Post-Vasectomy Follow-up Attrition and PVSA Nonadherence in a Brazilian Public University Hospital: A Prospective Care-Cascade Study

Post-vasectomy semen analysis (PVSA) is recommended to confirm sterility, yet adherence remains suboptimal. We evaluated completion of a six-month post-vasectomy follow-up care cascade, explored factors associated with attrition, and summarized patient-reported barriers.

We conducted a prospective observational cohort study at a tertiary public university hospital including all adults undergoing elective vasectomy from December 2024 to May 2025. Complete follow-up required (1) attendance at a postoperative visit, (2) PVSA completion, and (3) documented communication of PVSA results via in-person or teleconsultation within six months. Patients missing any step were classified as lost to follow-up. Nonadherent patients were contacted after six months to ascertain reasons.

Among 102 patients, complete follow-up was achieved in 44 (43.1%). Postoperative visit attendance occurred in 78 (76.5%), PVSA was performed in 51 (50.0%), and PVSA results were communicated to 44 (43.1%). The main drop-off occurred between the postoperative consultation and PVSA completion. Among respondents, lack of time due to work commitments was the most frequent barrier; a minority reported not perceiving PVSA as necessary. No demographic or clinical variable was significantly associated with loss to follow-up.

Fewer than half of patients achieved formal confirmation of sterility within six months after vasectomy. Attrition appears largely driven by logistical and behavioral barriers rather than clinical characteristics, supporting interventions that simplify PVSA access and streamline follow-up workflows.