The clinical impact of British guidelines on post-vasectomy semen analysis.

INTRODUCTION: Following vasectomy, azoospermia may not be achieved and rare non-motile sperm (RNMS) may persist in the semen. International guidelines vary in management of this finding. Giving 'special clearance' enables vasectomy to be considered a success despite the presence of RNMS. The latest 2016 British guidelines require two centrifuged semen samples with RNMS in order to give special clearance. We investigate the impact of these latest recommendations. MATERIAL AND METHODS: Retrospectively, patients who underwent vasectomy between 2014 and 2018 were assessed. The patient sample was divided into two groups, pre- and post-implementation of the new guidelines. The primary outcome measures were (i) total number of post-operative semen samples submitted, (ii) post-vasectomy semen analysis (PVSA) outcomes, and (iii) the numbers issued special clearance. RESULTS: Implementation of the updated guidelines increased detection of RNMS from 18% to 27% (p <0.01) and increased use of repeat testing. In the two year period prior to implementation, no patients required special clearance, however, once implemented, it was offered to 10 patients. Furthermore, there was a 5-fold increase in PVSA processing costs. The first post-vasectomy semen sample demonstrated azoospermia or RNMS in 97.5% of patients. CONCLUSIONS: British guidelines are more resource intensive, result in prolonged follow-up with increasing rates of special clearance. The European Association of Urology permits clearance, not special clearance, after a single non-centrifuged sample demonstrating azoospermia or RNMS. Bringing British recommendations in-line with European guidance would enable clearance in up to 97.5% of patients following a single sample at 12 weeks.

Cervical dural calcification and cervical myelopathy in X-linked hypophosphataemic rickets: a case report and review of the literature.

X-linked hypophosphataemic rickets (XLHR) is a genetic disorder resulting from a genetic mutation in the PHEX gene. This may cause ossification of soft tissue structures risking spinal cord compression. We present the first known case of cervical dural calcification secondary to XLHR to cause myelopathic symptoms due to cord compression.

The use of vacuum-assisted closure in spinal wound infections with or without exposed dura.

INTRODUCTION: The treatment of postoperative deep spinal wound infection involves debridement and intravenous antibiotics. Authors have previously reported success in a small series of patients treated with vacuum-assisted closure (VAC) therapy, but its use over exposed dura is controversial and the outcome has not been reported in large series. PURPOSE: To review the outcomes following the treatment of postoperative spinal infections with VAC therapy, particularly those with exposed dura. METHODS: This is a review of prospectively collected data in 42 patients, all of whom had deep postoperative spinal infections. 30 of these patients had exposed dura. All patients had an initial debridement followed by application of VAC Whitefoam (with exposed dura) or grey Granufoam (where no dura was exposed). Pressure was set at 50 mmHg with exposed dura or 125 mmHg where no dura was exposed. All patients underwent a minimum 6 week course of antibiotics. We report on the number of visits to theatre required for dressing changes and debridement and the eventual outcomes. RESULTS: Five patients required a flap reconstruction. Two patients died before definitive final closure due to other complications (pneumonia and stroke). In all the other patients, their wounds healed fully. A mean of 2.3 infection surgeries were required to eradicate infection and achieve wound closure. CONCLUSIONS: This is one of the largest studies which confirms the safety and efficacy of VAC dressings in patients with spinal wound infections, even when the dura is exposed. These slides can be retrieved under Electronic Supplementary Material.