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

DeRosa, Raffaella; Lustik, Michael B.; Stackhouse, Danielle A.; McMann, Leah P.

doi:10.1016/j.urology.2014.11.010

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…This amendment resulted in higher rates of occlusive success at the first PVSA, from 69% to 94% in a study of 1623 active service members. The same study showed that foregoing a second PVSA in men with RNMS resulted in significant cost saving by reducing unneeded testing and unnecessary repeat vasectomies 4. Furthermore, compliance with testing decreases with subsequent PVSAs 3.…”

Section: Discussionmentioning

confidence: 90%

“…In 2012, the AUA released guidelines regarding various aspects of vasectomy care including the timing for obtaining PVSAs and their interpretation. These guidelines have been shown to improve compliance, decrease the use of multiple PVSAs, and reduce the number of repeat vasectomies in civilian and military urologic practices 3467. The implementation and use of these guidelines by nonurologists (FMPs) has not previously been studied.…”

Section: Discussionmentioning

confidence: 99%

“…The goals of the protocol recommended by the AUA were to simplify postvasectomy practices, increase patient compliance, and optimize the timing so as to confirm occlusive effectiveness at the soonest possible time while minimizing the number of PVSAs needed 2. Studies of both civilian and military urologic practices have shown that the AUA guidelines have been successful in improving compliance, avoiding unnecessary PVSAs, and reducing repeat vasectomies 34. Although these guidelines are available to all physicians, their implementation in nonurologic practices has not been studied.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

et al. 2019

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Urologists perform the majority of vasectomies in the United States; however, family medicine physicians (FMPs) perform up to 35%. We hypothesized that differences exist in practice patterns and outcomes between urologists and FMPs. Patients who underwent a vasectomy from 2010 to 2016 were identified. Postvasectomy semen analysis (PVSA) practices were compared between urologists and FMPs, before and after release of the 2012 AUA vasectomy guidelines. From 2010 to 2016, FMPs performed 1435 (35.1%) of all vasectomies. PVSA follow-up rates were similar between the two groups (63.4% vs 64.8%, P = 0.18). Of the patients with follow-up, the median number of PVSAs obtained was 1 (range 1–6) in both groups (P = 0.22). Following the release of guidelines, fewer urologists obtained multiple PVSAs (69.8% vs 28.9% pre- and post-2012, P < 0.01). FMPs had a significant but lesser change in the use of multiple PVSAs (47.5% vs 38.4%, P < 0.01). Both groups made appropriate changes in the timing of the first PVSA, but FMPs continued to obtain PVSAs before 8 weeks (15.0% vs 6.5%, P < 0.01). FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks, the earliest recommended by the AUA guidelines (4.1% vs 1.3%, P < 0.01). Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012. In summary, FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation, suggesting less penetration of AUA guidelines to nonurology specialties. Furthermore, FMPs had more positive results on PVSAs obtained within the recommended window.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

et al. 2019

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“…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.…”

Section: Ensuring Sterilitymentioning

confidence: 99%

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

Lowe

2016

Transl. Androl. Urol.

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Vasectomy provides a long-term effective sterilization for men and is performed on nearly 500,000 men annually in the United States. Improvements in technique have led to a decreased failure rate and fewer complications, although significant variations in technique exist. Use of cautery occlusion with or without fascial interposition appears to have the least failures. A no-scalpel approach lowers risk of hematoma formation, infection and bleeding post-operatively. A patient can be considered sterile when azoospermia is achieved or the semen analysis shows less than 100,000 non-motile sperm per milliliter. Incorporating these principles may allow the physician to optimize outcomes in vasectomy.

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“…However, the AUA guidelines do not specify a recommended type of secondary contraceptive method that should be used ( 9 ). Reported rates of compliance with PVSA are low and estimated to range from 48–71% ( 9 , 13 , 14 ). Similarly, use of secondary contraception following vasectomy is also thought to be low; however evidence is limited ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Use of secondary contraception following vasectomy: insights from the Pregnancy Risk Assessment Monitoring System, 2007–2011

Patel

Williams

Warner

et al. 2018

Transl. Androl. Urol.

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BackgroundTo assess postpartum use of secondary contraception with vasectomy within Pregnancy Risk Assessment Monitoring System (PRAMS).MethodsSecondary contraception and type of method used were assessed among married women reporting partner vasectomy 4 months after a recent live birth in female residents of 15 US states and New York City who participated in the 2007–2011 PRAMS.ResultsBetween 2007 and 2011, 1,004 married women who had a recent live birth participating in PRAMS reported they and their partners relied on vasectomy for postpartum contraception. Among these couples, 57.8% reported not using additional forms of contraception postpartum. Of those reporting additional contraception, condoms were most commonly used (50.0%), followed by oral contraceptive pills (26.5%), and withdrawal (9.5%). Multivariable modeling showed that use of secondary contraception was twice as high among women reporting a second birth versus women reporting a fourth or higher birth [adjusted prevalence odds ratio (POR) =2.0 (1.1–3.2)]. No other sociodemographic characteristics (maternal age, maternal race, parental education, household income) were significantly associated with use of secondary contraception with vasectomy.ConclusionsMost couples within PRAMS reporting partner vasectomy as postpartum contraception did not use secondary contraception in the months immediately after vasectomy, and, of those who did, most relied on less effective methods. Clinicians need to better understand reasons for limited use of secondary contraception with vasectomy to improve counseling strategies for reducing unintended pregnancy.

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

Cited by 10 publications

References 19 publications

Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

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

Use of secondary contraception following vasectomy: insights from the Pregnancy Risk Assessment Monitoring System, 2007–2011

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