Approximately 6% of men who have had a vasectomy subsequently decide to have it reversed.
For such men there are various options available, including vasal reconstruction, surgical sperm retrieval with assisted reproductive techniques, use of donated sperm or adoption. The decision-making process with regard to the most appropriate management is challenging and the urologist requires both an intimate knowledge of the advantages and disadvantages of each of the available options and the opportunity to counsel a couple appropriately. The study confirms that patient management after previous vasectomy is a complex process, demanding detailed knowledge about the availability and outcomes of alternatives to vasectomy reversal. It recommends that couples should not be seen by urologists with diverse interests but by those with appropriate knowledge of all of the factors influencing outcome and the available management options and their costs. Urologists should also have appropriate facilities to offer intra-operative demonstration of and, potentially, storage of sperm.
OBJECTIVES:To review the management of men presenting for reversal of vasectomy amongst consultant members of the British Association of Urological Surgeons (BAUS) between 2001 and 2010. To make recommendations for contemporary practice.
SUBJECTS AND METHODS:Three consecutive questionnaire-based surveys were undertaken by BAUS consultant members in 2001, 2005 and 2010. Standard questionnaires were sent on each occasion asking urologists about their counselling of couples regarding options in achieving a conception, expectation of outcome from reconstructive surgery and the techniques of vaso-vasostomy used. In 2005 additional information was obtained about the availability of fertility treatments and sub-specialization of the urologist and in 2010 about the eligibility criteria for in-vitro fertilization (IVF) treatment and synchronous sperm retrieval.
RESULTS:Overall there was a 47% response rate with >80% of respondents still performing vaso-vasostomy. More than 75% of respondents were doing < 15 procedures a year and < 50% of respondents counselled couples about other management options. Only 41% gave their personalized outcomes from vaso-vasostomy, whilst >80% were using some form of magnification intra-operatively. Members of the BAUS section of andrology were more likely to discuss options for becoming a parent and criteria for IVF treatment, to present their individualized outcomes from vaso-vasotomy and to carry out >15 procedures a year than urologists with no andrological affiliation.
CONCLUSIONS: Patient management after previous vasectomy is a complex process necessitating detailed knowledge concerning the availability and outcomes of alternatives to vaso-vasostomy. Couples should not be seen by urologists with diverse interests but by those with appropriate knowledge of all of the factors influencing outcome. Vaso-vasostomy should no longer be seen as a procedure within the remit of any adequately trained urologist but as one option to be considered by a sub-specialist with access to appropriate micro-surgical training and assisted reproductive technologies.
Grey BR, Thompson A, Jenkins BL, Payne SR. Are you the author?
Department of Urology, Central Manchester University Hospitals NHS Foundation Trust, Manchester; Department of Urology, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan; Department of Urology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK.
Reference: BJU Int. 2012 Feb 9. Epub ahead of print.