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Welcome
You both have agreed on decision
#1, the reversal, now comes decision #2-
the surgeon.
This site provides information to
help you with your second decision. Some of you
will decide to make contact and others will decide not to follow-up, but I trust the
information here will be useful to aid you in your final
choice.
What is the
Standard of Care?
The simple question, "What is the
standard of practice in vasectomy reversal?", does
not have a simple, easy answer. The best way I
know to approach it is to share a survey of practice
patterns in the United States. This is the only
U.S. survey I am aware of in the surgical literature
since 1973. It was published in the January 2004
Journal of Urology. Over 1500 questionnaires were
mailed, and out of those urologists responding, 367
indicated they performed vasectomy reversal.
Almost 10% of these were fellowship (sub-specialty)
trained in vasectomy reversal surgery, about 20% were
academic urologists ( associated with a teaching
institution) and approximately 70% practiced in the
community (non-academic) setting.
On average, the fellowship trained
group performed 26 reversals yearly, the academic group
12 reversals yearly, and the community urologists
performed 7 vasectomy reversals a year. An
operating microscope was used by 93% of the fellowship
trained practitioners, 65% of academic urologists, and
56% of community based urologists.
An average of 70% of all
practitioners indicated they routinely examined the
vasal fluid (fluid from the vas) during operation.
Only 18% of surgeons overall would perform an epididymal
bypass (vasoepididymostomy) rather than a simple vas
reconnection (vasovasostomy), based on poor quality
vasal fluid. And only 10 out of 29 (34%) of the
fellowship trained urologists would proceed to a bypass
based on poor vasal fluid.
An average of eight sutures,
overall, were used to connect each vas together in two
layers. The average number of sutures used in the
fellowship trained group was ten, not significantly
different from the other two groups. An even range
of suture sizes (from 5-zero to 10-zero) was used by the
academic and community urologists, however, the
fellowship trained surgeons used statistically different
finer sutures (90% used 9-zero or smaller).
Overall, the survey demonstrates a
variety in the practice of vasectomy reversal.
And although the study does not completely or
definitively answer the question posed above regarding
standard of care, it does indicate a trend toward more
procedures performed per year, as well as the use of a
microscope and smaller sutures with increasing level of
expertise.
I have performed over 700
microsurgical reversals as of June 2008, currently doing
over 300 a year. The semen analysis results for my
patients indicate a 100% patency success rate for
patients less than 3 years from their vasectomy.
That is to say of patients less than 3 years from
vasectomy, 100% have had return of live sperm to the semen.
Live sperm return is 93% overall for
patients from 3-8 years from vasectomy based on semen
analysis reports for the practice.
Again, welcome to the
site. I trust the information in
the about
microsurgery page, as well as the other site pages
listed on the navigation bar to the right , will
help the two of you with your decision #2.
David S. Wilson, M.D.
Crain DS, Roberts JL, Amling CL.
Practice patterns in vasectomy reversal surgery: results
of a questionnaire study among practicing urologists. J
Urol. 2004 Jan;171(1):311-15.
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