1898 UROLOGICAL MANAGEMENT OF FERTILITY OPTIONS FOLLOWING PREVIOUS VASECTOMY: ANALYSIS OF CURRENT PRACTICE

Autor:	Ira D. Sharlip, Ola Blach, Arnold M. Belker, Anand Shridharani, Jay I. Sandlow
Rok vydání:	2013
Předmět:	Gynecology medicine.medical_specialty business.industry Urology Best practice media_common.quotation_subject Vasectomy Vasectomy reversal Fertility Audit Subspecialty Test (assessment) Exact test Family medicine Medicine business media_common
Zdroj:	Journal of Urology. 189
ISSN:	1527-3792 0022-5347
Popis:	INTRODUCTION AND OBJECTIVES: The recently completed AUA Vasectomy Guidelines identified vasectomy reversal (VR) as one potential area for further research. Current practice is characterized by wide variation in preoperative counseling, surgical technique and postoperative follow-up amongst urologists. The objective of this study was to review the management of fertility options following previous vasectomy and compare the performance of urologists with and without andrology fellowship based on ten index parameters deemed to reflect best practice. METHODS: In October 2012, a questionnaire-based audit was undertaken of all AUA affiliated urologists regarding their individual practice in managing men requesting VR. Fisher’s exact test was used to test the hypothesis that the management of fertility options following previous vasectomy, and the practice of VR, are no different when undertaken by urologists with and without andrology fellowship training. RESULTS: Of the 645 respondents, 325 (50.4%) performed VR. The majority, 54.1%, performed 1-5 VR a year with just 11.9% performing 25 per year (p 0.0001). 74 urologists were fellowship trained in andrology or male infertility, while 235 performed VR without subspecialty training; responses from the 16 who did not provide this information were excluded from analysis. Differential performance of the urologists with and without andrological training is shown in figure 1 below, along with p-values for the Fisher’s exact test: CONCLUSIONS: There are significant differences in the standards of practice of VR by urologists with and without andrology fellowship training. The vast majority of non-fellowship trained urologists perform 5 VR per year. These physicians are significantly less likely to counsel couples about all fertility options, be conversant in IVF/ICSI, provide individualized outcomes data, as well as utilize microsurgical techniques. Based on these differences, outcomes data should be analysed to determine if success rates differ, and if so, guidelines should be established. Source of Funding: None
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::97e1967cce18a89387955bab695135ec https://doi.org/10.1016/j.juro.2013.02.2317 Zobrazit plný text záznamu