2012年,美国泌尿外科协会发布了输精管切除术指南,以促进最佳实践,包括何时获得输精管结扎术后精液分析。在这项研究中,我们评估了自本指南发表以来输精管切除术后精液分析的实践模式。
我们回顾性分析了2013年至2017年间接受输精管结扎后精液分析的男性数据库。血管切除术由泌尿科医师和非泌尿科医师在学术和社区环境中进行。
共有4,827名男性接受了输精管结扎后精液分析,其中22.3%接受了1次或多次重复分析。在初始分析中,无精子症占58.2%,28.3%的罕见精子不运动少于100,000/ml,8.7%的精子超过100,000/ml,精子不活动,4.8%的精子活动。输精管结扎后精液重复分析的比率从2013年的30.7%下降到2016年的18.6%。在最初的输精管结扎后精液分析中,对无精子症或罕见的不运动精子患者进行了72%的重复输精管结扎后精液分析。在421名精子超过100,000/ml的男性中,61.3%没有获得重复分析。在最初具有大于100,000/ml的非活动精子后进行重复分析的情况下,67.5%的人被降级为罕见的精子不运动或无精子症,32.5%的精子持续计数大于100,000/ml的非运动性精子,没有人发育出运动性精子。
输精管结扎后精液分析的重复率正在下降,可能凸显了不必要测试的减少。然而,输精管结扎术指南和实践模式之间存在持续的不一致,72%的输精管结扎后重复精液分析是根据指南建议进行的。有趣的是,在再次进行输精管切除术后精液分析时,没有精子超过100,000/ml的男性继续有活动精子.需要进一步的提供者教育,随后的研究可能允许指南修改,其中所有非活动精子的特征相似。
In 2012 the American Urological Association published
vasectomy guidelines to promote best practices, including when to obtain post-vasectomy semen analyses. In this study we assessed practice patterns of post-
vasectomy semen analysis since this
guideline publication.
We retrospectively analyzed a database of men who underwent post-vasectomy semen analysis between 2013 and 2017. Vasectomies were performed by urologist and nonurologist providers in academic and community settings.
A total of 4,827 men underwent post-vasectomy semen analysis with 22.3% undergoing 1 or more repeat analyses. On initial analysis 58.2% were azoospermic, 28.3% had less than 100,000/ml rare nonmotile sperm, 8.7% had greater than 100,000/ml nonmotile sperm and 4.8% had motile sperm. The rate of repeat post-vasectomy semen analysis decreased from 30.7% in 2013 to 18.6% in 2016. Overall 72% of repeat post-vasectomy semen analyses were performed for patients with azoospermia or rare nonmotile sperm on initial post-vasectomy semen analysis. Of the 421 men with greater than 100,000/ml nonmotile sperm, 61.3% did not obtain a repeat analysis. Among cases of repeat analysis after initially having greater than 100,000/ml nonmotile sperm, 67.5% were downgraded to rare nonmotile sperm or azoospermia, 32.5% had a persistent count greater than 100,000/ml nonmotile sperm and none developed motile sperm.
The rate of repeat post-vasectomy semen analysis is decreasing, likely highlighting a decrease in unnecessary testing. However, there is ongoing discordance between
vasectomy guidelines and practice patterns, with 72% of repeat post-
vasectomy semen analyses obtained unnecessarily based on
guideline recommendations. Interestingly, no men with greater than 100,000/ml nonmotile sperm went on to have motile sperm on repeat post-vasectomy semen analysis. Further provider education is warranted and subsequent studies may allow for
guideline modification wherein all nonmotile sperm are characterized similarly.