The clinical impact of British guidelines on post-vasectomy semen analysis: A retrospective cohort study
BAUS ePoster online library. Beder D. Jun 25, 2019; 265256; CU-3
Mr. Daniel Beder
Mr. Daniel Beder
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Introduction: Special clearance is given when rare non-motile sperm (RNMS) persist in the semen post-vasectomy. The 2016 British guidelines on post-vasectomy semen analysis (PVSA) advise that special clearance requires 2 semen samples which demonstrate RNMS, as well as centrifugation of semen samples that demonstrated azoospermia on standard analysis. This study investigated the clinical impact of the 2016 British guidelines on PVSA. Patients and Methods: A retrospective study covering a four-year period, was performed on patients undergoing vasectomy. The patient sample was divided into two groups, pre- and post-introduction of the 2016 guidelines. The primary outcome measures were (i) the total number of post-operative semen samples submitted, (ii) outcome of PVSA, and (iii) the numbers issued special clearance. Results: Compliance with the updated guidelines increased detection of RNMS from 18% to 29% and increased repeat testing. Five patients in Group 2 required special clearance whereas no patients did in Group 1. A further 5 patients were considered for special clearance but did not submit further samples. Furthermore, there was a 5-fold increase in PVSA processing costs. Defining clearance as a single sample showing azoospermia or RNMS results in 95.7% of patients achieving clearance after a single sample and would have avoided 114 PVSA. Conclusions: Centrifuging samples in line with the 2016 British guidelines for PVSA increases repeat testing and use of special clearance. The European Association of Urology recommends clearance following standard analysis of a single sample demonstrating azoospermia or RNMS. This may serve as a basis for updating British guidelines.

Vasectomy is relied upon by 42 million couples worldwide for contraception and 9 582 vasectomies were performed by the National Health Service in 2017/18 (Haldar et al., 2000; NHS Digital, 2018). Vasectomy introduces a permanent obstruction in the vas deferens and procedura
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