Vasectomy management in Morecambe Bay NHS Trust

INTRODUCTION: Vasectomy is a common method of contraception in the UK. However, there is a wide variation in management protocols. The aim of the present study was to identify differences within the hospitals of Morecambe Bay NHS Trust and to recommend a uniform practice. PATIENTS AND METHODS: Retrospective case notes review of 395 vasectomy procedures performed within the Morecambe Bay NHS Trust in a 1-year period. RESULTS: Inconsistency was found with regards to the anaesthetic technique, the vas histology request and the timing of the semen analysis. The non-compliance rate for postvasectomy semen analysis was 33.4%. The complication and failure rates were 4.04% and 0.51%, respectively. Motile sperm (n = 4) was submitted at an average time of 8 weeks' postvasectomy. In half of those cases, vasectomy proved unsuccessful. Immotile sperm (n = 41) was submitted at an average time of 9.5 weeks and, in 80% of those men, semen cleared at an average time of 15.5 weeks' postvasectomy. An azoospermic (n = 285) sample was submitted at an average time of 10.5 weeks. Eleven of those men submitted a second sample with immotile sperm at an average time of 12 weeks' postvasectomy and that was eventually clear at 18 weeks in the majority of cases. CONCLUSIONS: A uniform vasectomy practice should include vasectomy under local anaesthesia if possible, no vas histology and a request for a single sample at 12 weeks. If this is clear, vasectomy should be considered successful. If any sperm are present, then a further sample should be requested at 16 weeks' postvasectomy. Immotile sperm at that time should not justify any further samples and a 'special clearance' should be issued to those men.