060 Discrepancy Between Vasectomy Guidelines and Practice Patterns in the Post 2012 AUA Guideline Era: What have we Learned?

Abstract

In 2012, the American Urological Association published vasectomy guidelines to guide clinicians in best practices. To assess practice patterns of post-vasectomy semen analyses (PVSA) in a large, community cohort. We analyzed a database of men who underwent PVSA between 2011 and 2017 at a centralized laboratory. Samples were collected both on- and off- site. Samples collected off-site were transported to the laboratory in 40 ml of nutrient solution to maintain motility, if present. Samples were centrifuged if initial evaluation revealed azoospermia. Vasectomies were performed by both urologic and non-urologic providers in both academic and community settings. A total of 5,596 men underwent PVSA with 1,095 (19.5%) undergoing one or more repeat analyses. On initial analysis, 3,211 (57.4%) were azoospermic, 1,622 (28.9%) had rare non-motile sperm (<100k), 495 (8.8%) had >100k non-motile sperm, and 258 (4.6%) had motile sperm. Several observations were inconsistent with AUA guidelines. 11.7% (376) of patients with initial azoospermia had a repeat analysis, of whom 6.1% had rare non-motile sperm and 0.5% (2/376) had motile sperm (subsequent failure after initial clearance). 26.6% (431) of patients with rare non-motile sperm on initial semen analysis underwent repeat semen analysis, with 76.8% (331) of these men demonstrating azoospermia, 21.6% (93) with persistent non-motile sperm, and, importantly, 0% developing motile sperm. Of men with >100k non-motile sperm on initial analysis, 60.0% (297) did not obtain a repeat semen analysis, contrary to current AUA recommendations. Among the 198 men who did obtain a repeat analysis after an initial analysis with >100k non-motile sperm, 86.4% (167) were downgraded to either rare non-motile sperm or azoospermia at last semen analysis, 13.6% (27) had persistent >100k non-motile sperm, and 0% (0) subsequently developed motile sperm.