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Vasectomies seasonal? Think holidays and basketball!

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March and the end of the calendar year have the highest proportion of vasectomies performed in the U.S. population.

Background: Vasectomy is a common and safe urologic procedure providing permanent sterilization. Despite ubiquitous use in the United States, temporal trends and actual number of vasectomies performed are poorly understood.

Objective: To estimate the annual number of vasectomies performed in the U.S. population including changes over time, monthly variation, and demographic information.

Design: Query of claims data.

Methods: Truven Health MarketScan claims data were obtained. Estimates of number of possible men who could have obtained vasectomy were taken from census data. Claims data only included men with private insurance.

Results: Data from 2007 to 2015 was included. Authors estimated 527,000 vasectomies occur yearly in the United States. Prevalence of vasectomy decreased across all age groups and regions during the time period. Men aged 35 to 44 years were the most likely to get vasectomy (1.3% of population) followed by men aged 25 to 34 years (0.98%). The proportion by location was highest in the North Central (0.66%) followed by the West Coast (0.61%), the South (0.50%), and the Northeast (0.41%). Urologists performed the largest proportion of vasectomies (82%) followed by primary care doctors (6.4%). More than 80% of all vasectomies are performed in the office setting. A slight increase is seen in March of the calendar year with much higher proportions of vasectomies occurring at the end of the calendar year.

Conclusions: Approximately 0.5% to 0.6% of the eligible male population has a vasectomy on a yearly basis. Trends are seen based on age, geography, and month of the year.

Reviewer’s Comments:

The monthly increases at the end of the year and in March around the NCAA (National Collegiate Athletic Association) college basketball tournament are real and seen in clinical practice.

This is not the type of study that necessarily changes the practice of urologists but is still interesting although possibly you could increase the number of vasectomy spots in the higher demand months to catch on the trends. The overall trend seen during the study years is likely due to the financial recovery after the crash of 2008. Although not examined here, previous studies have found correlations between vasectomies, vasectomy reversals, and financial indicators.(Reviewer–Charles Welliver, MD).

Bananas and Vasectomies-Oh my!

Don’t “slip-up!”

Dr. McHugh’s chocolate lab Penelope is famous on AccessWDUN!

Everything you wanted to know about a vasectomy but your wife forgot to ask!

Georgia Vasectomy/Vasectomy Reversal-John McHugh M.D.

“Dr. McHugh has a top 5% badge, because he treated more vasectomy patients than 95% of similar doctors nationwide for 2014–2018.” Amino.com, Inc.

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Considering a vasectomy or know someone who is? Take a look at Dr. McHugh’s Ebook or share with someone it may benefit.

Vasectomy- Everything you wanted to know about a vasectomy but your wife was forgot to ask!

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Vasectomy Reversal-What a Woman Wants to Know.

Georgia Vasectomy/Vasectomy Reversal-John McHugh M.D.

From Vasectomy.com

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The decision to reverse a vasectomy should be considered carefully by each couple. As a woman, you may have special concerns that are difficult to express.

Vasectomy reversal (and the microsurgery involved) raises questions for both men and women. Although men need to be forthcoming about any questions, concerns and fears they share with their physician, it is just as important for women to be informed and reassured about the procedure. You may be surprised to know that many women share the apprehensions about reversal surgery that you may have.

Candid questions, correct information, and the assurance of an experienced urologist are the keys to feeling more comfortable and sure about the decision you and your spouse have made to have a vasectomy reversal. Make a list of the questions that concern you most before meeting with your doctor.

Here are some of the questions women commonly ask:

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Vasectomy…oh happy days!

Talk about options for having a vasectomy…

  1. No needle No scalpel vasectomy done in the office with pre-procedure medications (sedative and pain pill).
  2. Special fair pricing for self-pay
  3. Special fair pricing for high deductible
  4. We accept most all major insurances-if we are out of network with yours we’ll still try to work with you and try to match their benefits as we were in network!
  5. I.V. general anesthesia for the patient who prefers being “asleep” and just waking up and its over!
  6. A vasectomy can be done any day of the week-I.V. anesthesia on Tuesday or Thursdays.
  7. One small “grain of rice” sized opening.
  8. We’ve done a “whole bunch” of vasectomies in our 30 plus years of doing vasectomies.

“Dr. McHugh is in the top 5% of physicians who see vasectomy patients in the U.S. 2014-1018.” -Amino. com, inc. 

Water Water Water Everywhere…now drink it! Prevents bladder infections.

Patients with cystitis should be objectively educated on pros and cons of increasing water intake.

 

Background: Increased water intake is commonly recommended to prevent recurrent cystitis in premenopausal women, but the overall conclusive evidence and research is weak.

Objective: To determine the impact of increasing daily water intake on recurrent cystitis frequency.

Design: Randomized, open-labeled, controlled, 12-month clinical conducted at 1 research center in Sofia, Bulgaria, but also overseen by U.S. researchers and supported by Danone Research.

Methods: 140 healthy women with ≥3 episodes of recurrent cystitis in the past year consuming <1.5 L (approximately 51 ounces) fluid daily were included. Baseline, 6-month, and 12-month visits occurred along with monthly phone calls. Participants were assigned to drink their normal fluid intake in addition to 1.5 L of water or no extra fluids (control group) for 12 months. Mean age was 35 years.

Results: Mean number of episodes was 1.7 for water and 3.2 for control (P <0.001). Mean number of antibiotic treatments used to treat cystitis was 1.9 and 3.6 (P <0.001). Mean time between episodes was 142.8 and 84.4 days (P <0.001). Participants in the water group versus control had increased mean urine volume (P <0.04) and voids and reduced urine osmolality (both P <0.001).

Conclusions: Increased water consumption is an effective antibiotic-reducing method to prevent recurrent cystitis in high-risk premenopausal women who usually drink low levels of fluids daily.

Reviewer’s Comments: The occasional Internet advice to consume 8 glasses of water per day to improve your health has minimal to no evidence, but preliminary research is beginning to support something similar to this practice in urology to prevent kidney stones and now perhaps recurrent cystitis in premenopausal women who usually consume low levels of fluids (average of 0.5 L or 17 ounces/day). This is an unusually low amount (basically 2 cups of water per day) that was being consumed at baseline. What was missed is that 20% to 25% on average of fluid or water intake in humans actually comes from food sources, and this was not taken into account or addressed, which is surprising. In addition, the study occurred in Bulgaria at a clinical research center and not in the United States despite the slight indirect implication, and a commercial water source funded the study. Side effects were similar between the groups. Regardless, discussing fluid intake with patients is a logical, practical, and cost-effective option for patients that fit the criteria of this study.(Reviewer–Mark Moyad, MD, MPH).

Article Reviewed: Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. Hooton TM, Vecchio M, et al: JAMA Intern Med; 2018;178 (November 1): 1509-1515.

Vasectomy message boards…are they helpful? Well…yes and no.

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Online themes focus on relaying personal experience or to obtain information on expectations after vasectomy.

I was told by a lawn management consultant that the soccer field I was trying to improve was of the “Heinz 57” variety. In other words a mixture of many types of grass and weeds. Decision making in medicine, and having a vasectomy and who will do it,  is often the result of the accumulation of a hodgepodge of information.

I have told my prostate caner patients for years to learn from the internet, friends, family, books and yes…wait for it…your doctor to arrive at a decision about your medical care that is best for you. Getting a vasectomy is no different. So…take what you get from others, all others, with a proverbial grain of salt!  J.M.

Background: Patients are increasingly utilizing the internet to gain knowledge and information about disease states and treatments.

Objective: To identify common themes and usages of online message boards focused on vasectomy.

Design: Review of online content from patients.

Methods: Using the search term “vasectomy,” internet discussion boards were identified. The 3 discussion boards with the most posts were selected for investigation. An iterative and structured analysis process was undertaken to determine common themes.

Results: 129 posts from the 3 message boards were examined. The 2 most common topics were changes in sexual function after vasectomy and pain after vasectomy. Changes in sexual function included a variety of concerns including unexpected genital or sexual issues arising after vasectomy. Declines in sexual drive, erection quality, and orgasmic or ejaculatory changes were described. Posts relating to pain around vasectomy discussed concerns related to a “normal” amount of postprocedural pain or how to manage pain after vasectomy. Other topics included planning for postvasectomy care, potential issues after vasectomy, and feelings about a vasectomy. Overall, online content roughly divided into 2 uses – sharing personal experiences regarding vasectomy and to get information about what to expect, and how to manage issues that may arise after vasectomy. Medical provider input was not seen, and while some factual content was identified, personal opinion was more common.

Conclusions: Internet message boards on vasectomy focus on information exchange and personal experience. Factual content is limited, and medical provider input is uncommon.

Reviewer’s Comments: This is an interesting study that analyzes how men use the internet to discuss vasectomy. I am generally positive on patients using the internet to gain a functional knowledge of medical conditions if they are open to additional education during our visit. The use here of patients being able to relate to other men either before or after their vasectomy is a benefit as this personal type of interaction is not part of the usual patient-physician interaction. Online message board content is of course subject to the patients who decide to post and may be skewed by patients with poor outcomes. The aforesaid findings can potentially help providers counsel patients on expectations after vasectomy.(Reviewer–Charles Welliver, MD).

Article Reviewed: A Thematic Analysis of Online Discussion Boards for Vasectomy. Samplaski MK: Urology; 2018;111 (January): 32-38.

Vasectomy vs. tubal ligation-Which is more common?

The prevalence of vasectomy was 6.6% (compared with a tubal ligation prevalence of 16.35%).

Many factors, including social, medical, and unknown reasons, contribute to the decision of a couple to proceed with one form or another of surgical sterilization.

Objective: To describe the demographics and family planning attitudes of vasectomized men.

Design: Retrospective cohort analysis of National Survey for Family Growth data collected through the National Center for Health Statistics between June 2006 and June 2010.

Methods: The survey sampled 10,403 men from various urban and rural communities, aged 15 to 45 years, regarding family planning attitudes. These sampled statistics could be extrapolated to provide a reasonably accurate national survey portrait.

Results: The prevalence of vasectomy was 6.6% (compared with a tubal ligation prevalence of 16.35%). The odds ratios (OR) for having a vasectomy in this sample were: currently married 7.8; previously married 5.8; and increased age 1.1. The odds increased with increased number of biologic children. Examples of factors decreasing the odds of having a vasectomy were: immigrant status (OR 0.18); African American (OR 0.22); Hispanic (OR 0.054); or Catholic (OR 0.55). Also, this survey determined that 19.6% of vasectomized men expressed a desire for future children suggesting a higher than previously recognized prevalence of sterilization regret; yet only 1.9% of vasectomized men in the sample reported having a reversal.

Conclusions: Many factors, some social, some medical, some unknown, contribute to the decision of a couple to proceed with one form or another of surgical sterilization.

Reviewer’s Comments: As pointed out in this article, there are many factors that contribute to the decision to cease further childbearing. A permanent sterilization procedure is a popular choice, particularly among married couples. The demographic factors that tilt a couple towards tubal ligation or vasectomy are explored in this article, and the data promote lively speculation.(Reviewer–Berel Held, MD).

Article Reviewed: Vasectomy Demographics and Postvasectomy Desire for Future Children: Results From a Contemporary National Survey. Sharma V, Le BV, et al: Fertil Steril; 2013;99 (June): 1880-1885.