Survey on vasectomy practices in France in 2022.

ABSTRACT

OBJECTIVES: Prior to the publication of the recommendations of the French Association of Urology (AFU) on vasectomy, we conducted a survey to assess current practices and required training interventions in France regarding vasectomy. METHOD: An invitation with a link to a 38-item questionnaire on MonkeySurvey was sent in November 2022 to the 1760 urologist members of the AFU. RESULTS: A total of 352 (20%) urologists completed the survey. Among the participants, 20% reported refusing the surgery to patients aged 25 to 30 years old and 17% if they had no children, respectively. Three quarters of participants mentioned systematically performing a scrotal exam at the time of the pre-vasectomy consultation. Forty-one percent of respondents reported systematically performing vasectomy under general anesthesia. While 56% of participants mentioned performing a minimally invasive technique for exposing the vas, 70% said they were willing to learn the no-scalpel technique for this purpose. The most frequently reported occlusion techniques combine excision of a vas segment and ligation of both ends of the divided vas. Only 26% reported performing fascial interposition and 4% using the "open end" technique. A post-vasectomy semen analysis showing less than 100,000 non-motile sperm per millilitre makes only 38% of respondents recommending stopping other contraceptive methods. Half of the respondents considered that current reimbursement fee structure for the procedure restrains the development of this clinical activity. CONCLUSION: Our survey suggests that vasectomy practice and services in France do not meet the international standards. We identified the clinical and organizational changes needed to improve practices and access to vasectomy services in France. LEVEL OF EVIDENCE Grade 3.