CLINICAL ASPECTS OF VASECTOMIES PERFORMED IN THE UNITED-STATES IN 1995

Objectives. Currently, no surveillance system collects data on the num bers and characteristics of vasectomies performed annually in the Unit ed States. This study provides nationwide data on the numbers of vasec tomies and the use of no-scalpel vasectomy, various occlusion methods, fascial interposition, and protocols for analyzing semen after vasect omy. Methods. A retrospective mail survey (with telephone follow-up) w as conducted of 1800 urology, family practice, and general surgery pra ctices drawn from the American Medical Association's Physician Master File and stratified by specialty and census region. Mail survey and te lephone follow-up yielded an 88% response rate. Results. In 1995, appr oximately 494,000 vasectomies are estimated to have been performed by 15,800 physicians in the United States. Urologists performed 76% of al l vasectomies, and nearly all (93%) urology practices performed vasect omies in 1995. Nearly one third (29%) of vasectomies in 1995 were no-s calpel vasectomies, and 37% of physicians performing no-scalpel vasect omies taught themselves the procedure. The most common occlusion metho d in 1995 (used for 38% of all vasectomies) was concurrent use of liga tion and cautery. In 1995, slightly less than half (48%) of all physic ians surveyed interposed the fascial sheath over one end of the vas wh en performing a vasectomy. Protocols for ensuring azoospermia varied: 56% of physicians required one postvasectomy semen specimen; 39% requi red two, and 5%, three or more. Conclusions. No-scalpel vasectomy, use d by nearly one third of U.S. physicians, has become an accepted part of urologic care. Physicians' variations in occlusion methods, use of fascial interposition, and postvasectomy protocols underscore the need for large scale, controlled, and statistically valid studies to deter mine the efficacy of occlusion methods and fascial interposition, as w ell as whether azoospermia is the only determination of a successful v asectomy. UROLOGY 52: 685-691, 1998. (C) 1998, Elsevier Science Inc. A ll rights reserved.