title: Impact of the 2012 American Urological Association vasectomy guidelines on postvasectomy outcomes in a military population.
abstract: OBJECTIVE
  To evaluate the impact of the 2012 American Urological Association vasectomy guidelines on postvasectomy clinical outcomes in a highly mobile military cohort and compare these outcomes with those of civilian counterparts.
  
  
  METHODS
  The records of service members who underwent vasectomy between January 2008 and December 2013 and provided at least 1 postvasectomy semen analysis (PVSA) were analyzed in the context of the 2012 guidelines. Time to occlusive success, repeat PVSAs and vasectomies, and health care cost savings were compared between our prior definition of vasectomy success, which required azoospermia, and the 2012 criteria, which included rare nonmotile sperm.
  
  
  RESULTS
  Of the 1623 men who underwent vasectomy, 738 men (45%) failed to submit a PVSA, leaving 895 men (55%) who provided at least 1 PVSA. A total of 1084 PVSAs were obtained in these men, who had a mean age of 37 ± 6 years. Defining success as azoospermia on first PVSA resulted in a sterility rate of 69%. After application of the 2012 guidelines, 845 patients (94%) achieved sterility by the first PVSA and more patients achieved sterility 60 days from vasectomy (96% vs 72%; P <.001). Inclusion of rare nonmotile sperm in our definition of success would have allowed 228 men to forego a second PVSA and prevented 2 (0.002%) unnecessary vasectomies, a savings of $6297.
  
  
  CONCLUSIONS
  PVSA compliance in our military cohort was similar to that of civilian counterparts. The American Urological Association vasectomy guidelines have the potential to decrease the number of repeat vasectomies and laboratory tests, improve the documented success rate, and increase follow-up compliance when applied to a military population.
authors.affiliation: Division of Urology, Department of Surgery, Tripler Army Medical Center, Honolulu, HI. Electronic address: Raffaella.Derosa.mil@mail.mil.
authors.forename: Raffaella
authors.initials: R
authors.lastname: DeRosa
authors.affiliation: Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Lustik
authors.affiliation: Division of Urology, Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Danielle A
authors.initials: DA
authors.lastname: Stackhouse
authors.affiliation: Division of Urology, Department of Surgery, Tripler Army Medical Center, Honolulu, HI.
authors.forename: Leah P
authors.initials: LP
authors.lastname: McMann
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008889:Military Personnel; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055101:Semen Analysis; D012955:Societies, Medical; D016896:Treatment Outcome; D014481:United States; D014572:Urology; D014659:Vasectomy / Q000592:standards*