Profile of No Scalpel Vasectomy patients in a District of West Bengal, India

Introduction:

Patients attend health care settings and they are examined, investigated and treated accordingly.^[1] In relation to family planning issue, they come in health care service centre to accept one of the contraceptive methods to control birth. Birth control is achieved through use of contraceptive methods.^[2] As a family planning method, sterilisation is being taken by 25% of total couples.^[3] Worldwide, around 3-6% of couples were seen using vasectomy as a method of contraception.^[4]

Vasectomy is one of the terminal surgical procedures. Small diameter (2 - 3 mm) of the lumen of the vas presents the challenge of No Scalpel Vasectomy (NSV) reversal and needs micro-surgical technique(s) using 8/0 prolene with either operating microscope or optical loop. Reversal for recanalization cannot be guaranteed. Local anaesthesia (peri-vasal block by 1-2% xylocaine), operation time (5 - 6 minutes), discharge time (after 30 minutes of close observation), sexual intercourse (3 days after vasectomy) were included as the issues of pre-vasectomy counselling and these were important matters to have informed written consent.^[5]

Male sexual physiology remains unchanged following vasectomy. No long term health risks are found associated with the procedure. On the contrary, vasectomy breaks the blood- testes barrier that leads to increased levels of anti-sperm antibodies. So, after successful reversal, presence of antibodies prevents the wanted pregnancy strongly.^[3] Typical success rate of pregnancy following a vasectomy reversal is around 55% if it is performed within 10 years, around 25% after 10 years. Higher rate of congenital defects may be lead by higher rate of aneuploidy, diploidy in sperm cell. ^[3]

Clients opted for vasectomy which was one of the common contraceptive methods. During 2012 - 13, West Bengal performed male sterilization and it was 7545 in number (2.24%) out of expected level of achievement (337350) whereas female sterilization was good in number over expectation (62.31%). ^[6]

The factors which act as determinants for adoption of vasectomy are said to be age, number of children, occupation, educational status, family income etc. These can be treated as predicting or independent variables. ^[7,8]

Very few studies were found on vasectomy and its associates in this state of West Bengal. Ethnicity, cultural aspects, educational qualities, attitude etc are different in this population compared with population of developed countries. Findings of this study might be different due to these factors and this necessitates the research on vasectomy in this set up.

This study was conducted to assess the socio-demographic profile of patients of vasectomy; to find out the varieties of complications, if any, of both immediate and remote in nature.

Materials and Methods:

The study was cross-sectional in design and study period was from 15^th July 2014 to 31^st March 2016. District Hospital of North 24 Parganas has been selected as study setting. Total vasectomy cases came to this hospital either directly or through referral. All Vasectomised patients attending Post-Partum Unit had been selected in this study. Patients with ambiguous data had been excluded from the sampling frame and they were not taken. The patients who were taken at hospital but operation was refused were wondering vagabond, immune-compromised, with large indirect hernia, lunatic, uncontrolled diabetic, gross skin disease, multiple sebaceous cysts in scrotum etc. Record review of the respective patients from the admission cum record register was taken. A schedule had been formulated by the investigators themselves through point to point discussion of study variables. During data collection these schedules had been filled in with utmost care. All the patients who underwent no scalpel vasectomy with correct records during the past one year have become the size of sample population. Total eligible vasectomised patients were taken in the study and they were 1573 patients. Predicting variables were age, number of children, occupation, residence etc and outcome variable was complication followed by operations etc. Record review had been done for elicitation of socio-demographic factors and other issues related to vasectomy already done The data included admission accounts with health status, operative note, per-operative event notes if any, post-operative events note if any, readmission note if required and their management, advice on semen analysis along with other predicting and outcome variables.

Results:

A cross-sectional study was conducted during first January to thirty first December 2015 through the record review. Total number of study population was 1573 who had been operated and post-operative care had been given. The people belonging to Islam religion were 7.88%. Others were people of Hinduism.

Discussion:

On the basis of mean age of the population undergone vasectomy, the clients were sexually active and economically productive population. Demographically it can be declared that this population group is required for vasectomy operation.

Average age structure for a man getting a vasectomy in United States of America was 38 years old. Sixty one percent were under age 40.^[9,10] These data were similar to this study result and some other study.^[11]

From socio-economic point of view, poor people were found coming for vasectomy in this study. There was no significant association between total family monthly income and acceptance of NSV in some other study.^[12]

Educational levels of the clients in this study were found that most of them came from illiterate group or very low level of education. This was not seen in some other study.^[9,11,13]

Two-third of the clients (66.3%) was found with two or more number of living children. This picture was similar to other study.^[10,14]

The most of the clients were found from agriculture industry. This finding was similar to some other study.^[13]

Surgical wound infection was found not in less number of clients (1.84%). Per-operative bleeding was seen without haematoma. Similar and non-similar findings were observed in some other study. Haematoma, wound and genito-urinary infections and traumatic fistulae were seen in that study. Surgical skill may play the role for these complications. Orchalgia was seen in a very high proportion in that study.^[15] Medical consultations for hematoma or infection were found less frequent (0.5%) in one study in comparison with this current study.^[16] Consultation for non-infectious pain was required in that study^[15] comparing this one.

Vasectomy is a procedure which did not get popularity in the state of West Bengal where tubectomy is more popular.^[7] This might be due to lack of awareness of vasectomy and its benefits and the work disturbance of men etc. ^[17,18]