Hertz Alexandria M, Stamm Andrew W, Anderson Mark I, Baker Karen C
Department of Urology, Madigan Army Medical Center, Tacoma, WA, USA.
Division of Urology and Transplantation, Virginia Mason Medical Center, Seattle, WA, USA.
Asian J Urol. 2021 Apr;8(2):197-203. doi: 10.1016/j.ajur.2020.04.001. Epub 2020 Apr 23.
Evaluate the influence of fellowship training, resident participation, reconstruction type, and patient factors on outcomes after vasectomy reversals in a high volume, open access system.
Retrospective review of all vasectomy reversals performed at a single institution from January 1, 2002 to December 31, 2016 was conducted. Patient and spouse demographics, patient tobacco use and comorbidities, surgeon training and case volume, resident participation, reconstruction type, and postoperative patency were collected and analyzed.
Five hundred and twenty-six vasectomy reversals were performed during the study period. Follow-up was available in 80.6% of the cohort and overall patency, regardless of reconstruction type was 88.7%. The mean time to reversal was 7.87 years (range of 0-34 years). The majority of cases included resident participation. Case volume was high with faculty and residents logging a mean of 37.0 and 38.7 (median 18 and 37) cases respectively. Bilateral vasovasostomy was the most common reconstruction type (83%) and demonstrated a significantly better patency rate (89%) than all other reconstructions (=0.0008). Overall patency and patency by reconstruction type were not statistically different among faculty surgeons and were not impacted by fertility fellowship training, resident participation or post-graduate year. Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency (=0.0023 and =0.043, respectively).
Surgeons with a high volume of vasectomy reversals have outcomes consistent with contemporary series regardless of fellowship training in fertility. Patency was better for bilateral vasovasostomies. Patency was not negatively impacted by tobacco use, comorbidities, resident participation, or post-graduate year.
在一个高容量、开放获取的系统中，评估专科培训、住院医师参与、重建类型和患者因素对输精管复通术后结局的影响。
对2002年1月1日至2016年12月31日在单一机构进行的所有输精管复通术进行回顾性研究。收集并分析患者及其配偶的人口统计学资料、患者吸烟情况和合并症、外科医生培训情况和手术量、住院医师参与情况、重建类型以及术后通畅情况。
研究期间共进行了526例输精管复通术。80.6%的队列有随访资料，无论重建类型如何，总体通畅率为88.7%。复通的平均时间为7.87年（范围为0至34年）。大多数病例有住院医师参与。手术量很大，教员和住院医师分别平均完成37.0例和38.7例（中位数分别为18例和37例）。双侧输精管吻合术是最常见的重建类型（83%），其通畅率（89%）显著高于所有其他重建类型（P=0.0008）。教员外科医生的总体通畅率和按重建类型划分的通畅率在统计学上无差异，且不受生殖专科培训、住院医师参与或研究生年级的影响。多因素分析表明，复通时间延长和重复重建对通畅率有负面影响（分别为P=0.0023和P=0.043）。
无论是否接受生殖专科培训，进行大量输精管复通术的外科医生的结局与当代系列研究结果一致。双侧输精管吻合术的通畅率更高。通畅率不受吸烟、合并症住院医师参与或研究生年级的负面影响。
