The Omission of Genitourinary Physical Exam in Telehealth Pre-Vasectomy Consults Does Not Reduce Rates of Office Procedure Completion

Comparing vasectomy techniques, recovery and complications: tips and tricks

Vasectomies are safe and effective, achieving up to 99.7% in sterilization, with complication rates around 1-2%. As vasectomy uptake rises, physicians should stay informed about counseling, isolation and occlusion techniques, post-op recovery, and associated risks and complications. Historically, pre-vasectomy counseling has been performed in-person, but recent literature has shown that telehealth is a viable alternative, and a physical exam may not be necessitated. With regard to vas isolation and occlusion, current international guidelines support a minimally invasive approach such as no-scalpel vasectomy with mucosal cautery and fascial interposition, as they are the most effective in achieving vasectomy success and have the lowest complication rates. After a vasectomy, patients should undergo a post-vasectomy semen analysis 8-16 weeks after the procedure to ensure severe non-motile oligozoospermia (≤100,000 non-motile sperm/mL) or azoospermia. While risks and complications from vas isolation and occlusion are rare, patients should be informed about the potential for hematomas, infections, postoperative pain, and vas recanalization. In the U.S, vasectomies have increased in utilization from previous years, likely in the setting of increased access to telehealth and restricted female reproductive access. This trend raises questions about future fertility options such as vasectomy reversals and highlights the need for informed decision-making.

Lowering the Carbon Footprint Through Telehealth Vasectomy Consults: A Retrospective Observational Study

OBJECTIVE

This study aimed to quantify the impact of shifting in-person pre-vasectomy consultations to telehealth visits on travel time and carbon footprint reduction.

MATERIALS AND METHODS

Utilizing retrospective chart analysis, we examined men who underwent vasectomy at our institution from November 15, 2020, to November 15, 2021. Using their home address, we estimated the distance and travel time with Google Maps direction services to our institution's outpatient urology clinic. We then quantified the number of miles of gas used by dividing that distance by 25 miles per gallon, based on the United States Environmental Protection Agency market average in 2020. We then estimated the pounds of carbon dioxide produced per gallon of gasoline using the United Energy Information Administration's estimate that each gallon of gasoline produces 18.74 pounds of carbon dioxide.

RESULTS

After including 126 cases, the average patient saved 26 miles round trip between their home address and our institution's outpatient clinic. This averaged 43 minutes per round trip. Using our reference values, each trip saved an estimated 1.04 gallons of gasoline and 19.48 pounds of carbon being produced.

CONCLUSIONS

By transitioning pre-vasectomy consults from an in-person to a telehealth format, patients have added convenience in reduced travel in addition to a lower individual carbon footprint. Impact statement: With an average of 500,000 vasectomies performed per year, transitioning from in-person to telehealth vasectomy pre-consults has the potential to save patients' travel time while reducing their carbon footprint.

Practice and development of male contraception: European Academy of Andrology and American Society of Andrology guidelines

BACKGROUNDS

Despite a wide spectrum of contraceptive methods for women, the unintended pregnancy rate remains high (45% in the US), with 50% resulting in abortion. Currently, 20% of global contraceptive use is male-directed, with a wide variation among countries due to limited availability and lack of efficacy. Worldwide studies indicate that >50% of men would opt to use a reversible method, and 90% of women would rely on their partner to use a contraceptive. Additional reasons for novel male contraceptive methods to be available include the increased life expectancy, sharing the reproductive risks among partners, social issues, the lack of pharma industry involvement and the lack of opinion makers advocating for male contraception.

AIM

The present guidelines aim to review the status regarding male contraception, the current state of the art to support the clinical practice, recommend minimal requirements for new male contraceptive development and provide and grade updated, evidence-based recommendations from the European Society of Andrology (EAA) and the American Society of Andrology (ASA).

METHODS

An expert panel of academicians appointed by the EAA and the ASA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.

RESULTS

Sixty evidence-based and graded recommendations were produced on couple-centered communication, behaviors, barrier methods, semen analysis and contraceptive efficacy, physical agents, surgical methods, actions before initiating male contraception, hormonal methods, non-hormonal methods, vaccines, and social and ethical considerations.

CONCLUSION

As gender roles transform and gender equity is established in relationships, the male contribution to family planning must be facilitated. Efficient and safe male-directed methods must be evaluated and introduced into clinical practice, preferably reversible, either hormonal or non-hormonal. From a future perspective, identifying new hormonal combinations, suitable testicular targets, and emerging vas occlusion methods will produce novel molecules and products for male contraception.

Comparative review of vasectomy guidelines and novel vasal occlusion techniques

Vasectomy is the most commonly performed urologic procedure in the United States and is a highly effective form of male contraception. The introduction of guidelines by urological societies has standardized vasectomy care. Providers should be awadre of the rationale behind these guidelines, as well as key differences among them. While few major changes to vasectomy technique have been adopted over the past 40 years, new, reversible vasal occlusive technologies may affect delivery of male contraceptive care in the future. Here, we perform a comparative review of vasectomy guidelines from six urological societies worldwide. In addition, we report on the status of several experimental vasal occlusion methods that may be available in the next decade.

Patient Portal Engagement Affects Postvasectomy Semen Analysis Completion

OBJECTIVE

To identify factors that affect completion of postvasectomy semen analysis (PVSA) in men receiving telehealth prevasectomy counseling. Telehealth visits have become increasingly common for prevasectomy consultations. Prior studies have shown that men prefer telehealth vasectomy consultations over in-person options. Postvasectomy semen testing should be completed to confirm sterilization.

METHODS

Three hundred and seventy-one men aged 19 and older who saw a single physician for a telehealth prevasectomy consultation and completed an in-office vasectomy were included in the study. Demographic information such as age, patient relationship status, and distance from the clinic were accessed via electronic medical record. Patients were assessed based on their engagement with electronic preprocedure instructions, and the primary outcome measured was completion of PVSA.

RESULTS

45.6% of men completed a PVSA. There was no significant difference in completion of the PVSA between those who opened their electronic instructions before their vasectomy and those who did not (46.1% vs 44.4%, P = .77). Of those who messaged the clinic for any reason at least once after their consultation, 62% completed their PVSA; 41% who did not contact the clinic completed the PVSA (P = .0009).

CONCLUSION

While there was no difference in completion of PVSA in patients who opened their instructions vs those who did not, patients with a higher level of engagement with the patient portals were more likely to complete their semen test. By understanding factors influencing patient compliance with postvasectomy semen testing, healthcare professionals can develop targeted interventions to ensure safe and successful outcomes.

Driving Time and Compliance With Postvasectomy Semen Analysis Drop-Off

OBJECTIVE

Current literature demonstrates low rates of compliance with postvasectomy semen analysis (PVSA). This study sought to determine factors that correlate with noncompliance with PVSA.

METHODS

A retrospective chart review was conducted for patients who underwent vasectomy within our institution. ArcGIS was used to securely calculate the shortest driving time from each patient's home to the single PVSA drop-off site. Kruskal-Wallis and chi-square tests analyzed characteristics of patients who did and did not submit PVSA samples, and odds ratios were calculated via multivariable logistic regression.

RESULTS

Overall, 515 of 850 patients met inclusion criteria and 219 (42.5%) of these had no recorded PVSA. Of those with a PVSA, 59% were completed within 16 weeks. Compliance with PVSA was associated with a shorter median driving time (30.6 minutes vs 34.2 minutes), more vasectomy in the operating room (19% vs 10%), and attending a follow-up appointment (40% vs 17%) (P < .005 for all). Age at vasectomy, race, ethnicity, BMI, paternity, and location of preoperative consultation did not significantly differ between the groups. Each 30 minutes of driving time was associated with a 48% reduction in the odds of a patient submitting PVSA at any time (OR 0.52 [0.37, 0.73]).

CONCLUSION

As driving time to a drop-off center appears to be a significant barrier to PVSA compliance, providers should consider alternative collection methods such as at-home or in-office semen analysis.