1. Early Vasectomy Reversal Experience and Outcomes of
Fellowship-Trained Microsurgeons
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
Poster #2011
Introduction
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).
Methods
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.
Results
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.
Conclusions
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.
Objective
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.
Limitations
Relatively small sample size
Individual surgical techniques may influence outcomes
Short-term follow-up without pregnancy data
Mean Semen Parameters (and ranges) of Patent Vasectomy Reversals
Reversal Type
Number
Volume (mL)
Concentration (million/mL)
Motility (%) VV
158
2.4 ( )
38.7 ( )
38 (0-90)
VV/EV 43
2.9 ( )
26.2 ( )
30 (0-75) EV 13
2.9 ( )
33 (0.5-88)
32 (0-79)
References
Hellawell et al. Urology 2008; 72(6):
Rosser et al. Cancer 2006; 107: 54-59
Belker et al. J Urol 1991; 145:
Sources of Funding
None 3