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Introduction: Reviews of vasectomy practices have been done in 1991, 1995 and 20021. These have shown growth in the use of electrocautery and the “No Scalpel Vasectomy” (NSV), with these being performed by 40% and 37% of practitioners2. The AUA released new vasectomy guidelines in 20123. We analyze the practice patterns of Urologists, Primary Care Physicians (PCP) and General Surgeons (GS) in the northwest.
Methods: We sent a survey to members of the WSAUA, Oregon Medical Association and the Oregon chapter of the American College of Surgeons. This survey included 16 questions covering: volume, antibiotic use, technique, pain management, semen analysis and cost.
Fig. 1: Urologists and General Surgeons wait significantly longer than PCPs to obtain a post-vasectomy semen analysis.
Fig. 2: The use of “No Scalpel Vasectomy” continues to rise with approximately 45% and 50% of Urologists and PCPs respectively performing a NSV technique
Results: As expected, Urologists perform more vasectomies with a mean of 86 performed yearly, though there was a large deviation (+/- 77) while PCPs and GS performed a mean of 12 and 10 respectively. Surgeons were more likely to perform the vasectomy on the same day of initial consult. 22% of Urologists used antibiotics at some point in the peri-procedural period. Over 30% of all practitioners used no narcotics. The use of NSV was indeed on the rise with 45% of Urologists and slightly over 50% of PCPs utilizing the technique. Urologists and GS waited a mean of 61 and 63 days respectively, while PCPs waited a mean of 33 before obtaining a semen analysis. Interestingly, price was not significantly different between the groups.
Polackwich AS, M.D., Hedges JC, MD., Ph.D., EF Fuchs, M.D. Oregon Health & Science University
Conclusions: Comparing the practice patterns of each specialty with each other and the 2012 AUA guidelines, we found that the use of NSV and electrocautery continue to rise. Urologists and GS continue to perform vasectomies on the same day as consult, though this is rare, and PCPs are more likely to obtain a SA early. While some suggest that PCPs performing vasectomies is more economical, we did not find this to be true.
Fig. 3: Vas Closure techniques