Author(s): Barclay J., Gujadhur R., Thorpe A., Thomas D., McCann A., Lee L., Pantelides M., Crump A.
Abstract: INTRODUCTION & OBJECTIVES: Vasectomy is a widely used method of male contraception worldwide, particularly in the UK. There has, however, until recently been broad variation in the follow-up protocols of post-vasectomy patients especially with regards to a) timing and b) number of semen analyses required. Current UK practice, based on the 2002 British Andrology Society guidelines, recommend that patients need to provide 2 negative semen samples at least 4 weeks apart and no sooner than 16 weeks post-surgery before clearance can be given. The 2012 EAU & AUA guidelines both recommend a single semen analysis at approximately 12 weeks showing azoospermia or persistent non-motile sperm (PNMS) of <100,000/mL is adequate to confirm operative success. Routine histological analysis of the vas is also not advocated. We discuss whether adopting these guidelines would improve both patient compliance and financial cost. MATERIAL & METHODS: A retrospective review of all the patients that underwent a vasectomy over a two year period (2012-13) in the North-Eastern centre (N.E.C) and over a one year period (2012) in the North-Western centre (N.W.C) was conducted. Operative reports, electronic pathology databases, outpatient attendance records and correspondence letters were then reviewed to determine outcomes. Local policy regarding post-vasectomy follow-up in the centres varied. The N.E.C's local policy was for 2 post-vasectomy semen analyses to be performed at 12 and 16 weeks post procedure. The N.W.C's local policy was for a single post-vasectomy semen analysis to be performed at 18 weeks post procedure. In both centres, if there were spermatozoa present following these samples, further samples are requested at 4 week intervals until 2 azoospermic samples were submitted. Special clearance was given at the operating surgeon's discretion. RESULTS: 497 patients underwent a vasectomy at one of the 3 hospitals during the study period (276 patients from the N.E.C; 221 patients from the N.W.C). 24% of patients provided no post-vasectomy semen samples at all despite having formal written requests on 2 occasions. 76% of patients (78% N.E.C; 74% N.W.C) provided a first sample when requested. 67% (56% N.E.C; 78% N.W.C) of patients that provided the requested initial samples (2 samples in N.E.C, 1 sample in N.W.C) were confirmed azoospermic. The remaining 33% of patients with PNMS, or persistent motile sperms (only 2 patients) had further semen samples requested at 4 week intervals. Of these, 68% achieved azoospermia after submitting further samples, 27% of patients with PNMS provided no further samples following their initial samples, despite written requests. 5% of patients still had PNMS after several further samples and were given special clearance. Routine histology of the vas was performed in all patients. CONCLUSIONS: Our results indicate that if we applied the new EAU and AUA guidelines, clearance could have been given to 98% of our patients on their first semen analysis, at 16-18 weeks post vasectomy. It is also worth noting that histological confirmation of a transected vas does not equate to operative success medico-legally. As a result of adopting these guidelines, fewer post-vasectomy semen samples would be required, and as such, we believe that not only would compliance rates improve, but a cost saving of upwards of 15,400 would have been achieved. From our data, we would recommend the adoption of current EAU and AUA vasectomy guidelines for UK practice.
Publication Type: Journal: Conference Abstract