

NM

Wieland et al (1972)22

2 mo

8

0

0

0

Johnsonbaugh et al (1977)23

3 mo

24

0

0

0

Glavind et al (1990)24

3 mo

51

NM

0

0

Tyler et al (1979)25

4 mo

~32

0

0

0

Nikkanen and Punnonen (1982)26

6 mo

22

0

+

0

Kobrinsky et al (1976)27

4–40 mo

11

0

0

0

Fisch et al (1989)28

2–64 mo

25

0

0

0

Purvis et al (1976)29

1 yr

30

0

0

0

Naik et al (1976)30

1 yr

19

0

0

0

Whitby et al (1976)31

1 yr

39

0

+

0

Alexander et al (1980)2

1 yr

99

0

0

0

de la Torre et al (1983)32

2 yr

20

0

0

0

Smith et al (1976)33

2 yr

56

+

0

0

Rosenberg et al (1974)34

2 yr

13

NM

0

0

Johnsonbaugh et al (1975)35

2–2.5 yr

9

0

0

0

Goebelsmann et al (1979)36

2 yr

16

0

0

0

Smith et al (1979)37

3 yr

56

+

0

0

Whitby et al (1979)38

5 yr

54

0

0

NM

Cross-Sectional

 

 

 

 

 

Varma et al (1975)39

5 yr

81

0

0

0

Devi et al (1977)40

1–10 yr

180

0

0

0

Skegg et al (1976)41

6 mo–5 yr

188

0

0

0

Mo et al (1995)42

10 to >20 yr

91

0*

0

0

Peng et al (1987)43

1 to 25 yr

505

0

0

0


* In men >20 years postvasectomy, testosterone levels were significantly higher than in age-matched controls.
0, no significant change; + , statistically significant increase; NM, not measured

TABLE 2. Summary of Designs of Four Record-Linkage Studies of Disease Incidence in Vasectomized Men and Comparison Subjects


 

 

No. and Description of

Study

Source of Study Subjects

Study Subjects

Goldacre et al (1978,

Scottish Medical Record

1,764 vasectomized men

 1979)70,71

 Linkage System

16,641 men who had other

 

 

 operations

Walker et al (1981)72

Puget Sound Health

6,092 vasectomized men

 

 Cooperative

~70,000 other male members

 

 

 of plan

Petitti et al (1983)73

Northern California Kaiser-

4,385 vasectomized men

 

 Permanente Medical Care

13,155 age- and race-matched,

 

 Program

 nonvasectomized men having

 

 

 routine medical checkups

Nienhuis et al (1992)74

Oxford Record Linkage

13,246 vasectomized men

 

 Study

 22,196 men admitted to the

 

 

 hospital for elective operations, or

 

 

 because of appendicitis, or injury

TABLE 3. Summary of Results of Three Record-Linkage Studies of Disease Incidence in Vasectomized Men and Comparison Subjects


International Classification

 

 

 

 

of Disease,

 

 

Number of

Risk Relative to

Adapted 8th Ed.

 

 

Cases in

Vasectomized Men

(ICDA-8) Code

Description

Study

Vasectomized Men

(95% Confidence Interval*)

140–209

Malignant neoplasm

Scottish

9

0.6†

 

 

Puget Sound

31

1.0 (0.6–1.6)

 

 

Kaiser

21

0.8 (0.5–1.3)

210–228

Benign neoplasm

Scottish

4

0.6†

 

 

Puget Sound

34

1.5 (0.9–2.5)

 

 

Kaiser

6

0.9 (0.3–2.1)

240–279

Endocrine, nutritional, and

Scottish

12

1.0†

 

 metabolic diseases

Puget Sound

32

0.5 (0.3–0.8)

 

 

Kaiser

5

0.8 (0.3–2.1)

290–318

Mental disorders

Scottish

5

0.3†

 

 

Puget Sound

14

0.3 (0.1–0.5)

 

 

Kaiser

8

0.6 (0.3–1.4)

390–458

Diseases of the

Scottish

76

1.0†

 

 circulatory system

Puget Sound

111

0.8 (0.6–1.0)

 

 

Kaiser

77

1.1 (0.8–1.4)

460–519

Diseases of the

Scottish

46

0.8†

 

 respiratory system

Puget Sound

77

0.8 (0.6–1.0)

 

 

Kaiser

21

1.0 (0.6–1.7)

520–577

Diseases of the

Scottish

90

0.8†

 

 digestive system

Puget Sound

194

1.0 (0.9–1.3)

 

 

Kaiser

79

0.8 (0.6–1.0)

580–611

Diseases of the

Scottish

21

0.6†

 

 genitourinary system

Puget Sound

116

1.6 (1.2–2.0)

 

 

Kaiser

28

1.2 (0.8–1.9)

710–739

Diseases of the

Scottish

47

0.7†

 

 musculoskeletal system

Puget Sound

121

1.3 (1.0–1.6)

 

 and connective tissue

Kaiser

26

1.1 (0.7–1.7)


* Where given
† Ratio of standardized first-event rate in vasectomized men to average of standardized first-event rates in the three comparison groups
(Adapted from references 70 to 73)

TABLE 4. Summary of Results of Disease Incidence in Vasectomized Men and Comparison Subjects from the Oxford Record Linkage Study


International

 

 

 

Classification

 

 

 

of Disease,

 

 

Risk Relative to

9th Revision

 

Number of Cases in

Vasectomized Men

(ICDA-9) Code

Description

Vasectomized Men

(95% Confidence Interval*)

185

Prostate cancer

1

0.44 (0.1–4.0)

186

Testicular cancer

4

0.46 (0.1–1.4)

200–208

Lymphoma, leukemia

16

0.92 (0.5–1.7)

242

Thyrotoxicosis

4

1.17 (0.3–4.2)

401–405

Hypertension

33

0.86 (0.6–1.3)

410

Myocardial infarction

97

1.0 (0.8–1.3)

411–414

Other ischemic heart disease

41

0.55 (0.4–0.8)

430–438

Stroke

25

0.65 (0.4–1.0)

556

Ulcerative colitis

8

0.78 (0.3–1.8)

592, 594

Renal calculus

35

1.2 (0.8–1.8)

600

Prostatic hypertrophy

7

0.57 (0.5–1.7)

714

Rheumatoid arthritis

11

0.84 (0.4–1.7)


* Relative risk in men with a vasectomy compared with combined controls.
(Adapted from Nienhuis et al: Incidence of disease after vasectomy: A record linkage retrospective cohort study. BMJ 304;743, 1992)

TABLE 5. Summary of Studies of Vasectomy and Cardiovascular Disease


 

 

 

 

Number of Cases

Relative Risk

Authors

Study Design

Study Population

Endpoint

With Vasectomy

(95% Confidence Interval)

Guang-hua et al (1978)81

Retrospective cohort

5,761 vasectomized

Ischemic heart disease

NR

0.5 (0.3–0.7)

 

 

5,761 nonvasectomized

Stroke

NR

2 (0.6–6.6)

Goldacre et al (1978, 1979, 1983)70,71,82

Cohort

1,764 vasectomized

Myocardial infarction

25

No association of vasectomy with increased risk of any endpoint

 

 

16,641 nonvasectomized

Stroke

6

 

 

 

Hypertension

5

 

 

 

 

Cardiovascular disease as a group

36

 

 

Fahrenbach et al (1980)83

Cross-sectional

41 vasectomized

Hypertensive and atherosclerotic retinal vascular changes

NR

In men <40 years old, vasectomized men had more retinal vascular changes than controls. There was no difference in damage between vasectomized men and controls >40.

 

 

112 nonvasectomized

 

 

 

Walker et al (1981, 1983, 1981)72,78,84

Cohort

4,800 vasectomized

Acute myocardial infarction

21

0.8 (0.4–1.3)

 

 

24,000 nonvasectomized

Cardiovascular disease as a group

111

0.8 (0.6–1.0)

Wallace et al (1981)85

Case-control

55 cases

Symptomatic coronary disease

14

No association between vasectomy and coronary

 

 

55 close relative controls

 

 

 

Linnet et al (1982)86

Cross-sectional

46 vasectomized

Atherosclerotic retinal vascular changes gradings between vasectomized men and controls

21

No difference in arteriolosclerotic retinopathy

 

 

46 nonvasectomized

 

 

 

Petitti et al (1982)15

Cross-sectional

4,385 vasectomized

History of myocardial infarction

158

1.0 (0.9–1.1)

 

 

13,155 age- and race-matched nonvasectomized

 

553

1.1 (1.0–1.2)

 

 

 

Chest pain or pressure

702

1.0 (0.9–1.0)

 

 

 

Hypertension

 

 

Goldacre et al (1983)82

Case control

1,512 cases

Myocardial infarction

NR

1.1 (0.7–1.8)

 

 

3,024 controls

Stroke

NR

0.8 (0.4–1.9)

 

 

 

Hypertension

NR

0.4 (0.1–1.3)

 

 

 

Cardiovascular disease as a group

NR

0.9 (0.6–1.3)

Petitti et al (1983)73

Cohort

4,385 vasectomized

Myocardial infarction

23

1.2 (0.7–1.9)

 

 

13,155 age- and race-matched nonvasectomized

Other ischemic heart disease

29

1.3 (0.8–1.9)

 

 

 

 

47

1.3 (0.8–1.9)

 

 

 

Cardiovascular disease as a group

 

 

Rimm et al (1983)87

Cross-sectional

370 vasectomized

Severity of angiographically diagnosed coronary artery disease

370*

Vasectomized men had significantly lower degree of coronary artery occlusion than age-matched controls

 

 

7,050 nonvasectomized

 

 

 

Perrin et al (1984)88

Cohort

1,383 vasectomized

Coronary disease

360

0.99 (0.84–1.17)

 

 

3,561 nonvasectomized

 

 

 

Rosenberg et al (1986)89

Case-control

2,238 cases

Myocardial infarction

332

1.0 (0.8–1.3)

 

 

3,361 controls

 

34

15+ yrs. 1.1 (0.7–2.0)

Chi et al (1990a)79

Case-control

163 cases

Nonfatal myocardial infarction

29

2.6 (1.1–6.1)

 

 

326 controls

 

 

i

Chi et al (1990b)90

Case-control

348 cases

Fatal cardiovascular disease (ischemic heart disease, nontraumatic cerebrovascular disease, hypertensive disease)

36

1.0 (0.4–2.4)

 

 

348 age-matched controls

 

 

 

Giovannucci et al (1992)80

Cohort

14,607 vasectomized

Fatal cardiovascular

253

0.8 (0.6–0.9)

 

 

14,607 nonvasectomized

 disease

1206

0.97 (0.9–1.1)

 

 

 

Fatal and nonfatal cardiovascular disease combined

 

 

Nienhuis et al (1992)74

Retrospective

13,246 vasectomized

Myocardial infarction

97

1.0 (0.8–1.3)

 

 cohort

22,196 nonvasectomized

 

 

 

Schuman et al (1993),11

Retrospective

10,079 vasectomized

Myocardial infarction

540†

0.9 (0.8–1.2)

Massey et al (1984)10

 cohort

10,079 nonvasectomized

Angina

344†

1 (0.8–1.2)

 

 

 

Stroke

97†

0.8 (0.5–1.2)


* All men in study had some degree of coronary artery disease
† Number of pairs in which a case occurred in one or both members
NR = not reported

TABLE 6. Summary of Studies of Vasectomy and Prostate Cancer


 

 

 

Number of

 

Estimated Relative Risk

 

 

 

Cases With

 

(95% Confidence Interval)

Reference

Study Design

Study Population

Vasectomy

All Durations

Long Duration*

Ross et al (1983)137

Case-control

110 matched case-control pairs

NR

0.5 (0.2–1.4)

Honda et al (1988)138

Case-control

216 matched case-control pairs

58

1.4 (0.9–2.3)

30+ yr: 4.4 (0.9–21)

Mettlin et al (1990)139

Case-control

614 cases

27

1.7 (1.1–2.6)

19+ yr: 1.5 (0.7–3.4)

 

 

2,588 controls

 

 

 

Rosenberg et al (1990)140

Case-control

220 cases

22

Noncancer controls 5.3

15+ yr: Noncancer controls

 

 

 

571 noncancer controls

(2.7–10)

6.4 (NR)

 

 

 

960 cancer controls

Cancer controls 3.5

15+ yr: Cancer controls

 

 

 

 

(2.1–6.0)

3.0 (NR)

Sidney et al (1991)141

Retrospective cohort

5,119 vasectomized

35

1.0 (0.7–1.6)

20+ yr: 1.2 (0.6–2.2)

 

 

15,357 matched controls

 

 

 

Spitz et al (1991)142

Case-control

343 cases

NR

1.6 (1.1–2.3)

27+ yr: 2.2 (1.1–4.3)

 

 

360 controls

 

 

 

Nienhuis et al (1992)74

Retrospective cohort

13,246 vasectomized

1

0.4 (0.1–4.0)

 

 

22,196 nonvasectomized

 

 

 

Giovannucci et al (1993a)143

Prospective cohort

10,055 vasectomized

59

1.7 (1.3–2.2)

22+ yr: 1.9 (1.3–2.72)

 

 

37,800 nonvasectomized

 

 

 

Giovannucci et al (1993b)144

Retrospective cohort

13,034 vasectomized

54

 

20+ yr: 1.9 (1.1–3.1)

 

 

12,306 nonvasectomized

 

 

 

Schuman et al (1993)11

Retrospective cohort

10,079 vasectomized

6

No increased incidence

 

 

10,079 nonvasectomized

 

 

of disease in vasectomized men compared with controls

Hayes et al (1993)145

Case-control

Blacks: 471 cases, 589 controls

Blacks: 7

Blacks 1.6 (0.5–4.8)

Blacks: 20+ yr: 1.2 (0.2–6.4)

 

 

Whites: 494 cases, 703 controls

Whites: 49

Whites 1.1 (0.8–1.7)

Whites: 20+ yr: 1.7 (0.8–3.3)

Rosenberg et al (1994)146

Case-control

355 cases

18

1.2 (0.6–2.7)

15+ yr: 1.4 (0.5–4.2)

 

 

2,048 controls

 

 

 

Moller et al (1994)147

Retrospective cohort

Cancer incidence in 73,917

12

0.94 (0.5–1.7)

 

 

vasectomized men com-

 

 

 

 

 

pared to the Danish population

 

 

 

Hsing et al (1994)148

Case-control

136 cases

14

Cancer: 2.0 (0.7–6.1)

 

 

158 hospital cancer controls

 

 

Noncancer: 3.3 (1.0–11.3)

 

 

158 hospital noncancer controls

 

 

Neighborhood: 6.7 (2.1–21.6)

 

 

322 neighborhood controls

 

 

 

John et al (1995)149

Case-control

1,624 cases

172

1.1 (0.8–1.4)

 

 

1,636 controls

 

 

 

Zhu et al (1996)

Case-control

175 cases

61

0.86 (0.6–1.3)

20+ yr: 0.8 (0.5–1.4)

 

 

258 controls

 

 

 

Platz et al (1997)151

Case-control

175 cases

17

1.5 (0.8–2.7)

20+ yr: 1.6 (0.8–3.1)

 

 

978 controls

 

 

 


* Number of years postvasectomy.
NR, not reported.

TABLE 7. Summary of Studies of Vasectomy and Testicular Cancer


 

 

 

Number of Cases

Relative Risk (95% of

Authors

Study Design

Study Population

With Vasectomy

Confidence Interval)

Goldacre et al (1978)70

Retrospective cohort

1,764 vasectomized

1

2.1 (0.1–11.6)

 

 

16,641 nonvasectomized

 

 

Moss et al (1986)158

Case-control

273 age-matched, case-control pairs

15

0.6 (0.3–1.2)

Swerdlow et al (1987)159

Case-control

259 cases

22

1.1 (0.6–2.0)

 

 

489 controls

 

 

Strader et al (1988)160

Case-control

333 cases

46

1.5 (1.0–2.2)

 

 

729 controls

 

 

Thornhill et al (1988)161

Case-control

240 cases

3

3.8 (0.8–11)

 

 

23,148 vasectomy man-years

 

 

Cale et al (1990)162

Retrospective cohort

Cancer incidence in 3,079 vasectomized men compared with national rates

8

4.2 (1.8–8.2)

Nienhuis et al (1992)74

Retrospective cohort

13,246 vasectomized

4

0.5 (0.1–1.4)

 

 

22,196 nonvasectomized

 

 

Giovannucci et al (1992)80

Retrospective cohort

14,607 vasectomized

0

 

 

14,607 nonvasectomized

 

 

Schuman et al (1993)11

Retrospective cohort

10,079 vasectomized

6

No increased incidence of disease in vasectomized men compared with controls

 

 

10,079 nonvasectomized

 

 

Rosenberg et al (1994)146

Case-control

132 cases

7

0.8 (0.4–1.9)

 

 

7,027 controls

 

 

UK Testicular Cancer

Case-control

794 age-matched,

81

1.09 (0.8–1.5)

Group (1994)163

 

case-control pairs

 

 

Moller et al (1994)147

Retrospective cohort

Cancer incidence in 73,917

 

 

 

 

 vasectomized men

 

 

 

 

 compared with the Danish

 

 

 

 

 general population

70

1.0 (0.8–1.3)

TABLE 8. Summary of Studies of Vasectomy and Urolithiasis


 

 

 

Number of

Relative Risk

 

 

 

Cases With

(95% Confidence

Authors

Study Design

Study Population

Vasectomy

Interval)

Petitti et al (1982)15

Cross-sectional

4,385 vasectomized

215

1.2 (1.0–1.4)

 

 

13,155 nonvasectomized

 

 

Kronmal et al (1988)164

Retrospective cohort

1,106 vasectomized

NR

1.7 (1.3–2.3)

 

 

10,099 nonvasectomized

 

 

Nienhuis et al (1992)74

Retrospective cohort

13,246 vasectomized

94

1.1 (0.7–1.9)

 

 

22,196 nonvasectomized

 

 

Schuman et al (1993)11

Retrospective cohort

10,079 vasectomized

268

No increased incidence of

 

 

10,079 nonvasectomized

 

 disease in vasectomized men

 

 

 

 

 compared with controls

Kronmal et al (1997)165

Case-control

244 cases

91

<46 yr old: 1.9 (1.2–3.1)

 

 

463 controls

 

46+ yr old: 0.9 (0.5–1.5)


NR, not reported.

TABLE 9. Summary of Studies Examining Total Mortality in Vasectomized and Nonvasectomized Men


 

 

 

Number of

 

 

 

 

Deaths in

Relative Risk

 

 

 

Vasectomized

(95% Confidence

Reference

Study Design

Study Population

Men

Interval)

Guang-hua et al (1978)81

Retrospective cohort

5,761 vasectomized

137

0.8 (0.7–0.9)

 

 

5,761 nonvasectomized

 

 

Schuman et al (1993)11 and

Retrospective cohort

10,079 vasectomized

538*

0.8 (0.7–0.9)

 Massey et al (1984)10

 

10,079 nonvasectomized

 

 

Giovannucci et al (1992)80

Retrospective cohort

14,607 vasectomized

1,052*

0.9 (0.8–1)

 

 

14,607 nonvasectomized

 

 


* Total deaths among all men in cohort.
Back to Top
REFERENCES

1. Alexander NJ, Clarkson TB: Vasectomy increases the severity of diet-induced atherosclerosis in Macaca fascicularis. Science 201: 538, 1978

2. Alexander NJ, Free MJ, Paulsen CA et al: A comparison of blood chemistry, reproductive hormones, and the development of antisperm antibodies after vasectomy in man. J Androl 1: 40, 1980

3. Phadke AM, Padukone K: Presence and significance of autoantibodies against spermatozoa in the blood of men with obstructed vas deferens. J Reprod Fertil 7: 163, 1964

4. Zappi E, Ahmed U, David J et al: Immunologic consequences of vasectomy. Fed Proc 29: 374, 1970

5. Shulman S, Zappi E, Ahmed U et al: Immunologic consequences of vasectomy. Contraception 5: 269, 1972

6. Ansbacher R: Sperm-agglutinating and sperm-immobilizing antibodies in vasectomized men. Fertil Steril 22: 629, 1971

7. Gupta I, Dhawan S, Goel GD et al: Low fertility rate in vasovasostomized males and its possible immunologic mechanism. Int J Fertil 20: 183, 1975

8. Hellema HWJ, Rumke P: Sperm autoantibodies as a consequence of vasectomy: I. Within 1 year post-operation. Clin Exp Immunol 31: 18, 1978

9. Bernstein GS, Chopp R, Cosgrove M et al: A controlled, prospective study of the effects of vasectomy. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, p 473. New York: Academic Press, 1979

10. Massey FJ Jr, Bernstein GS, O'Fallon WM et al: Vasectomy and health: Results from a large cohort study. JAMA 252: 1023, 1984

11. Schuman LM, Coulson AH, Mandel JS et al (eds): Health status of American men— study of post-vasectomy sequelae. J Clin Epidemiol 46: 697, 1993

12. Shain RN, Miller WB, Holden AE et al: Impact of tubal sterilization and vasectomy on female marital sexuality: Results of a controlled longitudinal study. Am J Obstet Gynecol 164: 763, 1991

13. Miller WB, Shain RN, Pasta DJ: The pre- and poststerilization predictors of poststerilization regret in husbands and wives. J Nerv Ment Dis 179: 602, 1991

14. Thapa S: Determinants of fertility in Nepal: Applications of an aggregate model. J Biosoc Sci 19: 351, 1987

15. Petitti DB, Klein R, Kipp H et al: A survey of personal habits, symptoms of illness, and histories of disease in men with and without vasectomies. Am J Public Health 72: 476, 1982

16. Ball RY, Mitchinson MJ: Obstructive lesions of the genital tract in men. J Reprod Fert 70: 667, 1984

17. Smith KD, Chowdhury M, Tcholakian RK: Endocrine effects of vasectomy in humans. In Sciarra JJ, Markland C, Speidel J (eds): Control of Male Fertility, p 169. Hagerstown, MD: Harper & Row, 1975

18. Smith G: The effects of ligation of the vasa deferentia and vasectomy on testicular function in the adult rat. J Endocrinol 23: 385, 1962

19. Plaut SM: Testicular morphology in rats vasectomized as adults. Science 181: 554, 1973

20. Gupta AS, Kothari LK, Bapna RB et al: Surgical sterilization by vasectomy and its effects on the structure and function of the testis in man. Br J Surg 1: 59, 1975

21. Bunge RG: Plasma testosterone levels in man before and after vasectomy. Invest Urol 10: 9, 1972

22. Wieland RG, Hallberg MC, Zorn EM et al: Pituitary-gonadal function before and after vasectomy. Fertil Steril 23: 779, 1972

23. Johnsonbaugh RE, Czerwinski CL, Edson M: Serum hormone levels before and two years after vasectomy. Contraception 16: 563, 1977

24. Glavind, K, Lauritsen NR, Klove-Mogensen et al: The effect of vasectomy on the production of the production of plasma lutenizing hormone and follicle stimulating hormone in man. Int Urol Nephrol 22: 553, 1990

25. Tyler JPP, Richardson DW, Newton JR: The hormonal and immunological status of vasectomized men. Contraception 19: 599, 1979

26. Nikkanen V, Punnonen R: Serum prolactin, FSH, LH and testosterone before and after vasectomy in normal men. Arch Androl 8: 311, 1982

27. Kobrinsky NL, Winter JSD, Reyes FI et al: Endocrine effects of vasectomy in man. Fertil Steril 27: 152, 1976

28. Fisch H, Laor E, BarChama N et al: Detection of testicular endocrine abnormalities and their correlation with serum antisperm antibodies in men following vasectomy. J Urol 141: 1129, 1989

29. Purvis K, Saksena SK, Cekan Z et al: Endocrine effects of vasectomy. Clin Endocrinol 5: 263, 1976

30. Naik VK, Thakur AN, Sheth AR et al: The effect of vasectomy on pituitary-gonadal function in men. J Reprod Fertil 48: 441, 1976

31. Whitby M, Gordon RD, Seeney N et al: Vasectomy: A long-term study of its effects on testicular endocrine function in man. Andrologia 8: 55, 1976

32. de la Torre B, Hedman M, Jensen P et al: Lack of effect of vasectomy on peripheral gonadotrophin and steroid levels. Int J Androl 6: 125, 1983

33. Smith KD, Tcholakian RK, Chowdhury M et al: An investigation of plasma hormone levels before and after vasectomy. Fertil Steril 17: 145, 1976

34. Rosenberg E, Marks SC, Howard PJ et al: Serum levels of follicle stimulating and luteinizing hormones before and after vasectomy in men. J Urol 111: 626, 1974

35. Johnsonbaugh RE, O'Connell K, Engel SB et al: Plasma testosterone, luteinizing hormone, and follicle-stimulating hormone after vasectomy. Fertil Steril 26: 329, 1975

36. Goebelsmann V, Bernstein GS, Gale JA et al: Serum gonadotropin, testosterone estradiol and estrone levels prior to and following bilateral vasectomy. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, p 165. New York: Academic Press, 1979

37. Smith KD, Tcholakian RK, Chowdury M et al: Endocrine studies in vasectomized men. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, p. 183. New York: Academic Press, 1979

38. Whitby RM, Gordon RD, Blair BR: The endocrine effects of vasectomy: A prospective five-year study. Fertil Steril 31: 518, 1979

39. Varma MM, Varma RR, Johanson AI et al: Long-term effects of vasectomy on pituitary-gonadal function in man. J Clin Endocrinol Metab 40: 868, 1975

40. Devi PK, Joshi UM, Moodbiri SB et al: Long term effects of vasectomy on pituitary-gonadal axis. Indian J Med Res 66: 591, 1977

41. Skegg DCG, Matthews JD, Guillebaud J et al: Hormonal assessment before and after vasectomy. BMJ 1: 621, 1976

42. Mo ZN, Huang X, Zhang SC et al: Early and late long-term effects of vasectomy on serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone levels. J Urol 154: 2065, 1995

43. Peng XS, Li FD, Miao ZR et al: Plasma reproductive hormones in normal vasectomized Chinese males. Int J Androl 10: 471, 1987

44. Hagedoorn JP, Davis JE: Fine structure of the seminiferous tubules after vasectomy in man. Physiologist 17: 236, 1974

45. Derrick FC, Glover WL, Kanjuparamban Z et al: Histological changes in the seminiferous tubules after vasectomy. Fertil Steril 25: 649, 1974

46. Fallon B, Jacobo E, Bunge RG: Restoration of fertility by vasovasostomy. J Urol 119: 85, 1978

47. Jenkins IL, Muir VY, Blacklock NJ et al: Consequences of vasectomy: An immunological and histological study related to subsequent fertility. Br J Urol 1979: 51:406

48. Bigazzi PE, Alexander NJ, Silber SS: Studies on testicular biopsies from vasectomized men. In: Lepow IH, Crozier R (eds): Vasectomy Immunologic and Pathophysiologic Effects in Animals and Man. New York: Academic Press, 1979

49. Jarow JP, Budin RE, Dym M et al: Quantitative pathologic changes in the human testis after vasectomy: A controlled study. N Engl J Med 313: 1252, 1985

50. Mehrotra R, Nath P, Singh KM et al: Changes in seminiferous tubules after vasectomy. Int J Pathol Microbiol 28: 371, 1985

51. Jarow JP, Goluboff ET, Chang TS et al: Relationship between antisperm antibodies and testicular histologic changes in humans after vasectomy. Urol 43: 521, 1994

52. Flickinger CJ, Howards SS, Herr JC: Effects of vasectomy on the epididymis. Microsc Res Tech 30: 82, 1995

53. McDonald SW: Vasectomy review: Sequelae in the human epididymis and ductus deferens. Clin Anat 9: 337, 1996

54. Pardanani DS, Patil NG, Pawar HN: Some gross observations of the epididymides following vasectomy: A clinical study. Fertil Steril 27: 267, 1976

55. Shapiro EI, Silber SJ: Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia. Fertil Steril 32: 546, 1979

56. Errey BB, Edwards IS: Open-ended vasectomy: An assessment. Fertil Steril 45: 843, 1986

57. Jarvis LJ, Dubbins PA: Changes in the epididymis after vasectomy: Sonographic findings. AJR Am J Roentgenol 152: 531, 1989

58. McMahon AJ, Buckley J, Taylor A et al: Chronic testicular pain following vasectomy. Br J Urol 69: 188, 1992

59. Thakur AN, Sheth AR, Rao SS et al: Effect of vasectomy on the prostatic function as indicated by seminal maltase activity. Contraception 11: 155, 1975

60. Naik VK, Joshi UM, Sheth AR: Long-term effects of vasectomy on prostatic function in men. J Reprod Fertil 58: 289, 1980

61. Jackobsen H, Torp-Pedersen S, Juul N et al: The long-term influence of vasectomy on prostate volume and morphology in man. Prostate 13: 57, 1988

62. Lassen PM, Thompson IM Jr, Helfrick B: Serum prostate-specific antigen concentration before and after vasectomy. Mil Med 161: 356, 1996

63. Zagury D, Bernard J, Leibowitch J et al: HTLV-III in cells cultured from semen of two patients with AIDS. Science 226: 449, 1984

64. Anderson DJ, Wolff H, Pudney J et al: Presence of HIV in semen. In Alexander NJ, Gabelnick HL, Spieler JM (eds): Heterosexual Transmission of AIDS, Chap. 14. New York: Alan R. Liss, 1990

65. Olsen GP, Shields JW: Seminal lymphocytes, plasma and AIDS. Nature 309: 116, 1984

66. Anderson DJ, Politch JA, Martinez A et al: White blood cells and HIV-1 in semen from vasectomized seropositive men. Lancet 338: 573, 1991

67. Schwartz GG: Can vasectomy reduce the sexual transmission of HIV? J Clin Epidemiol 43: 1433, 1990

68. Fathalla MF: Relationship between Contraceptive Technology and HIV Transmission: An overview. In Alexander NJ, Gabelnick HL, Spieler JM (eds): Heterosexual Transmission of AIDS, Chap. 19. New York: Alan R. Liss, 1990

69. Krieger JN, Nirapathpongporn A, Chaiyaporn M et al: Vasectomy and human immunodeficiency virus type 1 in semen. J Urol 159: 820, 1998

70. Goldacre MJ, Clarke JA, Heasman MA et al: Follow-up of vasectomy using medical record linkage. Am J Epidemiol 108: 176, 1978

71. Goldacre M, Vessey M: Record linkage study of morbidity following vasectomy. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, Chap. 27. New York: Academic Press, 1979

72. Walker AM, Jick H, Hunter JR et al: Hospitalization rates in vasectomized men. JAMA 245: 2315, 1981

73. Petitti DB, Klein R, Kipp H et al: Vasectomy and the incidence of hospitalized illness. J Urol 129: 760, 1983

74. Nienhuis H, Goldacre M, Seagroatt V et al: Incidence of disease after vasectomy: A record linkage retrospective cohort study. BMJ 304: 743, 1992

75. Clarkson TB, Alexander NJ: Long-term vasectomy: Effects on the occurrence and extent of atherosclerosis in rhesus monkeys. J Clin Invest 65: 15, 1980

76. Clarkson TB, Lombardi DM, Alexander NJ et al: Diet and vasectomy: Effects on atherogenesis in cynomolgus macaques. Exp Mol Pathol 44: 29, 1986

77. Clarkson TB, Alexander NJ, Morgan TM: Atherosclerosis of cynomolgus monkeys hyper- and hyporesponsive to dietary cholesterol: Lack of effect of vasectomy. Arteriosclerosis 8: 488, 1988

78. Walker AM, Jick H, Hunter JR et al: Vasectomy and nonfatal myocardial infarction: Continued observation indicates no elevation of risk. J Urol 130: 936, 1983

79. Chi I-C, Ko UR, Wilkens LR et al: Vasectomy and nonfatal acute myocardial infarction: A hospital-based case-control study in Seoul, Korea. Int J Epidemiol 19: 32, 1990a

80. Giovannucci E, Tosteson TD, Speizer FE et al: A long-term study of mortality in men who have undergone vasectomy. N Engl J Med 326: 1392, 1992

81. Guang-hua T, Yu-hui Z, Yue-min M et al: Vasectomy and health: Cardiovascular and other diseases following vasectomy in Sichuan Province, People's Republic of China. Int J Epidemiol 17: 608, 1978

82. Goldacre MJ, Holford TR, Vessey MP: Cardiovascular disease and vasectomy: Findings from two epidemiologic studies. N Engl J Med 308: 805, 1983

83. Fahrenbach HB, Alexander NJ, Senner JW et al: Effect of vasectomy on the retinal vasculature of men. J Androl 1: 299, 1980

84. Walker AM, Jick H, Hunter JR et al: Vasectomy and nonfatal myocardial infarction. Lancet 1: 13, 1981

85. Wallace RB, Lee J, Gerber WL et al: Vasectomy and coronary disease in men less than 50 years old; Absence of an association. J Urol 128: 182, 1981

86. Linnet L, Moller NPH, Bernth-Petersen P et al: No increase in arteriosclerotic retinopathy or activity in tests for circulating immune complexes 5 years after vasectomy. Fertil Steril 37: 798, 1982

87. Rimm AA, Hoffman RG, Anderson AJ et al: The relationship between vasectomy and angiographically determined atherosclerosis in men. Prev Med 12: 262, 1983

88. Perrin EB, Woods JS, Namekata T et al: Long-term effect of vasectomy on coronary disease. Am J Public Health 74: 128, 1984

89. Rosenberg L, Schwingl PJ, Kaufman DW et al: The risk of myocardial infarction 10 years or more after vasectomy in men under 55 years of age. Am Epidemiol 123: 1049, 1986

90. Chi I-C, Kong SK, Wilkens LR et al: Vasectomy and cardiovascular deaths in Korean men: A community-based case-control study. Int J Epidemiol 19: 1113, 1990b

91. Roberts HJ: Delayed thrombophlebitis and systemic complications after vasectomy: Possible role of diabetogenic hyperinsulinism. J Am Geriatr Soc 16: 267, 1968

92. Roberts HJ: Thrombophlebitis after vasectomy. N Engl J Med 284: 1330, 1971

93. Kisker T, Wu K, Culp D et al: Blood coagulation studies in vasectomy. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Man and Animals, p 105. New York: Academic Press, 1979

94. Petitti DB, Klein R, Kipp H et al: Physiologic measures in men with and without vasectomies. Fertil Steril 37: 437, 1982

95. Alexander NJ, Senner JW, Hoch EJ: Evaluation of blood pressure in vasectomized and non-vasectomized men. Int J Epidemiol 10: 217, 1981

96. Mullooly JP, Wiest WM, Alexander NJ et al: Vasectomy, serum assays, and coronary heart disease symptoms and risk factors. J Clin Epidemiol 46: 101, 1993

97. Verheught FWA, Tijssen JGP, Boerne GJM et al: Vasectomy and cholesterol. N Engl J Med 305: 462, 1981

98. Samuel T, Kolk AHJ, Rumke P et al: Autoimmunity to sperm antigens in vasectomized men. Clin Exp Immunol 21: 65, 1975

99. Tung KS: Human sperm antigens and antisperm antibodies: I. Studies on vasectomy patients. Clin Exp Immunol 20: 93, 1975

100. Rose NR, Lucas PL: Immunological consequences of vasectomy: Two-year summary of a prospective study. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, p 553. New York: Academic Press, 1979

101. Anderson DJ, Alexander NJ, Fulgham DL et al: Immunity to tumor-associated antigens in vasectomized men. J Natl Cancer Inst 69: 551, 1982

102. Coulson AH, Crozier R, Massey FJ et al: Health status of men—study of post-vasectomy sequelae: Results. J Clin Epidemiol 46: 857, 1993

103. Lepow IH, Crozier RH (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man. New York: Academic Press, 1979

104. Gubin DA, Dmochowski R, Kutteh WH: Multivariant analysis of men from infertile couples with and without antisperm antibodies. Am J Repro Immunol 39: 157, 1998

105. Witkin SS, Zelikovsky G, Bongiovanni AM et al: Sperm-related antigens, antibodies, and circulating immune complexes in sera of recently vasectomized men. J Clin Invest 70: 33, 1982

106. Lenzi A, Gandini L, Lombardo F: Antisperm antibody detection: 2. Clinical, biological, and statistical correlation between methods. Am J Reprod Immunol 38: 224, 1997

107. Ansbacher R, Hodge P, William A et al: Vas ligation: Humoral sperm antibodies. Int J Fertil 21: 258, 1976

108. Linnet L, Hjort T: Sperm agglutinins in seminal plasma and serum after vasectomy: Correlation between immunological and clinical findings. Clin Exp Immunol 30: 413, 1977

109. Meinertz H, Linnet L, Wolf H et al: Antisperm antibodies on epididymal spermatozoa. Am J Reprod Immunol 25: 158, 1991

110. Rousseaux-Prevost R, de Almeida M, Jouannet P et al: Auto-antibodies to human sperm basic nuclear proteins in infertile and vasectomized men: Characterization of antigens and epitopes recognized by antibodies. Mol Immunol 29: 895, 1992

111. Ansbacher R: Humoral sperm antibodies: A 10-year follow-up of vas-ligated men. Fertil Steril 36: 222, 1981

112. Hellema HWJ, Rumke PH: Sperm autoantibodies as a consequence of vasectomy: II. Long-term follow-up studies. Clin Exp Immunol 38: 31, 1979

113. Rumke P, Hellema HWJ: Immunologic studies in long-term follow-up of vasectomized men. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, p 521. New York: Academic Press, 1979

114. Crewe P, Dawson L, Tidmarsh E et al: Autoimmune implications of vasectomy in man. Clin Exp Immunol 24: 368, 1976

115. Howard PJ, James LP: Immunological implications of vasectomy. J Urol 109: 76, 1973

116. Bullock JY, Gilmore LL, Wilson JD: Autoantibodies following vasectomy. J Urol 118: 604, 1977

117. Matthews JD, Skegg DC, Vessey MP et al: Weak autoantibody reactions to antigens other than sperm after vasectomy. BMJ 2: 1359, 1976

118. Hess EV, Herman JH, Hank JL et al: Studies on the immune system in human vasectomy. In Lepow IH, Crozier R (eds): Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, p 509. New York: Academic Press, 1979

119. Henry JB: Immunological effects of vasectomy. JAMA 225: 642, 1973

120. Mumford DM, Gordon HL, Ansbacher R et al: Incidence of lymphocytotoxins in vasectomy patients—a prelminary report. In Sciarra JJ, Markland C, Speidel JJ (eds): Control of Male Fertility, p 196. Hagerstown, MD: Harper & Row, 1975

121. White AG, Watson GS, Darg C et al: Lymphocytotoxins in vasectomized men. J Urol 114: 240, 1975

122. Jennings PB, Wettlaufer JN, Paulsen CA: Absence of circulating HL-A lymphocytotoxic antibodies in men 21 to 44 months after vasectomy. Fertil Steril 28: 446, 1977

123. Bigazzi PW, Kosuda LL, Hser KC et al: Immune complex orchitis in vasectomized rabbits. J Exp Med 143: 382, 1976

124. Witkin SS, Brandlund I, Svehag S-E et al: Comparison of different assays for circulating immune complexes in vasectomized and non-vasectomized men. J Clin Lab Immunol 10: 193, 1983

125. ICMR Task Force. Long-term effects of vasectomy. Part II: Immunological parameters. An ICMR Task Force study on regulation of male fertility (surgical approaches). Contraception 26:527, 1983

126. Alexander NJ, Fulgham DL, Plunkett ER et al: Antisperm antibodies and circulating immune complexes of vasectomized men with and without coronary events. Am J Reprod Immunol Microbiol 12: 38, 1986

127. Levy IG, Gibbons, L, Collin JP et al: Prostate cancer trends in Canada: Rising incidence or increased detection. Can Med Assoc J 149: 617, 1993

128. Hayes RB: Are dietary fat and vasectomy risk factors for prostate cancer? J Natl Cancer Inst 87: 629, 1995

129. Carter BS, Beaty TH, Steinberg GD et al: Mendelian inheritance of familial prostate cancer. Proc Natl Acad Sci USA 89: 3367, 1992

130. Cannon-Albright LA, Thomas A, Goldgar DE et al: Familiality of cancer in Utah. Cancer Res 54: 2378, 1994

131. Waterhouse J, Muir C, Shanmugaratum K et al (eds): Cancer Incidence in Five Continents. Vol IV. IARC Scientific Publication No. 42. Lyons, France: International Agency for Research on Cancer, 1982

132. Kovi H, Heshmat MY: Incidence of cancer in Negroes in Washington, DC, and selected African cities. Am J Epidemiol 96: 401, 1973

133. Haenszel W, Kurihara M: Studies of Japanese migrants, I: Mortality from cancer and other diseases among Japanese in the United States. J Natl Cancer Inst 40: 43, 1968

134. Bairati I, Meyer F, Fradet Y et al: Dietary fat and advanced prostate cancer. J Urol 159: 1271, 1998

135. Fair WR, Fleshner NE, Heston W: Cancer of the prostate: A nutritional disease. Urology 50: 840, 1997

136. Whittemore AS, Kolonel LN, Wu AH et al: Prostate cancer in relation to diet, physical activity, and body size in blacks, whites, and Asians in the United States and Canada. J Natl Cancer Inst 87: 652, 1995

137. Ross RK, Paganini-Hill A, Henderson BE: The etiology of prostate cancer: What does the epidemiology suggest? Prostate 4: 333, 1983

138. Honda GD, Bernstein L, Ross RK et al: Vasectomy, cigarette smoking, and age at first sexual intercourse as risk factors for prostate cancer in middle-aged men. Br J Cancer 57: 326, 1988

139. Mettlin C, Natarajan N, Huben R: Vasectomy and prostate cancer risk. Am J Epidemiol 132; 1056, 1990

140. Rosenberg L, Palmer JR, Zauber AG et al: Vasectomy and the risk of prostate cancer. Am J Epidemiol 132; 1051, 1990

141. Sidney S, Quesenberry CP, Sadler MC et al: Vasectomy and the risk of prostate cancer in a cohort of multiphasic health-checkup examinees: Second report. Cancer Causes Control 2: 113, 1991

142. Spitz MR, Fueger JJ, Babaian RJ et al: Vasectomy and the risk of prostate cancer. Am J Epidemiol 134: 108, 1991

143. Giovannucci E, Ascherio A, Rimm EB et al: A prospective cohort study of vasectomy and prostate cancer in US men. JAMA 269: 873, 1993a

144. Giovannucci E, Tosteson TD, Speizer FE et al: A retrospective cohort study of vasectomy and prostate cancer in US men. JAMA 269: 878, 1993b

145. Hayes RB, Pottern LM, Greenberg R et al: Vasectomy and prostate cancer in US blacks and whites. Am J Epidemiol 137: 263, 1993

146. Rosenberg L, Palmer JR, Zauber AG et al: The relation of vasectomy to the risk of cancer. Am J Epidemiol 140: 431, 1994

147. Moller H, Knudsen LB, Lynge E: Risk of testicular cancer after vasectomy: Cohort study of over 73,000 men. BMJ 309: 295, 1994

148. Hsing AW, Wang RT, Gu FL et al: Vasectomy and prostate cancer risks in China. Cancer Epidemiol Biomarkers Prev 3: 285, 1994

149. John EM, Whittemore, AS, Wu AH: Vasectomy and prostate cancer: Results from a multiethnic case-control study. J Natl Cancer Inst 87: 662, 1995

150. Zhu K, Stanford JL, Daling JR: Vasectomy and prostate cancer: A case-control study in a health maintenance organization. Am J Epidemiol 144: 717, 1996

151. Platz EA, Yeole BB, Cho E et al: Vasectomy and prostate cancer: A case-control study in India. Int J Epidermiol 26: 933, 1997

152. Guess HA: Invited commentary: Vasectomy and prostate cancer. Am J Epidemiol 132: 1062, 1990

153. Sidney S: Vasectomy and the risk of prostatic cancer and benign prostatic hypertrophy. J Urol 138: 795, 1987

154. DerSimonian R, Clemens J, Spirtas R et al: Vasectomy and prostate cancer risk: Methodological review of the evidence. J Clin Epidemiol 46: 163, 1993

155. Healy B: From the National Institutes of Health: Does vasectomy cause prostate cancer? JAMA 269: 2620, 1993

156. Bernal-Delgado E, Latour-Perez J, Pradas-Arnal F et al: The association between vasectomy and prostate cancer: A systematic review of the literature. Fertil Steril 70: 191, 1998

157. Peterson HB, Howards SS: Vasectomy and prostate cancer: The evidence to date. Fertil Steril 70: 201, 1998

158. Moss AR, Osmond D, Bacchetti P et al: Hormonal risk factors in testicular cancer: A case-control study. Am J Epidemiol 124: 39, 1986

159. Swerdlow AJ, Huttly SR, Smith PG: Testicular cancer and antecedent diseases. Br J Cancer 55: 97, 1987

160. Strader CH, Weiss NS, Daling JR: Vasectomy and the incidence of testicular cancer. Am J Epidemiol 128: 56, 1988

161. Thornhill JA, Conroy RM, Kelly DG et al: An evaluation of predisposing factors for testis cancer in Ireland. Eur Urol 14: 429, 1988

162. Cale ARJ, Farouk M, Prescott RJ et al: Does vasectomy accelerate testicular tumour? Importance of testicular examinations before and after vasectomy. BMJ 300: 370, 1990

163. United Kingdom Testicular Cancer Group: Aetiology of testicular cancer: Association with congenital abnormalities, age at puberty, infertility, and exercise. BMJ 308: 1393, 1994

164. Kronmal RA, Krieger JN, Kennedy JW et al: Vasectomy and urolithiasis. Lancet 2: 22, 1988

165. Kronmal RA, Krieger JN, Coxon V et al: Vasectomy is associated with an increased risk for urolithiasis. Am J Kidney Dis 29: 207, 1997

166. Choe JM, Kirkemo AK: Questionnaire-based outcomes study of nononcological post-vasectomy complications. J Urol 155: 1284, 1996

167. Ehn BE, Liljestrand J: A long-term follow-up of 108 vasectomized men. Good counselling routines are important. Scand J Urol Nephrol 29: 477, 1995

168. Myers SA, Mershon CE, Fuchs, EF: Vasectomy reversal for treatment of the post-vasectomy pain syndrome. J Urol 157: 518, 1997

169. Ahmed I, Rasheed S, White C et al: The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management. Br J Urol 79: 269, 1997

170. Temmerman M. Cammu H, Devroey P et al: Evaluation of one-hundred open-ended vasectomies. Contraception 33: 529, 1986

171. Schmidt SS: Spermatic granuloma: An often painful lesion. Fertil Steril 31: 178, 1979

Back to Top