K A Sivardeen1, M Budhoo. 1. Department of Surgery, Manchester Royal Infirmary, Manchester, UK.
Abstract
BACKGROUND: Vasectomy is a safe and reliable means of contraception that is used by 42 million couples world-wide. There are no standardised guidelines in the follow-up of these patients to assess the efficacy of the procedure, however. Through this paper we aim to recommend a guideline that is both clinically effective and cost effective, and would avoid medicolegal debate. PATIENTS AND METHODS: A questionnaire was sent to consultant general surgeons and urologists working both within and outside the North-West region, to assess the range of protocols used in the follow-up of patients undergoing vasectomy. RESULTS: Of respondents, 75% sent the vas deferens routinely for histology: 90.4% requested 2 sperm samples routinely whilst 4.8% requested 1 sample and 4.8% requested 3 samples. 95.2% requested further sperm samples if non-motile sperm were present. 98.8% performed their first sperm sample by 12 weeks. CONCLUSIONS: There is a wide range of protocols used in the follow-up of patients post-vasectomy. Most do not appear to be evidence-based. We recommend a guideline which re-emphasises the importance of pre-operative counselling, only 1 routine sperm sample taken 16 weeks post-vasectomy, and further samples taken only if motile sperm is seen. Non-motile sperm is not an indication for further sperm samples. We believe this guideline would be both clinically effective and cost effective.
BACKGROUND: Vasectomy is a safe and reliable means of contraception that is used by 42 million couples world-wide. There are no standardised guidelines in the follow-up of these patients to assess the efficacy of the procedure, however. Through this paper we aim to recommend a guideline that is both clinically effective and cost effective, and would avoid medicolegal debate. PATIENTS AND METHODS: A questionnaire was sent to consultant general surgeons and urologists working both within and outside the North-West region, to assess the range of protocols used in the follow-up of patients undergoing vasectomy. RESULTS: Of respondents, 75% sent the vas deferens routinely for histology: 90.4% requested 2 sperm samples routinely whilst 4.8% requested 1 sample and 4.8% requested 3 samples. 95.2% requested further sperm samples if non-motile sperm were present. 98.8% performed their first sperm sample by 12 weeks. CONCLUSIONS: There is a wide range of protocols used in the follow-up of patients post-vasectomy. Most do not appear to be evidence-based. We recommend a guideline which re-emphasises the importance of pre-operative counselling, only 1 routine sperm sample taken 16 weeks post-vasectomy, and further samples taken only if motile sperm is seen. Non-motile sperm is not an indication for further sperm samples. We believe this guideline would be both clinically effective and cost effective.