1899 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: A COMPARATIVE STUDY OF PRACTICE IN THE UNITED STATES AND THE UNITED KINGDOM

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 20131899 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: A COMPARATIVE STUDY OF PRACTICE IN THE UNITED STATES AND THE UNITED KINGDOM Ola Blach, Steve Bramwell, and Jay Sandlow Ola BlachOla Blach Aberdeen, United Kingdom More articles by this author , Steve BramwellSteve Bramwell Inverness, United Kingdom 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.2013.02.2318AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The 2010 survey into “UK urologists' management of secondary azoospermia following previous vasectomy” showed that urologists with specialist andrology training and high case volumes were best equipped to successfully manage couples considering vasectomy reversal (VR). To date, no similar surveys have been conducted in the USA. The objective of this study was to review the US management of fertility options following previous vasectomy based on the exact criteria used in the UK's survey, and compare the features of practice in both countries. 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, and no different in the US and the UK. RESULTS 50.4% of the US respondents (325/645) practiced VR, compared to 83.6% (178/213) in the UK. The majority in both countries performed 1-10 VR a year; just 11.9% of the US urologists and 10% of the UK urologists carried out >25 and >15 (p<0.0001) VR a year, respectively. Only 74 of the US and 61 of the UK urologists were fellowship trained in andrology; responses from those who did not provide this information were excluded from analysis. Differential performance of the urologists with and without andrological training, both in the US and the UK, is shown in figure 1 below, along with p-values for the Fisher's exact test: CONCLUSIONS A number of differences in the management of fertility options following previous vasectomy exist between the US and the UK. US urologists perform more VR each year, offer more detailed information on all fertility options and likely outcomes, and utilize microsurgical techniques more often. Unlike the UK urologists however, they less frequently counsel the infertile couples together and refer patients to specialist centres for IVF/ICSI. Importantly, in both countries, the urologists with specialist andrology training and high case volumes seem to be best equipped to appropriately manage couples considering VR. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e778-e779 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ola Blach Aberdeen, United Kingdom More articles by this author Steve Bramwell Inverness, United Kingdom More articles by this author Jay Sandlow Milwaukee, WI More articles by this author Expand All Advertisement Advertisement Loading ...