Ten Year Review of Vasectomy Pathology: Strengthening the Case Against Routine Histological Evaluation
CUA Online Library. Roberts G. 06/25/13; 31306; MP-06.05
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Abstract
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Introduction and Objectives: The AUA guideline on vasectomy concludes that routine histologic confirmation is unnecessary in performing vasectomy because the finding of azoospermia after a bilateral vasectomy is the standard for success. The guideline statement is based on expert opinion. Despite this direction, many centers continue to send all routine vasectomy specimens for pathological evaluation. This study evaluates a 10-year cohort of routine histological vasectomy specimens for rates of “failed” vasectomy, cost analysis, and rates of dangerous pathology.
Methods: A retrospective review of a single pathology lab’s database from 1999 to 2009 was completed.
Results: A total of 3883 procedures were completed with 7766 individual specimens submitted. Only 17 cases were reported as absence of vas deferens in specimen or 0.44% (95% CI: 0.26% to 0.70%). 82% of abnormal specimens were determined to be vascular or nerve tissue, with the remainder being adipose or fibrous tissue. Of the 17 abnormal cases, 12 (71%) completed post-operative semen analysis and 2 patients directly repeated the procedure with success. Of the pathological “failures” only 58.3% (95% CI: 27.7% to 84.8%) were actual vasectomy failures by semen analysis, i.e 42% showed absence of sperm in the hanging drop despite having no vas deferens in the pathological specimen. In our data, the probability of failed vasectomy was 0.0026. That is, 1 failed vasectomy could be expected in every 385 procedures. Estimated cost of histologic analysis per specimen in our center was $72.50. The average cost per year on routine vasectomy pathology was $28,152. No malignancy, hyperplasia or suspicious histology was reported in all specimens.
Conclusions: The likelihood of dangerous pathology in vasectomy is essentially nil. Considering the cost of histological examination, the rarity of excising structures other than the vas deferens and the high probability that even with abnormal histology cases the patient will be azoospermic, physicians should consider only sending difficult cases for histologic analysis. Ultimately, post-op semen analysis will determine success or failure of vasectomy, not histology.
Methods: A retrospective review of a single pathology lab’s database from 1999 to 2009 was completed.
Results: A total of 3883 procedures were completed with 7766 individual specimens submitted. Only 17 cases were reported as absence of vas deferens in specimen or 0.44% (95% CI: 0.26% to 0.70%). 82% of abnormal specimens were determined to be vascular or nerve tissue, with the remainder being adipose or fibrous tissue. Of the 17 abnormal cases, 12 (71%) completed post-operative semen analysis and 2 patients directly repeated the procedure with success. Of the pathological “failures” only 58.3% (95% CI: 27.7% to 84.8%) were actual vasectomy failures by semen analysis, i.e 42% showed absence of sperm in the hanging drop despite having no vas deferens in the pathological specimen. In our data, the probability of failed vasectomy was 0.0026. That is, 1 failed vasectomy could be expected in every 385 procedures. Estimated cost of histologic analysis per specimen in our center was $72.50. The average cost per year on routine vasectomy pathology was $28,152. No malignancy, hyperplasia or suspicious histology was reported in all specimens.
Conclusions: The likelihood of dangerous pathology in vasectomy is essentially nil. Considering the cost of histological examination, the rarity of excising structures other than the vas deferens and the high probability that even with abnormal histology cases the patient will be azoospermic, physicians should consider only sending difficult cases for histologic analysis. Ultimately, post-op semen analysis will determine success or failure of vasectomy, not histology.
Introduction and Objectives: The AUA guideline on vasectomy concludes that routine histologic confirmation is unnecessary in performing vasectomy because the finding of azoospermia after a bilateral vasectomy is the standard for success. The guideline statement is based on expert opinion. Despite this direction, many centers continue to send all routine vasectomy specimens for pathological evaluation. This study evaluates a 10-year cohort of routine histological vasectomy specimens for rates of “failed” vasectomy, cost analysis, and rates of dangerous pathology.
Methods: A retrospective review of a single pathology lab’s database from 1999 to 2009 was completed.
Results: A total of 3883 procedures were completed with 7766 individual specimens submitted. Only 17 cases were reported as absence of vas deferens in specimen or 0.44% (95% CI: 0.26% to 0.70%). 82% of abnormal specimens were determined to be vascular or nerve tissue, with the remainder being adipose or fibrous tissue. Of the 17 abnormal cases, 12 (71%) completed post-operative semen analysis and 2 patients directly repeated the procedure with success. Of the pathological “failures” only 58.3% (95% CI: 27.7% to 84.8%) were actual vasectomy failures by semen analysis, i.e 42% showed absence of sperm in the hanging drop despite having no vas deferens in the pathological specimen. In our data, the probability of failed vasectomy was 0.0026. That is, 1 failed vasectomy could be expected in every 385 procedures. Estimated cost of histologic analysis per specimen in our center was $72.50. The average cost per year on routine vasectomy pathology was $28,152. No malignancy, hyperplasia or suspicious histology was reported in all specimens.
Conclusions: The likelihood of dangerous pathology in vasectomy is essentially nil. Considering the cost of histological examination, the rarity of excising structures other than the vas deferens and the high probability that even with abnormal histology cases the patient will be azoospermic, physicians should consider only sending difficult cases for histologic analysis. Ultimately, post-op semen analysis will determine success or failure of vasectomy, not histology.
Methods: A retrospective review of a single pathology lab’s database from 1999 to 2009 was completed.
Results: A total of 3883 procedures were completed with 7766 individual specimens submitted. Only 17 cases were reported as absence of vas deferens in specimen or 0.44% (95% CI: 0.26% to 0.70%). 82% of abnormal specimens were determined to be vascular or nerve tissue, with the remainder being adipose or fibrous tissue. Of the 17 abnormal cases, 12 (71%) completed post-operative semen analysis and 2 patients directly repeated the procedure with success. Of the pathological “failures” only 58.3% (95% CI: 27.7% to 84.8%) were actual vasectomy failures by semen analysis, i.e 42% showed absence of sperm in the hanging drop despite having no vas deferens in the pathological specimen. In our data, the probability of failed vasectomy was 0.0026. That is, 1 failed vasectomy could be expected in every 385 procedures. Estimated cost of histologic analysis per specimen in our center was $72.50. The average cost per year on routine vasectomy pathology was $28,152. No malignancy, hyperplasia or suspicious histology was reported in all specimens.
Conclusions: The likelihood of dangerous pathology in vasectomy is essentially nil. Considering the cost of histological examination, the rarity of excising structures other than the vas deferens and the high probability that even with abnormal histology cases the patient will be azoospermic, physicians should consider only sending difficult cases for histologic analysis. Ultimately, post-op semen analysis will determine success or failure of vasectomy, not histology.
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