Presentation Authors: Jonathan Beilan*, Alexander Tatem, Jabez Jabez Gondokusumo, Nannan Thirumavalavan, Larry Lipshultz, Houston, TX
Introduction: Vasectomy reversal (VR) is a specialized procedure currently being offered by an increasing number of practitioners. Vasoepididymostomy (VE) represents the most challenging microsurgical technique within the field of reproductive urology. We surveyed reproductive urologists to assess current practice patterns regarding both intra-operative and post-operative considerations surrounding VE.
Methods: An anonymous questionnaire was sent to members of the Society for Male Reproduction and Urology (SMRU). The survey included questions on case volume, preferred intra-operative techniques, and post-operative management strategies. Responses were collected using Survey Monkey (San Mateo, CA).
Results: 320 people were contacted to participate in the survey. 74 people (23.1%) completed the survey in its entirety. The study population represents a wide range of operative experience: 15 (20.3%) participants perform 0-10 VR's per year, 18 (24.3%) perform 11-20 per year, 13 (17.57%) perform 21-30 per year, 13 (17.57%) perform 31-60 per year, and 15 (20.3%) perform over 60 per year. Interestingly, comparing practitioners who perform â‰¤30 VR's annually (n=46) to those people who perform >30 (n=28) reveals a significantly lower rate of VE (â‰¤20% vs >20%, p=0.0001). The most commonly used technique to create the epididymotomy is to place two 10-0 sutures into the tubule, followed by a sharp incision between the needles (74.3% of respondents). An intussusception anastomosis is the most commonly reported technique; 46.0% of participants utilize longitudinal stitch placement, while 35.1% place sutures horizontally._x000D_
The most commonly reported time interval to evaluate the first post-reversal semen analysis is 6-8 weeks (39.2%). In the setting of a subpar post-reversal semen analysis (SA), NSAIDs are the most popular first-line management option (52.7%). Corticosteroids are the most frequently employed second-line option (37.8%). If these two modalities fail, referral to an IVF center (39.1%) and repeat surgery (31.1%) represent final strategies. While managing the patient with a subpar post-reversal SA, it is most common to repeat the SA every 8-12 weeks (41.2%).
Conclusions: VE is a technically demanding procedure that requires not only microsurgical expertise but also familiarity with post-operative care. Our analysis shows that a higher operative volume is associated with a higher rate of conversion to VE. This indicates that a more experienced surgeon is more likely to perform a VE when indicated.
Source of Funding: This work is supported in part by NIH grant K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program (NT is a K12 Scholar).