Paul Hancock

Bio: Paul Hancock is an academic researcher. The author has contributed to research in topics: Vasectomy & Semen analysis. The author has an hindex of 1, co-authored 1 publications receiving 10 citations.

2016 Laboratory guidelines for postvasectomy semen analysis: Association of Biomedical Andrologists, the British Andrology Society and the British Association of Urological Surgeons

Abstract: Post-vasectomy semen analysis (PVSA) is the procedure used to establish whether sperm are present in the semen following a vasectomy. PVSA is presently carried out by a wide variety of individuals, ranging from doctors and nurses in general practitioner (GP) surgeries to specialist scientists in andrology laboratories, with highly variable results.Key recommendations are that: (1) PVSA should take place a minimum of 12 weeks after surgery and after a minimum of 20 ejaculations. (2) Laboratories should routinely examine samples within 4 h of production if assessing for the presence of sperm. If non-motile sperm are observed, further samples must be examined within 1 h of production. (3) Assessment of a single sample is acceptable to confirm vasectomy success if all recommendations and laboratory methodology are met and no sperm are observed. Clearance can then be given. (4) The level for special clearance should be <100 000/mL non-motile sperm. Special clearance cannot be provided if any motile sperm are observed and should only be given after assessment of two samples in full accordance with the methods contained within these guidelines. Surgeons are responsible both preoperatively and postoperatively for the counselling of patients and their partners regarding complications and the possibility of late recanalisation after clearance. These 2016 guidelines replace the 2002 British Andrology Society (BAS) laboratory guidelines and should be regarded as definitive for the UK in the provision of a quality PVSA service, accredited to ISO 15189:2012, as overseen by the United Kingdom Accreditation Service (UKAS).

Sperm toxicity testing: UK best practice guideline from the Association of Biomedical Andrologists

Abstract: In order to ensure the quality and integrity of diagnostic semen analysis results, materials used should be tested to ensure that they do not interfere with sperm function. As a toxicity test, complex sperm function testing may be considered controversial, since the fertilizing capacity of single sperm can never be assured. In preference, sperm motility offers a unique means of assessing the toxicity of reagents and materials before they are used in routine practice. Motility is the semen parameter most likely to be influenced by the external environment. Indeed, it is the main reason that laboratories insist on supplying their own approved specimen containers and ensuring that patients, as far as possible, adhere to strict conditions for sample collection and transport prior to testing. This differs to other indirect tests of toxicity such as the mouse embryo assay, whereby the rate of mouse pre-implantation embryo development to the blastocyst stage is compared. This guideline is aimed at health care scientists who deal with andrology in both general pathology and specialised fertility laboratories, and provides a model approach to sperm toxicity testing. For assisted reproduction clinics, the same methodology can be used to test any consumables that are used for sperm processing, and as an indirect guide for any consumables that come into direct contact with oocytes and pre-implantation embryos.

Andrology and accreditation - An opportunity for Cytologists.

Abstract: The change to HPV testing as the primary screening modality is under way or imminent in the Cervical Screening Programmes (CSP) of the UK nations. This will necessitate major structural changes in all cytopathology laboratories, both in those that continue to provide a service to the CSP and those that do not. This article describes the development (from an existing service) and subsequent United Kingdom Accreditation Service (UKAS) accreditation of andrology testing in a District General Hospital setting, describing key areas for development and utilising cytopathology and histopathology staff of various grades and thus providing one avenue of skill redeployment for those cytopathology staff who will no longer provide morphological screening expertise to the CSP. This article is protected by copyright. All rights reserved.

A missing vas deferens: practical implications for urologists performing vasectomies and managing infertile men

Abstract: The vas deferens derives from the Wolffian (mesonephric) duct and shares a common origin with the kidney (1). Intrinsic Wolffian duct defects may result in failure of the vas deferens to develop, a condition that can occur in isolation or combined with renal agenesis or malformations. A missing vas, that is, unilateral absence of vas deferens, albeit relatively uncommon may be found by urologists performing vasectomies or evaluating men with fertility problems (1, 2). It is, therefore, important that urologists be aware of the practical implications when finding such a case scenario. In this issue of the International Braz J Urol, Miller and colleagues give us useful guidance by reporting the prevalence of congenital unilateral absence of vas deferens in a cohort of 23,013 men presenting for vasectomy over a 20-year period in Quebec City, Canada (3). Among the confirmed cases, namely, those with i. No prior genital surgery or trauma and ii. A missing vas at the time of vasectomy, and iii. Confirmed sterility by a post-vasectomy semen analysis (PVSA) after unilateral vasectomy, a missing vas was found once in every 479 men subjected to vasectomy. In their study, most vasectomies had been performed using a non-scalpel technique combining thermal cautery and fascial interposition (4), which has shown to be as effective as ligation and fascial interposition (5). To our knowledge, the paper by Miller et al. is the largest series reported to date thus making it sound to assume that most urologists performing vasectomies will find such a case in their career. Interestingly, the authors identified a group of 34 men (0.15%) in whom a missing vas was suspected but could not be confirmed, mostly due to the absence of a PVSA to confirm sterility or a history of prior surgery or scrotal anomaly that might account for the missing vas. The study of Miller and colleagues highlights three relevant aspects for practicing urologists that need to be discussed further. First, the importance of physical examination before the vasectomy and during fertility evaluation. Second, the role of post-vasectomy semen analyses, and lastly, the importance of surgical planning in difficult vasectomy cases. Palpation of the vas deferens is essential and should be included as part of the routine physical examination in all men seeking vasectomy or fertility (6). The finding of a missing vas should prompt urologists to order an abdominal ultrasound study to detect any renal anomalies (6). In healthy men seeking vasectomy, it might be argued that ultrasound is unnecessary as the finding of a single kidney is not clinically relevant. An objection is that although up to 80% of men with a congenital unilateral absence of vas deferens (CUAVD) have ipsilateral renal agenesis, the kidney may be present and other renal malformations such as ectopia, malrotation, fusion or polycystic disease may occur (7). Despite not warranting further intervention, informing the affected men that they have only one kidney or a renal anomaly is good medical practice as it may prompt such men to take a better life-style, thus preventing doi: 10.1590/S1677-5538.IBJU.2016.05.03

Is azoospermia the appropriate standard for post-vasectomy semen analysis? Or an unachievable goal of best practice laboratory guidelines.

Abstract: The increasingly stringent laboratory-approach to diagnosing azoospermia for post-vasectomy semen analysis (PVSA) continues to be at odds with the simpler approach desired by clinicians. This study describes the analysis of 10 years of PVSA and discusses the outcome in relation to risk, cost and assesses whether more stringent procedures are required. PVSA was performed on 4788 patients initially using a 2-test strategy (16 and 20 weeks post-surgery), moving to 1 test during 2013-2014. Azoospermia was confirmed by the analysis of 10 µl of semen followed by 10 µl of centrifuged pellet. In total, there were 9260 tests with a median of 1.93 tests/patient and 18.7 weeks to clearance. Surgical failure occurred in 1.75%, falling to 1.1% between 2011 and 2016. There were no cases of unwanted pregnancy, recanalization or complaints although misdiagnosis was detected in 1 case as a result of failure to confirm patient identification. Azoospermia performed according to World Health Organization (WHO) guidelines is sufficiently robust to confirm success/failure of vasectomy. With uncertainty surrounding the diagnosis, efforts to improve detection of occasional non-motile sperm are futile, cost more and fail to reduce risk of inappropriate clearance. Misdiagnosis is more likely from patient identification error and mitigation may include reverting to the safety net of a 2-test strategy.