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MP74-07 POST-VASECTOMY SEMEN ANALYSIS OPTIMAL TIMING AND FINANCIAL IMPLICATIONS OF REPEAT TESTING
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e941
MP74-07 POST-VASECTOMY SEMEN ANALYSIS OPTIMAL TIMING AND FINANCIAL IMPLICATIONS OF REPEAT TESTING Veeru Kasivisvanathan*, Osayuki Nehikhare, Ahayla Kadirvelarasan, Yasir Ali, Nathan Golban, Sinthu Kulendran, Theo Malthouse, Yousif Ali, Ben Challacombe, Paul Hegarty, Majed Shabbir, London, United Kingdom
Source of Funding: none
INTRODUCTION AND OBJECTIVES: Guidelines on postvasectomy semen analysis (PVSA) are highly variable. AUA recommend a single PVSA from 8-16 weeks, EAU recommend a single PVSA at 12 weeks, whereas the British Andrology Society recommends two PVSAs at 16 and 18-20 weeks. We aimed to evaluate the optimal PVSA timing and the utility of repeating PVSA in patients undergoing bilateral vasectomy. We also aimed to identify risk factors for failure to obtain azoospermia. METHODS: Data for all patients undergoing vasectomy between Jan 2007-May 2013 at a single institution were identified from electronic records. Patients were typically asked to provide two semen samples at 12 and 16 weeks. Agreement between samples in failure to obtain azoospermia was established. Univariate and multivariate analysis to identify risk factors for failure to obtain azoospermia at 16-18 weeks was carried out. RESULTS: 190 men submitted PVSAs at both 12-14 weeks and 16-18 weeks. In these men first and second samples agreed in 148/ 190 (78%) of cases. The PVSA at 12-14 weeks failed to show azoospermia in 67/190 (35%) whereas at 16-18 weeks, 49/190 (26%) failed to show azoospermia. This difference of 9% (95% CI 2%-17%) was statistically significant (p¼0.008). Surgical occlusion technique (p¼0.995), primary surgeon seniority (p¼0.995), presence of an assistant (p¼0.9) or anaesthetic type (p¼0.878) did not influence failure to obtain azoospermia at 16 weeks on multivariate analysis. Adopting a single sample PVSA strategy at 16-18 weeks in this series would have saved $19628. CONCLUSIONS: 12-14 weeks may not be the optimal time for a PVSA and may be too early. A single 16-18 week sample would allow clearance of a greater proportion of men, would have important cost saving implications and may alleviate anxiety and increase patient compliance.
MP74-06 THE PRIVATES STUDY: PAIN RATES IN VASECTOMY AND TESTING TO ENSURE STERILITY Michael Kottwitz*, Springfield, IL; Charles Welliver, Albany, NY; Bradley Holland, Danuta Dynda, Georgia Mueller, Tobias S. Kohler, Springfield, IL INTRODUCTION AND OBJECTIVES: Literature on post vasectomy pain rates and complications is disparate. Also, sterility implications of the updated AUA Guidelines on post vasectomy semen analysis is not yet known. METHODS: Four year, single surgeon (TSK) retrospective review of office vasectomies. Surgical and demographic data, semen analyses (SA), and patient post-procedure clinic contacts were assessed. RESULTS: We had 303 subjects with average age 38 years and a mean follow up of 1140 days. 9% of patients called with complaints and scheduled postoperative visits. Complaints included incisional concerns (3%, 9/303), scrotal pain (3%), epididymal fullness (1%) and infection (1%). Two percent of patients required a second visit for post-vasectomy pain (PVP) and one patient (with pre-procedure pain) returned 3 times. Two per cent (5/303) refilled narcotics while 4% were prescribed NSAIDs. No patients had PVP refractory to NSAIDs. Only 62% of men provided any required post-vasectomy SA. A phone call to the office for any reason increased the likelihood that a man would provide the SA (p<0.001). Using the new AUA vasectomy guidelines, 94% would have been cleared after the first sample, 99% after the 2nd sample and 100% after the 3rd sample. CONCLUSIONS: Men undergoing vasectomy can safely be told they are at a very low risk for refractory PVP, the need for narcotic refills, and secondary procedures of any kind. Using the new AUA guidelines, only 6% of men require a second SA to ensure sterility. Source of Funding: none
Source of Funding: None
MP74-08 IMPORTANCE OF INTRAOPERATIVE ASSESSMENT OF SPERM IDENTIFICATION IN PREDICTING THE FINAL SPERM RETRIEVAL OUTCOME WITH MICRODISSECTION TESTICULAR SPERM EXTRACTION Khalid Alrabeeah*, Audrey Wachter, Evelyne Boulet, Simon Phillips, Naif AlHathal, Francois Bissonnette, Isaac Jacques Kadoch, Armand Zini, Montreal, Canada INTRODUCTION AND OBJECTIVES: To determine whether assessment of sperm recovery at the time of microdissection testicular
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e941
MP74-07 POST-VASECTOMY SEMEN ANALYSIS OPTIMAL TIMING AND FINANCIAL IMPLICATIONS OF REPEAT TESTING Veeru Kasivisvanathan*, Osayuki Nehikhare, Ahayla Kadirvelarasan, Yasir Ali, Nathan Golban, Sinthu Kulendran, Theo Malthouse, Yousif Ali, Ben Challacombe, Paul Hegarty, Majed Shabbir, London, United Kingdom
Source of Funding: none
INTRODUCTION AND OBJECTIVES: Guidelines on postvasectomy semen analysis (PVSA) are highly variable. AUA recommend a single PVSA from 8-16 weeks, EAU recommend a single PVSA at 12 weeks, whereas the British Andrology Society recommends two PVSAs at 16 and 18-20 weeks. We aimed to evaluate the optimal PVSA timing and the utility of repeating PVSA in patients undergoing bilateral vasectomy. We also aimed to identify risk factors for failure to obtain azoospermia. METHODS: Data for all patients undergoing vasectomy between Jan 2007-May 2013 at a single institution were identified from electronic records. Patients were typically asked to provide two semen samples at 12 and 16 weeks. Agreement between samples in failure to obtain azoospermia was established. Univariate and multivariate analysis to identify risk factors for failure to obtain azoospermia at 16-18 weeks was carried out. RESULTS: 190 men submitted PVSAs at both 12-14 weeks and 16-18 weeks. In these men first and second samples agreed in 148/ 190 (78%) of cases. The PVSA at 12-14 weeks failed to show azoospermia in 67/190 (35%) whereas at 16-18 weeks, 49/190 (26%) failed to show azoospermia. This difference of 9% (95% CI 2%-17%) was statistically significant (p¼0.008). Surgical occlusion technique (p¼0.995), primary surgeon seniority (p¼0.995), presence of an assistant (p¼0.9) or anaesthetic type (p¼0.878) did not influence failure to obtain azoospermia at 16 weeks on multivariate analysis. Adopting a single sample PVSA strategy at 16-18 weeks in this series would have saved $19628. CONCLUSIONS: 12-14 weeks may not be the optimal time for a PVSA and may be too early. A single 16-18 week sample would allow clearance of a greater proportion of men, would have important cost saving implications and may alleviate anxiety and increase patient compliance.
MP74-06 THE PRIVATES STUDY: PAIN RATES IN VASECTOMY AND TESTING TO ENSURE STERILITY Michael Kottwitz*, Springfield, IL; Charles Welliver, Albany, NY; Bradley Holland, Danuta Dynda, Georgia Mueller, Tobias S. Kohler, Springfield, IL INTRODUCTION AND OBJECTIVES: Literature on post vasectomy pain rates and complications is disparate. Also, sterility implications of the updated AUA Guidelines on post vasectomy semen analysis is not yet known. METHODS: Four year, single surgeon (TSK) retrospective review of office vasectomies. Surgical and demographic data, semen analyses (SA), and patient post-procedure clinic contacts were assessed. RESULTS: We had 303 subjects with average age 38 years and a mean follow up of 1140 days. 9% of patients called with complaints and scheduled postoperative visits. Complaints included incisional concerns (3%, 9/303), scrotal pain (3%), epididymal fullness (1%) and infection (1%). Two percent of patients required a second visit for post-vasectomy pain (PVP) and one patient (with pre-procedure pain) returned 3 times. Two per cent (5/303) refilled narcotics while 4% were prescribed NSAIDs. No patients had PVP refractory to NSAIDs. Only 62% of men provided any required post-vasectomy SA. A phone call to the office for any reason increased the likelihood that a man would provide the SA (p<0.001). Using the new AUA vasectomy guidelines, 94% would have been cleared after the first sample, 99% after the 2nd sample and 100% after the 3rd sample. CONCLUSIONS: Men undergoing vasectomy can safely be told they are at a very low risk for refractory PVP, the need for narcotic refills, and secondary procedures of any kind. Using the new AUA guidelines, only 6% of men require a second SA to ensure sterility. Source of Funding: none
Source of Funding: None
MP74-08 IMPORTANCE OF INTRAOPERATIVE ASSESSMENT OF SPERM IDENTIFICATION IN PREDICTING THE FINAL SPERM RETRIEVAL OUTCOME WITH MICRODISSECTION TESTICULAR SPERM EXTRACTION Khalid Alrabeeah*, Audrey Wachter, Evelyne Boulet, Simon Phillips, Naif AlHathal, Francois Bissonnette, Isaac Jacques Kadoch, Armand Zini, Montreal, Canada INTRODUCTION AND OBJECTIVES: To determine whether assessment of sperm recovery at the time of microdissection testicular