Immediate sterility after vasectomy with the use of 0.1% ethacridine lactateDS Kamat, EK Bharucha, PC Sankholkar
Departments of Obstetrics & Gynaecology and Surgery, B.J. Medical College and Sassoon General Hospitals, Poona 1., India
Irrigation of the vas with 0.1% ethacridine during vasectomy flushes the sperms and causes lysis from the distal genital tract, without any serious complication or side effect. In the light of this experience, it is suggested that this method can be used in all vasectomy operations carried out for primary sterilisation so as to produce immediate sterility.
It takes several weeks for the semen to be sperm-free after vasectomy. A world wide search is going on for an effective non-toxic chemical agent which can be injected into the distal segment of the vas at the time of vasectomy so as to produce immediate sterility by washing out and destroying the residual sperms in the distal genital tract.
Von Friesen  described a method it which 0.1% ethacridine was used. He claimed that ethacridine kills the spermatozoa in the vas deferens and seminal vesicles.
Craft and McQueen  described a significant success over plain vasectomy by using "sterile water".
Similarly Urquhard-Hay  has described his success by using 0.1% Euflavin.
In our preliminary study  on dogs and human spermatozoa with ethacridine lactate, it was noted that ethacridine was safe for this purpose.
Vasectomy for the purpose of contraception was carried out in 43 patients in Sassoon General Hospital, Poona, on an outpatient basis using local anaesthesia. Each vas was exteriorized through a separate scrotal incision 1 cm long and divided; the two ends were separated and ligated.
The selection of cases for control and irrigation was done on randomized basis. In controls, only vasectomy was done without irrigation. In the irrigated group, the distal end of each vas was cannulated with a blunt-ended 24 number needle attached to a 5 ml syringe containing a sterile solution of 0.1% ethacridine lactate; 2.5 ml of the solution was injected slowly down each vas before the ligation of both the proximal and the distal ends.
The skin incision was closed by applying Halax spray dressing. Benzathine penicillin was given to all these cases.
Each patient was reviewed at one week, one month and three months after the procedure. Examination of semen was carried out during this follow up visits. Specimens were collected by masturbation and examined immediately.
The subjects were in the 24-44 year age group. All had more than two living children.
During irrigation of the vas with ethacridine solution, all patients experienced a sensation in the posterior urethra which most of them have descr.bed as a desire to void.
The urine was yellowish in all cases for 24 hours after surgery. None of the patients had pain, dysuria, frequency or haematuria in the post-operative period.
Semen examination following vasectomy
[Table 1] shows the gross difference in the results of semen examination following vasectomy between the two groups The treated patients were azoospermic at all times tested.
Pus cells were present in all the specimens examined at different intervals, but the average number decreased with subsequent time intervals. The mean number of pus cells present in the irrigated group at the end of one week seems to be more than in the control group.
R.B.C.s (4-5/HPF) were present in one case from the control group; on the other hand they were present in 5 cases from the irrigated group at the end of one week. No R.B.C.s were detected at one month and three month interval specimens from both the groups.
Persistence of sperms, in the semen after vasectomy is wellknown. Medicolegally, two azoospermic specimens of semen 2 to 3 months after operation should be obtained before labelling the subject as sterile.
We routinely advise the use of condoms for a minimum period of 3 months after vasectomy. Many patients ignore this advice. Eight pregnancies were terminated in the Sassoon General Hospitals, Poona within a period of one year, for conception occurring after vasectomy operation. In all these cases, either ignorance or accidental rupture of the condom was the likely cause.
Ethacridine lactate (0.1%) is bacteriostatic as well as disinfectant. In our preliminary study on dog and human spermatozoa ethacridine lactate was observed to be a safe and effective spermicidal drug for inducing immediate sterility after vasectomy.  It causes instant immobilization and lysis of spermatozoa if used in 0.1% concentration.
The present study proves the safety and efficacy of ethacridine lactate for irrigation of the vas at the time of vasectomy. The presence of pus cells and R.B.C.s at one week specimen may be due to mild local irritation in the distal genital tract.
We are thankful to the Director of Medical Education and Research, Bombay and the Dean, B. J. Medical College, Poona for permitting us to conduct this experiment.
Our thanks are also due to Dr. U. D. Sutaria and Dr. S. P. Dani for their guidance and help.