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Journal ArticleDOI

Vasectomy: AUA Guideline

01 Dec 2012-The Journal of Urology (Wolters KluwerPhiladelphia, PA)-Vol. 188, Iss: 6, pp 2482-2491
TL;DR: This guideline was peer reviewed by 55 independent experts during the guideline development process and recommended that vasectomy be considered for permanent contraception much more frequently than is the current practice in the U.S. and many other nations.
About: This article is published in The Journal of Urology.The article was published on 2012-12-01. It has received 157 citations till now. The article focuses on the topics: Guideline & Vasectomy.
Citations
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Journal ArticleDOI
TL;DR: It is demonstrated that a low-cost smartphone accessory can be used for home-based male infertility screening and suggested that the integration of microfluidics, optical sensing accessories, and advances in consumer electronics, particularly smartphone capabilities, can make remote semen quality testing accessible to people in both developed and developing countries who have access to smartphones.
Abstract: Male infertility affects up to 12% of the world’s male population and is linked to various environmental and medical conditions. Manual microscope-based testing and computer-assisted semen analysis (CASA) are the current standard methods to diagnose male infertility; however, these methods are labor-intensive, expensive, and laboratory-based. Cultural and socially dominated stigma against male infertility testing hinders a large number of men from getting tested for infertility, especially in resource-limited African countries. We describe the development and clinical testing of an automated smartphone-based semen analyzer designed for quantitative measurement of sperm concentration and motility for point-of-care male infertility screening. Using a total of 350 clinical semen specimens at a fertility clinic, we have shown that our assay can analyze an unwashed, unprocessed liquefied semen sample with

129 citations

Journal ArticleDOI
TL;DR: The smartphone-based YO Home Sperm Test has a high level of accuracy and precision when compared with the SQA-Vision, which supports its use as an effective home sperm test for screening "low" and "moderate/normal" MSC cases.

49 citations


Cites background from "Vasectomy: AUA Guideline"

  • ...Of course, computer-assisted semen analysis has its own pitfalls, and human oversight in the semen analysis laboratory is critical, as the accompanying editorial highlights.(2) But this device offers a real opportunity for men beginning to investigate their fertility....

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Journal ArticleDOI
TL;DR: The approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies are evaluated to demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.
Abstract: Importance Despite increasing concerns regarding the cost of health care, the consideration of costs in the development of clinical guidance documents by physician specialty societies has received little analysis. Objective To evaluate the approach to consideration of cost in publicly available clinical guidance documents and methodological statements produced between 2008 and 2012 by the 30 largest US physician specialty societies. Design Qualitative document review. Main Outcomes and Measures Whether costs are considered in clinical guidance development, mechanism of cost consideration, and the way that cost issues were used in support of specific clinical practice recommendations. Results Methodological statements for clinical guidance documents indicated that 17 of 30 physician societies (57%) explicitly integrated costs, 4 (13%) implicitly considered costs, 3 (10%) intentionally excluded costs, and 6 (20%) made no mention. Of the 17 societies that explicitly integrated costs, 9 (53%) consistently used a formal system in which the strength of recommendation was influenced in part by costs, whereas 8 (47%) were inconsistent in their approach or failed to mention the exact mechanism for considering costs. Among the 138 specific recommendations in these guidance documents that included cost as part of the rationale, the most common form of recommendation (50 [36%]) encouraged the use of a specific medical service because of equal effectiveness and lower cost. Conclusions and Relevance Slightly more than half of the largest US physician societies explicitly consider costs in developing their clinical guidance documents; among these, approximately half use an explicit mechanism for integrating costs into the strength of recommendations. Many societies remain vague in their approach. Physician specialty societies should demonstrate greater transparency and rigor in their approach to cost consideration in documents meant to influence care decisions.

47 citations

Journal ArticleDOI
TL;DR: The currently available, soon to be available, and theoretically possible methods of male contraception are reviewed.

37 citations


Cites background from "Vasectomy: AUA Guideline"

  • ...It is a highly effective procedure with failure rates typically less than 1%.(16) In the United States, most vasectomies are performed by urologists as an outpatient procedure under local anesthesia....

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  • ...The 2012 American Urological Association guidelines on vasectomies found that the evidence studying the effectiveness of these technical variations is limited and only grade C evidence exists.(16) However, the expert opinion was that as long as the procedure is performed through a minimally invasive approach, such as no-scalpel vasectomy or with a small (<10 mm) incision using specialized instruments for vasal isolation, uses mucosal cautery and fascial interposition when the open testicular end is opted for, virtually all of the technical variations have documented approximately less than 1% failure rate and are acceptable as long as the surgeon has a similarly acceptable failure rate....

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Journal ArticleDOI
TL;DR: All patients-including adolescents; those who identify as lesbian, gay, bisexual, or transgender; and patients with disabilities or limited English proficiency-should receive high-quality care in an accommodating, nonjudgmental environment.
Abstract: The Centers for Disease Control and Prevention has released comprehensive recommendations for provision of family planning services. Contraceptive services may be addressed in five steps and counseling may be provided in a tiered approach whereby the most effective options are presented before less effective options. Clinicians should discuss all contraceptive methods that can be used safely by the patient regardless of whether a method is available on site and even if the patient is an adolescent or a nulliparous woman. Physical assessment is usually limited to blood pressure evaluation before starting hormonal contraceptives or pelvic examination before placing an intrauterine device. Monitoring the patients weight also may be helpful. If it is reasonably certain that the patient is not pregnant any contraceptive may be started immediately. When hormonal contraceptives are selected one years supply should be prescribed to reduce barriers to use. Condoms should be made readily available. Documentation of visits for contraception should include patient understanding of use benefits and risks plus an individualized follow-up plan. Bleeding irregularities generally are not harmful and may resolve with continued use of the contraceptive method. All patients-including adolescents; those who identify as lesbian gay bisexual or transgender; and patients with disabilities or limited English proficiency-should receive high-quality care in an accommodating nonjudgmental environment. The Centers for Disease Control and Prevention supports advance provision of emergency contraceptives. Because no test reliably verifies cessation of fertility it is prudent to consider contraceptive use until menopause or at least until 50 to 55 years of age.

33 citations

References
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Journal ArticleDOI
TL;DR: The Delphi technique is well suited as a method for consensus-building by using a series of questionnaires delivered using multiple iterations to collect data from a panel of selected subjects.
Abstract: The Delphi technique is a widely used and accepted method for gathering data from respondents within their domain of expertise. The technique is designed as a group communication process which aims to achieve a convergence of opinion on a specific real-world issue. The Delphi process has been used in various fields of study such as program planning, needs assessment, policy determination, and resource utilization to develop a full range of alternatives, explore or expose underlying assumptions, as well as correlate judgments on a topic spanning a wide range of disciplines. The Delphi technique is well suited as a method for consensus-building by using a series of questionnaires delivered using multiple iterations to collect data from a panel of selected subjects. Subject selection, time frames for conducting and completing a study, the possibility of low response rates, and unintentionally guiding feedback from the respondent group are areas which should be considered when designing and implementing a Delphi study.

3,704 citations

01 Dec 2005
TL;DR: National estimates of fertility, family planning, and reproductive health indicators among females 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG).
Abstract: OBJECTIVE This report presents national estimates of fertility, family planning, and reproductive health indicators among females 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). For selected indicators, data are also compared with earlier cycles of the NSFG. METHODS Descriptive tables of numbers and percentages are presented and interpreted. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males, and this report focuses on data from the female sample. The overall response rate for the Cycle 6 NSFG was 79 percent, and the response rate for women was 80 percent. RESULTS Given the range of topics covered in the report, only selected findings are listed here. About 14 percent of recent births to women 15-44 years of age in 2002 were unwanted at time of conception, an increase from the 9 percent seen for recent births in 1995. Among recent births, 64 percent occurred within marriage, 14 percent within cohabiting unions, and 21 percent to women who were neither married nor cohabiting. The overall rate of breastfeeding initiation among recent births increased from 55 to 67 percent between 1995 and 2002. About 50 percent of women 15-44 had ever cohabited compared with 41 percent of women in the 1995 survey; the percentage of women currently cohabiting also increased, from 7 to 9 percent between 1995 and 2002.

993 citations


"Vasectomy: AUA Guideline" refers background in this paper

  • ...7% who relied on tubal ligation.(5) Worldwide, the discrepancy between vasectomy and tubal ligation is even more marked than in the U....

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Journal ArticleDOI
28 May 1994-BMJ
TL;DR: This study confirms previous reports that developmental urogenital abnormalities result in an increased risk of testicular cancer and suggests the trend to perform orchidopexy at younger ages may reduce the risk associated with undescended testis.
Abstract: Objective : To determine the risk of testicular cancer associated with undescended testis, inguinal hernia, age at puberty, marital status, infertility, vasectomy, and amount of exercise. Design : A population based case-control study with a questionnaire administered by an interviewer and with relevant supplementary data extracted from general practioners9 notes. Setting : Nine health regions within England and Wales. Subjects : 794 men, aged 15-49 years, with a testicular germ cell tumour diagnosed between 1 January 1984 and 1 January 1987; each had an age matched (within one year) control selected from the list of their general practioner. Results : There was a significant association of testicular cancer with undescended testis (odds ratio 3.82; 95% confidence interval 2.24 to 6.52) and inguinal hernia (1.91; 1.12 to 3.23). The excess risk associated with undescended testis was eliminated in men who had had an orchidopexy before the age of 10 years. There were positive associations with earl age at voice breaking, early age at starting to shave, and infertility. There was a significant association with a sedentary lifestyle and a moderate protective effect of exercise. There was no association with vasectomy. Conclusion : This study confirms previous reports that developmental urogenital abnormalities result in an increased risk of testicular cancer. The trend to perform orchidopexy at younger ages may reduce the risk associated with undescended testis. The increased risks associated with early age at puberty and low amounts of exercise may be related to effects of exposure to endogenous hormones. Changes in both of these factors may partly contribute to the increasing rates of testicular cancer observed in the past few decades.

318 citations

Journal ArticleDOI
TL;DR: In this paper, a Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period, and sensitivity analyses were performed on costs and failure rates.

276 citations