2293 IMPACT OF THE 2012 AUA VASECTOMY GUIDELINES ON POST-VASECTOMY OUTCOMES

Abstract

You have accessJournal of UrologyInfertility: Evaluation1 Apr 20132293 IMPACT OF THE 2012 AUA VASECTOMY GUIDELINES ON POST-VASECTOMY OUTCOMES Niraj Badhiwala, Robert Coward, Ryan Smith, Jason Kovac, Tung-Chin Hsieh, Matthew McIntyre, Lata Murthy, Dolores Lamb, and Larry Lipshultz Niraj BadhiwalaNiraj Badhiwala Houston, TX More articles by this author , Robert CowardRobert Coward Houston, TX More articles by this author , Ryan SmithRyan Smith Houston, TX More articles by this author , Jason KovacJason Kovac Houston, TX More articles by this author , Tung-Chin HsiehTung-Chin Hsieh Houston, TX More articles by this author , Matthew McIntyreMatthew McIntyre Houston, TX More articles by this author , Lata MurthyLata Murthy Houston, TX More articles by this author , Dolores LambDolores Lamb Houston, TX More articles by this author , and Larry LipshultzLarry Lipshultz Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2234AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 2012 AUA Vasectomy Guidelines have proposed the inclusion of rare, non-motile sperm (RNMS), in addition to azoospermia, as endpoints of post-vasectomy success. Our institution, and many others, have previously defined success as two sequential centrifuged semen pellets demonstrating azoospermia. Inclusion of RNMS, defined as the presence of ≤ 100,000 non-motile sperm/mL, has the potential to reduce the number of repeat semen analyses and diminish the time to determination of a successful vasectomy. Using post-vasectomy semen analysis (PVSA) data, we examined our previous outcomes within the context of the new 2012 AUA Vasectomy Guidelines. METHODS All men undergoing vasectomy (n=1415) with subsequent PVSA between November 1999 and June 2012 were retrospectively reviewed. The majority (n=1009, 71%) had vasectomies performed by a single surgeon. Demographics and PVSA were obtained from an IRB-approved institutional database. Total number of PVSA, success rate, need for repeat vasectomy, and compliance with scheduled follow-up were reviewed and re-analyzed using the 2012 AUA Vasectomy Guidelines. RESULTS A total of 2468 PVSAs were obtained in 1415 patients with a mean age of 39.3 ± 6.8 years. Vasectomy success, defined as azoospermia after two sequential pellet analyses, was identified in 388 patients (27.4%). Of the remaining patients, 793 (56.0%) had only one PVSA and were then lost to follow-up, while 622 patients (44.0%) underwent 2 or more PVSA due to lack of pelleted azoospermia. Of those, 556 (70.1%) ultimately had azoospermia, 192 (24.2%) had RNMS, 12 (1.5%) had > 100,000/mL non-motile sperm, and 33 (4.1%) had motile sperm. Four patients underwent repeat vasectomy for persistent RNMS. Upon re-analysis using the 2012 AUA Vasectomy Guidelines, success rates would have been 96.4% (n=1364; p < 0.05). Since all four repeat vasectomies were done for the continued presence of RNMS, they would have been deemed unnecessary using the new guidelines. Moreover, 994 PVSAs would have been avoided using the 2012 AUA Vasectomy Guidelines. Compliance would have improved to 96.4% from the 56.0% that did not return for their second PVSA. CONCLUSIONS The 2012 AUA Vasectomy Guidelines provide clear, evidence-based criteria for vasectomy success. The Guidelines simplify follow-up protocols, improve patient compliance, and help avoid unnecessary PVSAs and repeat vasectomies. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e940 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niraj Badhiwala Houston, TX More articles by this author Robert Coward Houston, TX More articles by this author Ryan Smith Houston, TX More articles by this author Jason Kovac Houston, TX More articles by this author Tung-Chin Hsieh Houston, TX More articles by this author Matthew McIntyre Houston, TX More articles by this author Lata Murthy Houston, TX More articles by this author Dolores Lamb Houston, TX More articles by this author Larry Lipshultz Houston, TX More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...