Impact of the 2012 American Urological Association Vasectomy Guidelines on Post-Vasectomy Outcomes

Abstract

Purpose The 2012 American Urological Association (AUA) vasectomy guidelines recommend the finding of rare nonmotile sperm, representing 100,000 or fewer nonmotile sperm per ml, as a metric of post-vasectomy success. At our institution success was previously defined as 2 sequential azoospermic centrifuged semen pellets. The criteria change of including rare nonmotile sperm as a success end point may simplify post-vasectomy followup and decrease the number of post-vasectomy semen analyses required to assure occlusive success. Materials and Methods In the context of the new 2012 guidelines we retrospectively reviewed and analyzed the records of 972 of the 1,740 vasectomies (55.9%) performed between January 2000 and June 2012 after which at least 1 post-vasectomy semen analysis was done. Results A total of 1,919 post-vasectomy semen analyses were obtained from 972 patients with a mean ± SE age of 39.7 ± 0.2 years. Occlusive success was evident in 337 azoospermic men (36.4%), while 514 (52.9%) underwent 2 or more post-vasectomy semen analyses and 458 (47.1%) returned for a single post-vasectomy semen analysis but were lost to followup. Of these noncompliant patients 76.0% were azoospermic, 19.7% had rare nonmotile sperm, 1.5% had greater than 100,000 nonmotile sperm per ml and 2.8% had motile sperm. Three patients underwent repeat vasectomy for persistent rare nonmotile sperm. If the criteria defined by the 2012 guidelines had been used to monitor these men, the occlusive success rate would have improved to 97.6% (949 patients) (p <0.05). Repeat vasectomies as well as 896 subsequent post-vasectomy semen analyses would have been avoided. Conclusions The AUA vasectomy guidelines provide clear, evidence-based criteria for vasectomy success. The guidelines simplify followup protocols, improve patient compliance and help avoid unnecessary post-vasectomy semen analyses and repeat vasectomies.

Impact of the 2012 American Urological Association Vasectomy Guidelines on Postvasectomy Outcomes in a Military Population

“…[11][12][13] Our original postvasectomy success rate, based solely on azoospermia, was 69%, which was lower than the estimated 76% reported in a civilian cohort. 8 After repeat analysis using the new guidelines, our postvasectomy success rate increased to 94% and was comparable with the current civilian rate of 97%, likely due to the inclusion of RNMS as success. 8 According to the 2012 AUA postvasectomy guidelines, 94.4% of our patients met the sterility criteria after 1 PVSA and 98.9% after the second PVSA.…”

“…8 After repeat analysis using the new guidelines, our postvasectomy success rate increased to 94% and was comparable with the current civilian rate of 97%, likely due to the inclusion of RNMS as success. 8 According to the 2012 AUA postvasectomy guidelines, 94.4% of our patients met the sterility criteria after 1 PVSA and 98.9% after the second PVSA. The difference in success rate from 1 PVSA to the addition of a second was marginal.…”

“…4,8,12,13 Despite these low compliance rates, no unintended pregnancies were reported in either the compliant or noncompliant group, and our contraceptive success rate was unchanged after application of the new guidelines.…”

“…7 These guidelines have reportedly improved patient compliance and have decreased repeat vasectomies, the number of semen analyses, and the time and use of alternate contraception while awaiting sterility results. 8 Despite equal access to health care in the military system, service members are frequently relocated and often deployed to austere combat environments, hampering follow-up. The 2012 AUA vasectomy guidelines were applied to our highly mobile, active-duty military population to determine the impact on patient compliance and postvasectomy success.…”

Optimizing outcomes in vasectomy: how to ensure sterility and prevent complications

“…Patient compliance with post-vasectomy semen analysis is poor. Multiple studies have suggested upwards of 50% of patients will not complete a single post-vasectomy semen analysis ( 8 , 14 - 16 ). By defining sterility as less than 100,000 non-motile sperm per milliliter, there has been a decrease in the number of repeat testing that has been performed and allows greater success rates at the first post-vasectomy semen analysis.…”