Impact of the 2012 American Urological Association
Vasectomy Guidelines on Post-Vasectomy Outcomes
Robert M. Coward, Niraj G. Badhiwala, Jason R. Kovac, Ryan P. Smith,
Dolores J. Lamb and Larry I. Lipshultz*,†
From the Scott Department of Urology, Baylor College of Medicine, Houston, Texas
Purpose:
The 2012 American Urological Association (AUA) vasectomy guidelines
recommend the fnding oF rare nonmotile sperm, representing 100,000 or Fewer
nonmotile sperm per ml, as a metric oF post-vasectomy success. At our institution
success was previously defned as 2 sequential azoospermic centriFuged semen
pellets. The criteria change oF including rare nonmotile sperm as a success end
point may simpliFy post-vasectomy Followup and decrease the number oF post-
vasectomy semen analyses required to assure occlusive success.
Materials and Methods:
In the context oF the new 2012 guidelines we retro-
spectively reviewed and analyzed the records oF 972 oF the 1,740 vasectomies
(55.9%) perFormed between January 2000 and June 2012 aFter which at least 1
post-vasectomy semen analysis was done.
Results:
A total oF 1,919 post-vasectomy semen analyses were obtained From
972 patients with a mean
±
SE age oF 39.7
±
0.2 years. Occlusive success was
evident in 337 azoospermic men (36.4%), while 514 (52.9%) underwent 2 or more
post-vasectomy semen analyses and 458 (47.1%) returned For a single post-
vasectomy semen analysis but were lost to Followup. OF these noncompliant
patients 76.0% were azoospermic, 19.7% had rare nonmotile sperm, 1.5% had
greater than 100,000 nonmotile sperm per ml and 2.8% had motile sperm. Three
patients underwent repeat vasectomy For persistent rare nonmotile sperm. IF the
criteria defned by the 2012 guidelines had been used to monitor these men, the
occlusive success rate would have improved to 97.6% (949 patients) (p
<
0.05).
Repeat vasectomies as well as 896 subsequent post-vasectomy semen analyses
would have been avoided.
Conclusions:
The AUA vasectomy guidelines provide clear, evidence-based
criteria For vasectomy success. The guidelines simpliFy Followup protocols,
improve patient compliance and help avoid unnecessary post-vasectomy semen
analyses and repeat vasectomies.
Key Words:
testis; sterilization, reproductive; semen analysis;
reoperation; guideline
V
ASECTOMY
is the most common uro-
logical procedure in the United States
with an estimated 500,000 or more
perFormed annually.
1,2
Although it is
eFFective, saFe and more cost eFfcient
with Faster convalescence than Female
sterilization, vasectomy is the second
most common Form oF permanent
sterilization.
3
In
2012
a
panel
comprising experts From the AUA
defned
evidence-based
vasectomy
guidelines.
4
These
guidelines
are
Abbreviations
and Acronyms
PVSA
¼
post-vasectomy semen
analysis
RNMS
¼
rare nonmotile sperm
Accepted for publication July 25, 2013.
Study received approval from the Baylor
College of Medicine institutional review board
for the protection of human subjects.
* Correspondence: 6624 Fannin St., Suite
1700, Houston, Texas 77030 (telephone: 713-
798-6163; FAX: 713-798-6007; e-mail: larryl@
bcm.edu
).
†
Financial interest and/or other relationship
with Eli Lilly, Endo, Auxilium, Pfizer, Allergan and
American Medical Systems.
0022-5347/14/1911-0169/0
THE JOURNAL OF UROLOGY
®
©
2014 by A
MERICAN
U
ROLOGICAL
A
SSOCIATION
E
DUCATION AND
R
ESEARCH
,I
NC
.
Vol. 191, 169-174, January 2014
Printed in U.S.A.
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