Impact of surgical volume and resident involvement on patency rates after vasectomy reversaldA 14-year experience in an open access system  

作　　者：Alexandria M.Hertz Andrew W.Stamm Mark I.Anderson Karen C.Baker 

机构地区：[1]Department of Urology,Madigan Army Medical Center,Tacoma,WA,USA [2]Division of Urology and Transplantation,Virginia Mason Medical Center,Seattle,WA,USA [3]Division of Urology,Duke University Hospital,Durham,NC,USA

出　　处：《Asian Journal of Urology》2021年第2期197-203,共7页亚洲泌尿外科杂志（英文）

摘　　要：Objective: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.Methods: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.Results: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(p=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 postgraduate year.Multivariate analysis demonstrated that increased time to reversal and repeat reconstructions had a negative impact on patency(p=0.0023 and p=0.043,respectively).Conclusions: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.

关 键 词：Vasectomy reversal VASOEPIDIDYMOSTOMY Obstructive azoospermia Outcomes research Learning curve 

分 类 号：R699.8[医药卫生—泌尿科学]