Haws J M, Morgan G T, Pollack A E, Koonin L M, Magnani R J, Gargiullo P M
AVSC International, New York, New York 10016, USA.
Urology. 1998 Oct;52(4):685-91. doi: 10.1016/s0090-4295(98)00274-x.
Currently, no surveillance system collects data on the numbers and characteristics of vasectomies performed annually in the United States. This study provides nationwide data on the numbers of vasectomies and the use of no-scalpel vasectomy, various occlusion methods, fascial interposition, and protocols for analyzing semen after vasectomy.
A retrospective mail survey (with telephone follow-up) was conducted of 1800 urology, family practice, and general surgery practices drawn from the American Medical Association's Physician Master File and stratified by specialty and census region. Mail survey and telephone follow-up yielded an 88% response rate.
In 1995, approximately 494,000 vasectomies are estimated to have been performed by 15,800 physicians in the United States. Urologists performed 76% of all vasectomies, and nearly all (93%) urology practices performed vasectomies in 1995. Nearly one third (29%) of vasectomies in 1995 were no-scalpel vasectomies, and 37% of physicians performing no-scalpel vasectomies taught themselves the procedure. The most common occlusion method in 1995 (used for 38% of all vasectomies) was concurrent use of ligation and cautery. In 1995, slightly less than half (48%) of all physicians surveyed interposed the fascial sheath over one end of the vas when performing a vasectomy. Protocols for ensuring azoospermia varied: 56% of physicians required one postvasectomy semen specimen; 39% required two, and 5%, three or more.
No-scalpel vasectomy, used 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 determine the efficacy of occlusion methods and fascial interposition, as well as whether azoospermia is the only determination of a successful vasectomy.
目前，美国尚无监测系统收集每年输精管切除术的数量及相关特征的数据。本研究提供了全国范围内输精管切除术的数量、无手术刀输精管切除术的使用情况、各种闭塞方法、筋膜间置术以及输精管切除术后精液分析方案的数据。
对从美国医学协会医师主档案中抽取的1800家泌尿外科、家庭医学和普通外科诊所进行回顾性邮件调查（并进行电话随访），按专业和人口普查区域分层。邮件调查和电话随访的回复率为88%。
1995年，美国约15800名医生估计共实施了约494000例输精管切除术。泌尿外科医生实施了所有输精管切除术的76%，1995年几乎所有（93%）的泌尿外科诊所都开展了输精管切除术。1995年近三分之一（29%）的输精管切除术为无手术刀输精管切除术，实施无手术刀输精管切除术的医生中有37%是自学该手术的。1995年最常用的闭塞方法（用于所有输精管切除术的38%）是结扎与烧灼同时使用。1995年，在所有接受调查的医生中，略少于一半（48%）的医生在进行输精管切除术时在输精管一端间置了筋膜鞘。确保无精子症的方案各不相同：56%的医生要求输精管切除术后提供一份精液标本；39%要求两份，5%要求三份或更多。
近三分之一的美国医生使用的无手术刀输精管切除术已成为泌尿外科治疗中被认可的一部分。医生在闭塞方法、筋膜间置术的使用以及输精管切除术后方案上的差异突出表明，需要开展大规模、对照且具有统计学效力的研究，以确定闭塞方法和筋膜间置术的疗效，以及无精子症是否是输精管切除术成功的唯一判定标准。
