Expanding the use of no-scalpel vasectomies
April 1, 1999
Expanding the use of no-scalpel vasectomies
The first-ever estimate of the extent of use of no-scalpel vasectomy (NSV) shows that within 10 years of its U.S. introduction, the technique for male sterilization accounts for about 29% of the vasectomies performed nationwide on an annual basis.1
No-scalpel vasectomy eliminates the need to make a surgical incision in the scrotum to reach the vas deferens, is less painful, heals more quickly, and has fewer complications. The American introduction of the NSV technique, which was developed in China, was pioneered in 1988 by AVSC International, a New York City-based nonprofit reproductive health care advocacy group. (For more details, see Contraceptive Technology Update, March 1998, p. 29.)
No-scalpel vasectomies now have become an accepted option in urologic care, according to the national study conducted by AVSC, the School of Public Health and Tropical Medicine at the New Orleans-based Tulane University Medical Center, and the Division for Reproductive Health at the Atlanta-based Centers for Disease Control and Prevention. What has led to this acceptance?
"I think the reasons are due to physicians finding out about it [NSV] and realizing the benefits of it, compared with traditional incisional vasectomy," says Jeanne Haws, MPA, senior director at AVSC. "Also, consumer demand helped fuel physician interest, with articles appearing in such varied venues as McCall’s, Men’s Health, Playboy, and Newsweek magazines and generating interest."
The study, a retrospective mail survey with telephone follow-up, included 1,800 urology, family practice, and general surgery practices drawn from the Chicago-based American Medical Association’s Physician Master File. In 1995, the most recent year for which data are available, about 494,000 vasectomies are estimated to have been performed by 15,800 U.S. physicians. Urologists performed 76% of the vasectomies, with 15% by family practitioners, and 9% by general surgeons.
No-scalpel vasectomies represent 29% of the vasectomies performed in 1995. Urologists and family practitioners were equally likely to adopt the technique. Despite admonitions from trainers and others that the technique should be learned from another provider, more than a third of the physicians who used NSV reported they taught themselves the procedure.
AVSC continues to offer training, made possible through a grant from the David and Lucile Packard Foundation of Los Altos, CA, to provid ers working in state or county health departments or public-sector clinics. (State health administrators interested in getting training for individuals in their state should check the resource box on p. 47 for more information. Private-sector physicians or others interested should refer to the AVSC Web site, http://www. avsc.org, for information on providers offering NSV who may be willing to train them in the procedure.)
Advanced-practice use
Advanced-practice providers such as nurse practitioners and physician assistants also have received training in the no-scalpel technique. John Riley, PA-C, co-medical director of the Anchorage (AK) Neighborhood Health Center, says he pursued NSV training because he wanted to expand the availability to those lower-income patients who might not otherwise have access to the procedure. Riley has performed about 30 procedures since he received training in 1997. A physician also performs NSV at the Center.
The Health Center is the only Anchorage family practice clinic offering a sliding fee scale, Riley notes. It provides a full range of medical services for men and women, including preventive care, family planning, treatment of sexually transmitted diseases, and care of acute and chronic illness. "We advertise the availability of sliding fee charges for NSV, and a person with income below the federal poverty level can get the procedure done for as little as $65," he says. "The NSV method has proven to be very popular with patients, and several come in asking for it by name."
Daryl Young, RN, ANP, MS, the director of student health services at the University of Alaska in Anchorage, also has put NSV training into practice. He offers the services at the student health center and the local Planned Parenthood clinic. He has performed 28 procedures since his 1997 training.
Much preparation went into establishing the service. He sought backup from local urologists and made a presentation to the state nursing board to add NSV to his scope of practice. Young says he carefully evaluates each patient who wants to be a NSV candidate and performs post-vasectomy sperm counts to ensure the effectiveness of the procedure.
Both providers received their training through a joint effort coordinated by AVSC, the National Association of Nurse Practitioners in Reproduc tive Health, based in Washington, DC, and Region X of the U.S. Public Health Service in Seattle. Candidates were screened and evaluated, notes Chris Knutson, CRN, ARNP, MN, a nursing care consultant with the Washington public health department in Olympia who worked with the project.
No-scalpel vasectomy definitely is not an entry-level skill, Knutson stresses. Providers who are experienced and procedure-oriented have better success with the technique, she notes.
Reference
1. Haws JM, Morgan GT, Pollack AE, et al. Clinical aspects of vasectomies performed in the United States in 1995. Urology 1998; 52:685-691.
Resource
For more on no-scalpel vasectomy, contact:
• AVSC International, 79 Madison Ave., New York, NY 10016. Telephone: (212) 561-8000. Fax: (212) 779-9439. E-mail: [email protected]. Web: www.avsc.org. The Web site offers easy-to-read information on conventional and no-scalpel vasectomy methods and features a state-by-state list of providers who offer no-scalpel vasectomies. If you provide no-scalpel vasec tomies and wish to be included on the list, contact Maureen McKenzie, training programs administrator, at (212) 561-8094. E-mail: [email protected]. Or write to her at the above address.
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