Dataset Information

Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices.

ABSTRACT:

Purpose

The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice.

Materials and methods

We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries.

Results

Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions.

Conclusions

Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.

SUBMITTER: Agarwal A

PROVIDER: S-EPMC9253792 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices.

Agarwal Ashok A Gupta Sajal S Sharma Rakesh K RK Finelli Renata R Kuroda Shinnosuke S Vij Sarah C SC Boitrelle Florence F Kavoussi Parviz P Rambhatla Amarnath A Saleh Ramadan R Chung Eric E Mostafa Taymour T Zini Armand A Ko Edmund E Parekh Neel N Martinez Marlon M Arafa Mohamed M Tadros Nicholas N de la Rosette Jean J Le Tan V TV Rajmil Osvaldo O Kandil Hussein H Blecher Gideon G Liguori Giovanni G Caroppo Ettore E Ho Christopher C K CCK Altman Andrew A Bajic Petar P Goldfarb David D Gill Bradley B Zylbersztejn Daniel Suslik DS Molina Juan Manuel Corral JMC Gava Marcello M MM Cardoso Joao Paulo Greco JPG Kosgi Raghavender R Çeker Gökhan G Zilaitiene Birute B Pescatori Edoardo E Borges Edson E Duarsa Gede Wirya Kusuma GWK Pinggera Germar-Michael GM Busetto Gian Maria GM Balercia Giancarlo G Franco Giorgio G Çalik Gökhan G Sallam Hassan N HN Park Hyun Jun HJ Ramsay Jonathan J Alvarez Juan J Khalafalla Kareim K Bowa Kasonde K Hakim Lukman L Simopoulou Mara M Rodriguez Marcelo Gabriel MG Sabbaghian Marjan M Elbardisi Haitham H Timpano Massimiliano M Altan Mesut M Elkhouly Mohamed M Al-Marhoon Mohamed S MS Sadighi Gilani Mohammad Ali MA Soebadi Mohammad Ayodhia MA Nasr-Esfahani Mohammad Hossein MH Garrido Nicolas N Vogiatzi Paraskevi P Birowo Ponco P Patel Premal P Javed Qaisar Q Ambar Rafael F RF Adriansjah Ricky R AlSaid Sami S Micic Sava S Lewis Sheena E SE Mutambirwa Shingai S Fukuhara Shinichiro S Parekattil Sijo S Ahn Sun Tae ST Jindal Sunil S Takeshima Teppei T Puigvert Ana A Amano Toshiyasu T Barrett Trenton T Toprak Tuncay T Malhotra Vineet V Atmoko Widi W Yumura Yasushi Y Morimoto Yoshiharu Y Lima Thiago Fernandes Negris TFN Kunz Yannic Y Kato Yuki Y Umemoto Yukihiro Y Colpi Giovanni M GM Durairajanayagam Damayanthi D Shah Rupin R

The world journal of men's health 20220102 3

<h4>Purpose</h4>The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice.<h4>Materials and methods</h4>We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along wit ...[more]

PMID: 35021311

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Project description:BackgroundPost-vasectomy semen analysis (PVSA) completion rates after vasectomy are poor, and minimizing the need for an additional in-person visit may improve compliance. We hypothesized that providing PVSA specimen cup at time of vasectomy instead of at a postoperative appointment might be associated with higher PVSA completion rates.MethodsWe performed a retrospective cohort study with historical control using medical records of all patients seen by a single provider for vasectomy consultation between October 2016 and June 2022. All patients who underwent vasectomy were included. Patients who underwent vasectomy prior to 05/01/2020 had PVSA specimen cup given at postoperative appointment two weeks following vasectomy, and those who underwent vasectomy after 05/01/2020 were given PVSA specimen cup at time of vasectomy. PVSA completion, demographic, and clinical outcomes data were collected. Logistic regressions were used to investigate associations between PVSA completion rates and timing of PVSA specimen cup provision.ResultsThere were no significant differences among study cohorts across all patient demographics analyzed, including age, body mass index (BMI), age of primary partner, presence of children, and history of prior genitourinary infection. A total of 491 patients were seen for vasectomy consultation between October 2016 and June 2022; among these patients, 370 underwent vasectomy. Of these, 173 (46.8%) patients underwent vasectomy prior to 05/01/2020 and were given PVSA specimen cup at postoperative visit; 197 (53.2%) patients underwent vasectomy after 05/01/2020 and were given PVSA specimen cup at vasectomy. Providing PVSA specimen cup at time of vasectomy was associated with higher odds of PVSA completion than providing PVSA specimen cup at postoperative visit [62.4% vs. 49.7%; odds ratio (OR) =1.68; 95% confidence interval (CI): 1.11, 2.55]. Adjusting for all identified confounders excludes 35 (9.5%) patients without a primary partner and shows no statistically significant association in cup timing [adjusted OR (aOR) =1.53; 95% CI: 0.98, 2.39]. Adjusting for all identified confounders except age of primary partner revealed timing of specimen cup provision at time of vasectomy was associated with higher odds of PVSA completion (aOR =1.64; 95% CI: 1.08, 2.52).ConclusionsPVSA specimen cup provision at time of vasectomy versus at postoperative appointment is associated with higher rates of PVSA completion in this retrospective cohort study.

Project description:ImportanceRace and ethnicity are routinely used to inform pulmonary function test (PFT) interpretation. However, there is no biological justification for such use, and it may reinforce health disparities.ObjectiveTo compare the PFT interpretations produced with race-neutral and race-specific equations.Design, setting, and participantsIn this cross-sectional study, race-neutral reference equations recently developed by the Global Lung Function Initiative (GLI) were used to interpret PFTs performed at an academic medical center between January 2010 and December 2020. The interpretations produced with these race-neutral reference equations were compared with those produced using the race and ethnicity-specific reference equations produced by GLI in 2012. The analysis was conducted from April to October 2022.Main outcomes and measuresThe primary outcomes were differences in the percentage of obstructive, restrictive, mixed, and nonspecific lung function impairments identified using the 2 sets of reference equations. Secondary outcomes were differences in severity of these impairments.ResultsPFTs were interpreted from 2722 Black (686 men [25.4%]; mean [SD] age, 51.8 [13.9] years) and 5709 White (2654 men [46.5%]; mean [SD] age, 56.4 [14.3] years) individuals. Among Black individuals, replacing the race-specific reference equations with the race-neutral reference equations was associated with an increase in the prevalence of restriction from 26.8% (95% CI, 25.2%-28.5%) to 37.5% (95% CI, 35.7%-39.3%) and of a nonspecific pattern of impairment from 3.2% (95% CI, 2.5%- 3.8%) to 6.5% (95% CI, 5.6%-7.4%) and no significant change in the prevalence of obstruction (19.9% [95% CI, 18.4%-21.4%] vs 19.5% [95% CI, 18.0%-21.0%]). Among White individuals, replacing the race-specific reference equations with the race-neutral reference equations was associated with a decrease in the prevalence of restriction from 22.6% (95% CI, 21.5%-23.6%) to 18.0% (95% CI, 17.0%-19.0%), a decrease in the prevalence of a nonspecific pattern of impairment from 8.7% (95% CI, 7.9%-9.4%) to 4.0% (95% CI, 3.5%-4.5%), and no significant change in the percentage with obstruction from 23.9% (95% CI, 22.8%-25.1%) to 25.1% (95% CI, 23.9%- 26.2%). The race-neutral reference equations were associated with an increase in severity in 22.8% (95% CI, 21.2%-24.4%) of Black individuals and a decrease in severity in 19.3% (95% CI, 18.2%-20.3%) of White individuals vs the race-specific reference equations.Conclusions and relevanceIn this cross-sectional study, the use of race-neutral reference equations to interpret PFTs resulted in a significant increase in the number of Black individuals with respiratory impairments along with a significant increase in the severity of the identified impairments. More work is needed to quantify the effect these reference equations would have on diagnosis, referral, and treatment patterns.

Project description:BackgroundLaboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting.MethodsFive databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group's criteria.ResultsWe identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group.ConclusionsOur review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods.Trial registrationPROSPERO CRD42016051941.

Project description:A field experiment, using a paired audit testing design with testers of different racial and language profiles, was conducted to document and evaluate individual encounters in inquiring about COVID-19 vaccinations in the U.S. states. Testers communicated with state health department and major vaccination site staff about obtaining the COVID-19 vaccine and assessed the extent to which evidence-informed communication tactics for encouraging take-up were employed. The audit testers included individuals representing Latinx identities, given research showing they face greater hardships in navigating vaccine infrastructure and place less trust in public immunization efforts. Data were collected in phone and electronic communications between mid-June and mid-August of 2021. Empirical analyses confirmed that states vary considerably in how clearly officials communicate vaccination requirements and procedures, and in what they ask of individuals before providing the opportunity to receive the COVID-19 vaccine. The Spanish-speaking tester was more likely to encounter negative or racialized language-primarily implicit in nature-such as calls abruptly ended (vs. attempting to secure language support) and requests for additional identification or personal information before continuing with vaccination registration. Examples of overtly negative or racist encounters included condescending comments about Latinx testers' identification (or perceived undocumented status) and the Spanish-speaking tester's communication in Spanish. Analysis of an index of good practices constructed from the audit data revealed that very few strategies for promoting vaccinations were regularly implemented. In regression analyses, an additional point on the good practices index predicted a 0.133 percentage point increase in the percent of the population receiving the first vaccine dose, suggesting the lack of implementation of these good practices may represent a missed opportunity to increase COVID-19 vaccination rates. We identified exemplars in the communications that the federal government could disseminate to rapidly improve state practices and the accessibility of accurate information on COVID-19 vaccination opportunities.

Dataset Information

Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices.

Purpose

Materials and methods

Results

Conclusions

Publications

Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices.

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