Transcript Vit. D - Williams' Urology

Early Vasectomy Reversal Experience and Outcomes of
Fellowship-Trained Microsurgeons
AUA Annual Meeting
April 2009, Chicago, IL
Poster #2011
Daniel H Williams IV, Edward Karpman, Ethan D Grober, Christopher G Schrepferman, Donald S Crain,
Weber W Chuang, David Shin, Mohit Khera, Wayne Kuang, Cigdem Tanrikut
Methods
Introduction
Surgical volume and experience have
been shown to correlate with favorable
post-operative outcomes in a variety of
surgical specialties and in urological
surgery.1,2
Newly-graduated surgical trainees lack
such years of independent experience.
However, it is unknown to what extent this
inexperience affects their early surgical
outcomes (given previous sound surgical
training).
Results
Patient records from the first two years of
clinical practice were retrospectively
reviewed.
In their first 2 years of practice, 10
microsurgeons performed 310 microsurgical
vasectomy reversals (range 1-75).
The following data points were recorded for
each microsurgeon:
• Number of vasectomy reversals
• Type of reversal performed
• Post-operative semen parameters (if
available)
• 221 bilateral vasovasostomies (VV)
• 59 unilateral vasovasostomy with unilateral
epididymovasostomy (VV/EV)
• 30 bilateral epididymovasostomies (EV)
Each urologist had completed a minimum
one-year clinical fellowship in male
reproductive medicine and microsurgery.
Post-operative semen analyses were available
for 236 (76.1%) patients.
The overall patency rate was 90.7% (214 of
236). Patency rates for VV, VV/EV, and EV
were 96%, 87.5%, and 54%, respectively.
Objective
The primary objective of this study was to
evaluate early vasectomy reversal
experience and outcomes of fellowshiptrained microsurgeons in their first two
years of clinical practice.
Sources of Funding
Conclusions
Overall, vasectomy reversal patency
rates in this study are consistent with
those reported by experienced urologists
performing microsurgical vasectomy
reversals (VV 87%, VV/EV 70%, EV 50%).3
Recent completion of fellowship training
by microsurgeons in this group did not
seem to have a negative impact on
vasectomy reversal patency rates.
These findings highlight the importance
of good microsurgical training prior to
independent clinical practice.
Limitations
Mean Semen Parameters (and ranges) of Patent Vasectomy Reversals
Reversal Type Number
Volume (mL)
Concentration
Motility (%)
(million/mL)
VV
2.4 (0.5-9.5)
38.7 (0.2-161)
158
38 (0-90)
3
VV/EV
43
2.9 (0.5-5.5)
26.2 (0.2-101)
30 (0-75)
EV
13
2.9 (1.5-3.5)
33 (0.5-88)
32 (0-79)
• None
• Relatively small sample size
• Individual surgical techniques may
influence outcomes
• Short-term follow-up without pregnancy
data
References
1. Hellawell et al. Urology 2008; 72(6):
1347-50
2. Rosser et al. Cancer 2006; 107: 54-59
3. Belker et al. J Urol 1991; 145: 505-511