INTRODUCTION: The 2012 AUA Vasectomy Guidelines recommended the finding of rare non-motile sperm (RNMS), representing the presence of = 100,000 non-motile sperm/mL, as a metric of post-vasectomy success.
Our institution previously defined success as two sequential azoospermic centrifuged semen pellets. The criteria change of including RNMS as a success endpoint may simplify post-vasectomy follow-up and reduce the number of post-vasectomy semen analyses (PVSA) required to assure occlusive success.
MATERIALS AND METHODS: Of 1,740 vasectomies performed between January 2000 and June 2012, 972 (55.9%) with at least one PVSA comprised the cohort and were retrospectively reviewed and analyzed in the context of the new 2012 Guidelines.
RESULTS: A total of 1919 PVSA were obtained on 972 patients (mean age=39.7 ± 0.2 years). Occlusive success was evident in 337 azoospermic subjects (36.4%), while 514 (52.9%) men underwent = 2 PVSA and 458 men (47.1%) returned for a single PVSA but were then lost to follow-up. Of these non-compliant patients, 76.0% were azoospermic, 19.7% had RNMS, 1.5% had >100,000/mL non-motile sperm, and 2.8% men had motile sperm. Three patients underwent repeat vasectomy for persistent RNMS. If the criteria defined by the 2012 Guidelines had been used to monitor these patients, the occlusive success rate would have improved to 97.6% (n=949; p< 0.05). The repeat vasectomies, as well as 896 subsequent PVSA, would have been avoided.
CONCLUSIONS: The AUA Vasectomy Guidelines provide clear, evidence-based criteria for vasectomy success. The Guidelines simplify follow-up protocols, improve patient compliance, and help avoid unnecessary PVSA and repeat vasectomies.
Coward RM, Badhiwala NG, Kovac JR, Smith RP, Lamb DJ, Lipshultz LI. Are you the author?
Scott Department of Urology, Baylor College of Medicine, Houston, TX, United States.
Reference: J Urol. 2013 Aug 2. pii: S0022-5347(13)05052-0.