Early Vasectomy Reversal Experience and Outcomes of
Daniel H Williams IV, Edward Karpman, Ethan D Grober, Christopher G Schrepferman, Donald S Crain,
Weber W Chuang, David Shin, Mohit Khera, Wayne Kuang, Cigdem Tanrikut
AUA Annual Meeting
April 2009, Chicago, IL
- Patient records from the first two years of clinical practice were retrospectively reviewed.
- The following data points were recorded for each microsurgeon:
- Number of vasectomy reversals
- Type of reversal performed
- Post-operative semen parameters (if available)
- Each urologist had completed a minimum one-year clinical fellowship in male reproductive medicine and microsurgery.
- Surgical volume and experience have been shown to correlate with favorable post-operative outcomes in a variety of surgical specialties and in urological surgery.1,2
- Newly-graduated surgical trainees lack such years of independent experience.
- However, it is unknown to what extent this inexperience affects their early surgical outcomes (given previous sound surgical training).
- In their first 2 years of practice, 10 microsurgeons performed 310 microsurgical vasectomy reversals (range 1-75).
- 221 bilateral vasovasostomies (VV)
- 59 unilateral vasovasostomy with unilateral epididymovasostomy (VV/EV)
- 30 bilateral epididymovasostomies (EV)
- Post-operative semen analyses were available for 236 (76.1%) patients.
- The overall patency rate was 90.7% (214 of 236). Patency rates for VV, VV/EV, and EV were 96%, 87.5%, and 54%, respectively.
Overall, vasectomy reversal patency rates in this study are consistent with those reported by experienced urologists performing microsurgical vasectomy reversals (VV 87%, VV/EV 70%, EV 50%).3
Recent completion of fellowship training by microsurgeons in this group did not seem to have a negative impact on vasectomy reversal patency rates.
These findings highlight the importance of good microsurgical training prior to independent clinical practice.
- The primary objective of this study was to evaluate early vasectomy reversal experience and outcomes of fellowship-trained microsurgeons in their first two years of clinical practice.
- Relatively small sample size
- Individual surgical techniques may influence outcomes
- Short-term follow-up without pregnancy data
- Hellawell et al. Urology 2008; 72(6): 1347-50
- Rosser et al. Cancer 2006; 107: 54-59
- Belker et al. J Urol 1991; 145: 505-511