MP74-02 INTRA-OPERATIVE FINDINGS INFLUENCE DECISION MAKING IN VASECTOMY REVERSAL PROCEDURES - SURVEY OF FELLOWSHIP-TRAINED, HIGH-VOLUME SURGEONS

Abstract

INTRODUCTION AND OBJECTIVES: Up to 6% of men who undergo surgical sterilization will desire vasectomy reversal, some requiring microscopic epididymovasostomy. Due to the technical difficulty of microsurgery, historical notion is that only fellowshiptrained urologists are capable of performing vasectomy reversal surgery. Limited data is available on urologists performing vasectomy reversal currently. We sought to evaluate the factors that characterize vasectomy reversal practice among practicing urologists. METHODS: We reviewed the American Board of Urology recertification case logs from 2008 to 2014. We identified urologists who had performed vasectomy reversal based on the following three CPT codes: 55400 (vasovasostomy), 54900 (epididymovasostomy, unilateral), 54901 (epididymovasostomy, bilateral). Demographic data on the urologists was obtained and reviewed. Multivariate analysis was performed to identify factors informing surgical approach. RESULTS: There were a total of 5167 urologists who submitted case logs during the study period. 777 urologists had performed at least one vasectomy reversal procedure (9.43%) of which epididymovasostomy accounted for 6.7%. Andrology and General were the specialties that performed epididymovasostomy. A greater proportion of Andrologytrained urologists performed bilateral epididymovasostomy as compared to general urologists (43.9% vs 31.0%, p < 0.05). Urologists who performed vasectomy reversal were more likely to be male, practice in South Central and Western sections, be Andrology or Infertility trained, and practice in government or private practice settings. A sub-analysis of those performing epididymovasostomy identified that these individuals were more likely to practice in academic settings and be Andrology-trained. Performance of 4 vasectomy reversal surgeries during the certification period placed the urologist into the 50 percent quartile by surgical volume. CONCLUSIONS: Contrary to conventional views, our data demonstrated that the majority of vasectomy reversal surgeries were performed by general urologists in a private practice setting, with a higher proportion of epididymovasostomy being performed by Andrology-trained microsurgeons. This data suggest that vasectomy reversal is more commonly performed in the general urology practice than previously suggested and greater emphasis should be placed on microsurgical training during residency with appropriate referral of patients requiring epididymovasostomy to Andrology-trained urologists.