Early Vasectomy Reversal Experience and Outcomes of Fellowship-Trained Microsurgeons

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 • 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. • 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). • 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 • References • 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 3 • Sources of Funding • None