k51 - male contraception.ppt [read-only]ocw.usu.ac.id/course/download/1110000106... · references:...
TRANSCRIPT
MALE CONTRACEPTION
dr. Syah Mirsya Warli, SpUdr. Bungaran Sihombing, SpU
Urology Division, Surgery DepartmentMedical Faculty, University of Sumatera UtaraUniversity of Sumatera Utara
1
References:
Guidelines on Male Infertility, European Association of Urology March 2007of Urology, March 2007Clinical Manual of Urology, (Philip M. Hanno et al eds), McGraw-Hill Int ed, 3rd ed, 2001), , ,Smith’s General Urology (Tanagho & McAninch eds), Lange Medical Books, 15th ed, 2000Infertility in The Male, (Lipshultz & Howards eds), Mosby, 1997
2
Male contraseption
male contraceptive method :d- condoms
- periodic abstinencewithdrawl- withdrawl
Typical 1st-year failure rates :- condoms 3 – 14%condoms 3 14%- periodic abstinence 20%- withdrawl 19%
3
Male contraception
Use of existing malecontraceptives in developed regioncontraceptives in developed region
Use of existing malecontraceptives in developing
regiong
4
Condoms
5
Condoms
Thin sheaths of rubber, vinyl or natural products which may be treated with a spermicide for added protectionmay be treated with a spermicide for added protection. They are placed on the penis once it is erectCondoms differ in such qualities as shape, color, q p , ,lubrication, thickness, texture and addition of spermicide (usually nonoxynol-9)
6
Types of Condom
Latex (rubber)Plastic (vinyl)Natural (animal products)
7
8
Mechanism of action condom
Prevent sperm from gaining access to female reproductive tractreproductive tractPrevent micro organism (Sexual Transmitted Disease) from passing from one partner to another ) p g p(latex & vinyl condom only)
9
Contraceptive benefits
Effective immediatelyD t ff t b tf diDo not affect breastfeedingCan be used as back up to other methodsNo method related health riskNo method-related health riskNo systemic side-effectsWidely availableWidely availableInexpensive
10
Research Contraceptive :
- prevent sperm production (use of androgen, progesteron, GnRH)
- interfere with the ability of sperm to mature and carry out fertilization by using an epididymalapproach to create a hostile environment for spermsprod ce better barrier methods- produce better barrier methods
- produce of antisperm contraceptive vaccine- inhibit sperm-egg interactionsinhibit sperm egg interactions
11
Hormonal male contraception
Based on suppression of gonadotrophin & the use of testosterone substitution to maintain male sexual function & bone mineralization & to prevent muscle wastinggResearch :- testosterone monotherapy- androgen/progestin combination- testosterone with GnRH analogues
l ti d d ti t- selective androgen and progestin receptormodulation12
Vasectomy
Is an effective method of permanent male surgical p gsterilizationBefore the procedure, the couple should be given
t i f ti b t th b fit & i kaccurate information about the benefit & risks
13
Surgical techniques
various techniquesl l t th l t i ino-scalpel vasectomy the least invasive
approach to the vascauterization of the lumen of the vas & fascialcauterization of the lumen of the vas & fascial interposition most effectiveocclusion technique
14
Vasectomy
15
Complications
Acute local complications :- haematoma, wound infection, epididymitis
5% casesL t li tiLong term complications :
- chronic testicular pain, epididymal tubal damage
16
Complications
Vasectomy does not significantly alter t i & L di ll f tispermatogenesis & Leydig cell function
Volume of ejaculate unchangedRate of prostate cancer could not increasedRate of prostate cancer could not increased
17
18
19
20
Vasectomy failure
Effective occlusion technique risk of recanalization < 1%< 1%No motile spermatozoa 3 mo laterPersistent motility sign of vasectomy failurePersistent motility sign of vasectomy failure need to repeat the procedureLong term recanalization may occur (rare)
21
Counseling
It should be considered irreversibleIt has a low complication rate. However, because vasectomy is an elective operation even smallvasectomy is an elective operation even small risks should be explained as men may wish to consider these before giving their consentIt has a low but existing failure rateIt has a low, but existing, failure rateCouples should be advised to continue with other effective contraception until clearance is
hi dachieved
22
Vasectomy
All available data indicate that vasectomy is safe & not associated with any serious, long term side effectFascial interposition & cauterization seem to give a higher efficacyhigher efficacy
23
Vasectomy reversal
Success rate > 90%, depend on :th ti l d ft t- the time elapsed after vasectomy
- type of vasectomy (open ended or sealed)type of reversal (vasovasostomy or- type of reversal (vasovasostomy or vasoepididymostomy)
- unilateral or bilateralunilateral or bilateral
24
Conclusions
The most cost-effective approach to treatment of post-vasectomy infertility is microsurgical reversal. This also has the highest chance of deliveryCouples can have a family after successful vasectomyCouples can have a family after successful vasectomy reversal. There is no need for hormonal treatment of the female partner, with its associated risks of ovarian hyperstimulation and multiple pregnancies
25
Th k YThank You
wr’0726