Vasectomy reversals should be carried out by urology specialists with access to appropriate micro-surgical training and assisted reproductive technologies, and not general urology surgeons, according to research published in the October issue of BJUI. The findings are based on a series of surveys carried out among consultant members of the British Association of Urological Surgeons (BAUS) over a ten-year period.
"It is clear from our research that couples should not be seen by urologists with diverse interests, but by those with appropriate knowledge of all of the factors influencing the outcome of a vasectomy reversal," says co-author and consultant urologist Dr Stephen R. Payne from Manchester Royal Infirmary in the UK.
BAUS members were surveyed in 2001, 2005 and 2010, with a total of 835 replies to the three questionnaires and an overall response rate of 47 percent. Every year some 20,000 vasectomies are performed in the UK. About six percent of men subsequently ask for the procedure to be reversed so that their partner can get pregnant. Various options are available to these couples, including vaso-vasostomy, a surgical reversal procedure where the ends of the vasa are identified and joined back together again. The overall findings of the surveys showed that:
- More than 80 percent of respondents performed vaso-vasostomy, but about three-quarters were only doing 15 or fewer procedures a year.
- 50 percent of urologists counselled couples about alternatives to vasectomy reversal.
- Less than half (41 percent) gave patients details on their personal outcomes for vaso-vasostomy.
However, the 2010 audit showed that members of the BAUS section of andrology, who specialise in problems relating to the male genital tract, were more likely than non-members to:
- Perform more than 15 vaso-vasotomies a year.
- Insist on seeing both partners.
- Discuss all options for parenting in detail.
- Be fully conversant with the criteria for in-vitro fertilisation (54 percent vs. 23 percent).
- Provide their individualised information about expected outcome.
- Routinely retrieve sperm when carrying out a vaso-vasostomy.
- Use an operating microscope (40 percent vs. 26 percent).