Patient Non-Compliance With Vasectomy Follow-Up
Urology – September 30, 2013 – Vol. 30 – No. 10
Nearly 50% of patients do not perform post-vasectomy requested semen analysis.
Article Reviewed: Compliance With Semen Analysis. Duplisea J, Whelan T: J Urol; 2013;189 (June): 2248-2251.
Background: Nearly half a million men undergo vasectomy in the United States each year. While this is generally a straightforward procedure, it is not 100% successful. Post-vasectomy semen analysis helps the physician confidently determine if the procedure was successful, but no consensus exists to guide post-vasectomy semen analysis routine; the 2012 AUA guidelines suggest a single negative sample performed 8 to 16 weeks post-procedure, and <100,000 sperm/mL (non-motile) is considered a success. Patient compliance with post-vasectomy semen analysis is low and few studies review the reasons for poor compliance.
Objective: To determine which men are more or less likely to comply with requested post-vasectomy semen analysis based on demographic data.
Design/Methods: The authors performed a retrospective review of 946 men undergoing vasectomy at a single institution/single surgeon performed between January 2002 and December 2009. For this particular surgeon, post-vasectomy semen analysis was requested for 2 samples 16 weeks after vasectomy. The information was reiterated during vasectomy and written instructions were provided. The surgeon removed a piece of vas for pathologic analysis.
Results: The mean age of vasectomy patients was 33.6 years and they had a mean of 2.15 children before vasectomy. Over 80% of men were married and the complication rate was 3.4%. Complications were mostly hematoma and sperm granuloma. Vasectomy was repeated in 4 men, 3 of whom requested the repeat due to persistent non-motile sperm. Nearly 50% of men submitted no samples (48%) and 16% only submitted 1 sample. Men who were noncompliant tended to be aged <34 years, had ≥3 children, and did not have complications. Based on further logistic regression analysis, only an increased number of children was predictive of noncompliance.
Conclusions: Men with more children, of younger age, and without complications tend to be less likely to submit a post-vasectomy semen analysis. While the best protocol for post-procedure evaluation remains to be determined, increasing compliance is in the best interest of the physician.
Reviewer’s Comments: The most recent AUA guidelines do not suggest that pathologic analysis is necessary during a vasectomy, making post-vasectomy semen analysis the determinant of success. Unfortunately, as nearly all urologists experience, the majority of patients are not compliant with post-vasectomy semen analysis. The authors requested 2 post-vasectomy semen analysis samples and this was only completed by 36% of patients. Based on the guidelines, only 1 patient truly required a repeat procedure. Even with low failure rates, vasectomy remains a frequently litigated urologic procedure and physicians want to ensure success. As much as can be reiterated to the patient, obtaining a single semen analysis at least 8 weeks post-procedure should be the goal of all physicians performing vasectomy.(Reviewer–Gregory Lowe, MD).