Shapiro Daniel D, Kamnetz Sandra A, Le Brian V
Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Urology. 2017 Nov;109:115-120. doi: 10.1016/j.urology.2017.08.002. Epub 2017 Aug 12.
To survey urologists and family medicine physicians (FMPs) within a single institution to determine current vasectomy practice patterns and determine compliance with 2012 American Urological Association (AUA) vasectomy guidelines.
In 2016, a single-institution survey was conducted to understand the vasectomy practice patterns among urologists and nonurologists. The survey questions and 3 clinical scenarios were designed based on the 2012 AUA vasectomy guidelines. Results of the survey were compiled between urologists and nonurologists and then compared with the guideline recommendations.
A total of 23 FMPs and 6 urologists responded. Fewer prevasectomy counseling topics were discussed by FMPs compared with urologists. A variety of vasectomy techniques were used among FMPs. Vas deferens segments were more likely to be sent for histology by FMPs than urologists (65% vs 17%, P = .02). FMPs were more likely to send postvasectomy semen analyses earlier than urologists (P = .02) and more likely to send multiple postvasectomy semen analyses (P = .006) before forgoing alternative contraceptive methods. Regarding the clinical scenario questions, FMPs were more likely to answer discordantly from guideline recommendations compared with urologists.
Significant vasectomy practice pattern heterogeneity still exists among nonurologists surveyed within our institution. The 2012 AUA vasectomy guidelines have yet to be broadly implemented within nonurology practices. Further studies are warranted to investigate national trends in nonurologist vasectomy practice patterns and determine how the guidelines can be better implemented in nonurologic practices.
对单一机构内的泌尿外科医生和家庭医学医生进行调查,以确定当前输精管结扎术的实践模式,并确定其是否符合2012年美国泌尿外科学会(AUA)输精管结扎术指南。
2016年,进行了一项单一机构调查,以了解泌尿外科医生和非泌尿外科医生的输精管结扎术实践模式。调查问题和3个临床场景是根据2012年AUA输精管结扎术指南设计的。对泌尿外科医生和非泌尿外科医生的调查结果进行汇总,然后与指南建议进行比较。
共有23名家庭医学医生和6名泌尿外科医生做出回应。与泌尿外科医生相比,家庭医学医生讨论的输精管结扎术前咨询主题较少。家庭医学医生使用了多种输精管结扎术技术。与泌尿外科医生相比,家庭医学医生更有可能将输精管段送去做组织学检查(65%对17%,P = 0.02)。家庭医学医生比泌尿外科医生更有可能在放弃其他避孕方法之前更早地进行输精管结扎术后精液分析(P = 0.02),并且更有可能进行多次输精管结扎术后精液分析(P = 0.006)。关于临床场景问题,与泌尿外科医生相比,家庭医学医生更有可能给出与指南建议不一致的答案。
在我们机构接受调查的非泌尿外科医生中,输精管结扎术的实践模式仍存在显著异质性。2012年AUA输精管结扎术指南尚未在非泌尿外科实践中广泛实施。有必要进一步开展研究,以调查非泌尿外科医生输精管结扎术实践模式的全国趋势,并确定如何在非泌尿外科实践中更好地实施这些指南。