ABSTRACT
OBJECTIVE
To ensure procedure success, American Urological Association Guidelines recommend
postvasectomy semen analysis (PVSA); however, current literature suggests poor compliance.
We sought to measure PVSA compliance and assess barriers to completion.
METHODS
A retrospective review was performed of vasectomies at San Diego Veterans Administration
Hospital and UC San Diego Health between 2006 and 2018. Patients received preprocedural
counseling regarding semen analysis necessity. Postprocedural management included
follow-up visit within 2-4 weeks and semen analysis after 15-20 ejaculations. Demographics
and periprocedural variables were collected. Telephone interviews assessed patient
reported reasons for noncompliance. Multivariable analysis was performed for factors
associated with semen analysis.
RESULTS
503 men, mean age 38.8 years, underwent vasectomy at San Diego Veterans Administration
Hospital (n = 331) and UC San Diego (n = 172). Overall, 80% completed clinical follow-up (n = 401) and 53% completed semen analysis (n = 268). The cohorts exhibited significantly different rates of semen analysis completion
(46% vs 67%, P <.001) and clinical follow-up (64% vs 85%, P = .038). No difference was observed in age, fatherhood, or marital status. On multivariable
analysis, fatherhood was the only factor associated with noncompliance of semen analysis
(odds ratio 0.52, 95% confidence interval 0.33-0.83). Among men interviewed, the primary
barriers to semen analysis completion were distance (38%), time constraints (34%),
and forgetfulness (23%). Ninety-two% reported increased likelihood of completion with
home-based semen testing.
CONCLUSION
Patients demonstrated poor PVSA compliance despite preprocedural counseling. Given
that distance and time constraints limited compliance, incorporating home-based semen
testing may improve the quality of care for men undergoing vasectomy.
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Article info
Publication history
Published online: November 25, 2019
Accepted:
October 15,
2019
Received:
September 2,
2019
Footnotes
Financial Disclosure: The authors have no financial acknowledgements or affiliations to disclose in relation to this manuscript.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
