Publications
Below are the Papers that the ASPC has had published relating to it's members data from Audit since 2022.
The full articles can be found in the Members-only area under ASPC PUBLICATIONS
2025
Remember Vasectomy – Challenges and Successes
One small snip for mankind
A Personal view
Gareth James, Melanie Atkinson.
BMJ Sex Reprod Health 2025;0:1–3. doi:10.1136/bmjsrh-2024-202431
Vasectomy offers men the choice to shift the burden of responsibility for contraception from women and remains a vital contraceptive option to men and women and should be easily accessible and promoted throughout the world. Vasectomy use has seemingly declined in England, however, NHS England figures do not factor in the vasectomies undertaken in the community, mostly by GPwSI, who are witnessing an increased demand. Numerous other challenges remain including, men’s misconceptions and fears regarding of vasectomy, the continued threat of cessation of services, lack of provision in certain areas, and the stagnant growth of NHS remuneration during the past decade. Many contraception providers themselves may have limited knowledge of vasectomy, and they and patients need to be given up-to-date clear information, such as from newly published data which provides accurate, contemporaneous complication rates. Successes meantime include changes to vasectomy pathways resulting in a more user-friendly and easier experience . The FSRH, SRH services, General Practice, the media, and the wider public need to better promote and champion vasectomy as a cost-effective contraception allowing men to control their own fertility. Women should also be better informed about vasectomy as a potential choice during discussions on contraceptive planning. However, empowering men to take responsibility is pointless if accurate data is not collected to inform fairer geographical provision, services are not commissioned, or potential vasectomy providers reject new contracts for their lack of fair remuneration.
2024
Complications of vasectomy: results from a prospective audit of 105,393 procedures
J. Peacock, G. James, M. Atkinson, J. Henderson
British journal Urology International Volume 134, Issue 5 November 2024 Pages 789-795
Introduction
Vasectomy is the most reliable form of male contraception. Prior to 2020, over 11,000 vasectomies were performed annually in the UK, the majority in primary care via the minimally invasive vasectomy technique. It is vital to pre-operatively counsel men thoroughly regarding potential complications post vasectomy, though the large series which forms the basis of this counselling date from at least 30 years ago. Refinements in surgical technique and equipment mandate contemporaneous data upon which to base present pre-operative counselling. The aim of this review is to provide up-to-date vasectomy complication rates from a dataset collected over 15 years.
Methodology
Data was collected between 2007 and 2022. Patient questionnaires were completed on day of surgery and 4-months post-operatively. Rates of early and late failure, infection, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. There were no specific exclusion criteria. Complication rates were compared to those published by major urological organisations.
Results
Over the 15-year study period, data from 105,393 vasectomies was collected, performed by over 150 community surgeons. Early failure rates were available for 69,500 patients, occurring in 648 patients (0.93%). Of 99,124 patients, late failure occurred in 41 (0.04%). Of 102,549 vasectomies, post-operative infection was reported in 1250 patients (1.22%), haematoma in 1599 patients (1.56%) and PVPS in 139 patients (0.14%).
Conclusions
Vasectomy remains a safe and reliable contraceptive method. Rates of complication were generally lower than those previously published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates which can inform future pre-vasectomy counselling.
2023
Risk of Post-Vasectomy Infections: Audits of 133,044 Vasectomies from Large Vasectomy Practices in Canada, Colombia, New Zealand, and the United Kingdom
Samuel Lawton 1, Alison Hoover 2, Gareth James 3, Simon Snook 4, Diana Soraya Torres Quiroz 5, Michel Labrecque 6
1 Emory University Rollins School of Public Health, Atlanta, United States; 2 Emory University School of Medicine, Atlanta, United States; 3 Association of Surgeons in Primary Care, United Kingdom, UK; 4 SNIP Vasectomy Clinics, New Zealand; 5 Profamilia, Bogota, Colombia; 6 Department of Family and Emergency Medicine, Laval University, Quebec City, Canada
International Brazilian Journal of Urology : Vol. 49 (4): 490-500, July - August, 2023 doi: 10.1590/S1677-5538.IBJU.2023.0143
Objectives: To estimate the risk of post-vasectomy infection in various settings and across various surgical techniques and sanitization practices.
Design, Setting, and Participants: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using No-Scalpel Vasectomy (NSV) in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and from United Kingdom members of the Association of Surgeons in Primary Care (2006-2019).
We defined infection as any mention in medical records of any antibiotics prescribed for treating a genital or urinary condition following vasectomy. We calculated the risk of infection on the total number of vasectomies performed at each site.
Results and Limitations: Post-vasectomy infection risks were 0.8% (219/26,809), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK respectively. Comparing audit periods suggests limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, and wearing surgical mask in Canada, and of type of skin disinfectant used and use of non-sterile gloves in New Zealand. The risk of infection was lower in Colombia when guideline recommended technique for vas occlusion was used (mucosal cautery and fascial interposition [FI] 0.9% vs. ligation, excision, and FI 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information registered in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk.
Conclusions: The risk of infection after vasectomy is low (about 1%) among international high-volume vasectomy practices performing NSV and various recommended occlusion techniques. Apart from vasectomy occlusion technique, no other factor clearly modified the risk of post-vasectomy infection.
2022
Comparison of postal and non- postal post- vasectomy semen sample submission strategies on compliance and failures: an 11- year analysis of the audit database of the Association of Surgeons in Primary Care of the UK
Melanie Atkinson, Gareth James, Katie Bond, Zoe Harcombe, Michel Labrecque
BMJ Sex Reproductive and Health 2022 Jan;48(1):54-59. doi: 10.1136/bmjsrh-2021-201064. Epub 2021 Jul 28.
Background: Vasectomy occlusive success is defined by the recommendation of ‘clearance’ to stop other contraception, and is elicited by post- vasectomy semen analysis (PVSA). We evaluated how the choice of either a postal or non- postal PVSA submission strategy was associated with compliance to PVSA and effectiveness of vasectomy.
Methods: We studied vasectomies performed in the UK from 2008 to 2019, reported in annual audits by Association of Surgeons in Primary Care members. We calculated the difference between the two strategies for compliance with PVSA, and early and late vasectomy failure. We determined compliance by adding the numbers of men with early failure and those given clearance. We performed stratified analyses by the number of test guidance for clearance (one- test/two- test) and the study period (20082013/2014–2019).
Results: Among 58 900 vasectomised men, 32 708 (56%) and 26 192 (44%) were advised submission by postal and non- postal strategies, respectively. Compliance with postal (79.5%) was significantly greater than with non- postal strategy (59.1%), the difference being 20.4% (95% CI 19.7% to 21.2%). In compliant patients, overall early failure detection was lower with postal (0.73%) than with non- postal (0.94%) strategy (−0.22%, 95% CI −0.41% to −0.04%), but this difference was neither clinically nor statistically significant with one- test guidance in 2014–2019. There was no difference in late failure rates.
Conclusions: Postal strategy significantly increased compliance to PVSA with similar failure detection rates. This resulted in more individuals receiving clearance or early failure because of the greater percentage of postal samples submitted. Postal strategy warrants inclusion in any future guidelines as a reliable and convenient option. Key messages
► Postal semen sample submission strategy after vasectomy results in better compliance and similar early failure and late failure rates compared with fresh sample non- postal strategy.
► When compliance is accounted for, postal strategy allows recommending cessation of other contraceptive methods (clearance) in one in five more men than a non- postal strategy.
► Postal semen sample submission strategy for post- vasectomy semen analysis warrants inclusion in future guidelines as a reliable and convenient option.