Low Compliance to post-Vasectomy Semen Analysis Guidelines in Veterans
Post-vasectomy semen analysis (PVSA) is required to confirm the success of vasectomy per AUA guidelines. However, patient compliance to PVSA is unknown. We sought to determine the PVSA compliance rate and to identify factors that predicted compliance to the PVSA testing.
We performed a retrospective review of men who underwent vasectomy at our Veterans Administration hospital between January 2006 and December 2016. All patients underwent one or more pre-procedure counseling. Counseling emphasized that PVSA was required for definitive confirmation of the procedure’s success and that contraception must be used until negative PVSA. Vasectomies were performed with local anesthesia in the office setting or under monitored anesthesia in the operating room. Specimens were sent for pathologic confirmation of vas. Post-vasectomy management included follow-up in 2-4 weeks and PVSA in 2-3 months or after 15-20 ejaculations. The PVSA compliance rate was calculated. Univariate and multivariable logistic regression analyses were performed to elucidate factors that predicted PVSA compliance.
331 men with mean age of 38 years underwent vasectomy. 84% were married and 88% had children. 78% of the vasectomies were performed in the office. Only 153 men completed PVSA, representing 46% compliance rate which remained stably low over time (Fig. 1). On univariate analysis, the PVSA group were less likely to have kids (84% vs 92%, p=0.033) and more likely to follow-up for post-procedure visit (86% vs 69%, p=0.00019) compared to the No-PVSA group. There was no difference between groups in terms of age, race, marital status, procedure year or location, procedure-specific factors, pathologic findings or complication. On multivariate analysis, attending post-vasectomy visit was associated with increased odds (OR 2.84, 95% CI 1.46-5.49) whereas fatherhood was associated with decreased odds (OR 0.37, 95% CI 0.17-0.83) of PVSA compliance
Despite peri-procedural counseling, only 46% of veterans complied with PVSA requirement. Men without kids and those who attended post-vasectomy visit were more likely to comply with PVSA. Future studies to better understand the barriers and to develop new testing technique are needed to improve compliance