Presentation Authors: Aaron Bradshaw*, Richmond Owusu, Eric Ballon-Landa, Tung-Chin Hsieh, San Diego, CA
Introduction: AUA Guidelines recommend that men obtain a post-vasectomy semen analysis (PVSA) to confirm sterility. Current literature suggests poor compliance. No studies specifically address barriers to completion. We sought to determine compliance rate for PVSA and assess barriers to compliance.
Methods: A retrospective review was performed on men undergoing vasectomy at San Diego Veterans Administration (SDVA) Hospital and UC San Diego Health (UCSD) between 2006 and 2018. Prior to vasectomy, patients received counseling regarding the need for confirmatory PVSA. Post-procedural management included follow up visit within 2-4 weeks and PVSA after 15-20 ejaculations. Demographics and periprocedural variables were collected. Phone interviews were conducted for men failing to complete PVSA to assess barriers to compliance and alternative semen testing. Multivariate analysis was performed to identify factors associated with PVSA completion.
Results: 503 men, mean age 38.8 years, underwent vasectomy at SDVA (n=331) and UCSD (n=172). Overall, 80% completed clinical follow up (n=401) and 53% completed PVSA (n=268). The SDVA and UCSD cohorts exhibited significantly different rates of PVSA completion (46% vs 67%, p < 0.001) and clinical follow up (64% vs 85%, p=0.038) with no difference in time to PVSA or follow up (Table 1). Men completing PVSA were more likely to undergo an office-based procedure (87% vs. 80%, p=0.047) performed by an attending as primary surgeon (43% vs 28%, p=0.001). No difference was observed in age, fatherhood or marital status. On multivariate analysis, fatherhood was the only factor associated with noncompliance of PVSA (OR 0.52, 95% CI 0.33 â€“ 0.83). Among men interviewed, 38% reported distance as the primary barrier to PVSA, 34% stating time constraints and 23% citing forgetfulness. 92% reported increased likelihood of completion with home-based semen testing.
Conclusions: Patients undergoing vasectomy demonstrated poor PVSA compliance despite pre-procedural counseling. Given that distance and time constraints limited compliance with guidelines, incorporating home-based semen testing in routine care may improve the quality of care for men undergoing vasectomy.