1898 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: ANALYSIS OF CURRENT PRACTICE

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 20131898 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: ANALYSIS OF CURRENT PRACTICE Ola Blach, Anand Shridharani, Ira Sharlip, Arnold Belker, and Jay Sandlow Ola BlachOla Blach Aberdeen, United Kingdom More articles by this author , Anand ShridharaniAnand Shridharani Milwaukee, WI More articles by this author , Ira SharlipIra Sharlip San Francisco, CA More articles by this author , Arnold BelkerArnold Belker Louisville, KY More articles by this author , and Jay SandlowJay Sandlow Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2317AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The recently completed AUA Vasectomy Guidelines identified vasectomy reversal (VR) as one potential area for further research. Current practice is characterized by wide variation in preoperative counseling, surgical technique and postoperative follow-up amongst urologists. The objective of this study was to review the management of fertility options following previous vasectomy and compare the performance of urologists with and without andrology fellowship based on ten index parameters deemed to reflect best practice. METHODS In October 2012, a questionnaire-based audit was undertaken of all AUA affiliated urologists regarding their individual practice in managing men requesting VR. Fisher's exact test was used to test the hypothesis that the management of fertility options following previous vasectomy, and the practice of VR, are no different when undertaken by urologists with and without andrology fellowship training. RESULTS Of the 645 respondents, 325 (50.4%) performed VR. The majority, 54.1%, performed 1-5 VR a year with just 11.9% performing >25 per year (p<0.0001). 74 urologists were fellowship trained in andrology or male infertility, while 235 performed VR without subspecialty training; responses from the 16 who did not provide this information were excluded from analysis. Differential performance of the urologists with and without andrological training is shown in figure 1 below, along with p-values for the Fisher's exact test: CONCLUSIONS There are significant differences in the standards of practice of VR by urologists with and without andrology fellowship training. The vast majority of non-fellowship trained urologists perform <5 VR per year. These physicians are significantly less likely to counsel couples about all fertility options, be conversant in IVF/ICSI, provide individualized outcomes data, as well as utilize microsurgical techniques. Based on these differences, outcomes data should be analysed to determine if success rates differ, and if so, guidelines should be established. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e778 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ola Blach Aberdeen, United Kingdom More articles by this author Anand Shridharani Milwaukee, WI More articles by this author Ira Sharlip San Francisco, CA More articles by this author Arnold Belker Louisville, KY More articles by this author Jay Sandlow Milwaukee, WI More articles by this author Expand All Advertisement Advertisement Loading ...