The following information must be obtained, if you are going to make a prudent selection of a microsurgeon for your reversal. Lacking this information, you will be taking the traditional “pig in a poke,” no disrespect intended. Each of the following topics I regard as credentials deserving strong consideration. I conclude with my personal information on each topic.
EXPERIENCE
How many total reversals has the surgeon you are considering performed in his career? How many did he perform last year?
You MUST ask!
Most true “vasectomy reversal surgeons” perform at least one vasectomy reversal each week and approximately fifty or more each year. A career total of fewer than several hundred vasectomy reversals indicates significant inexperience.
STATISTICS
What is the "patency rate" of the surgeon you are considering?
Worth asking, but often the answers need analysis!
The "patency rate" is the frequency of the post-op confirmation of sperm in every patient’s semen. This is almost routinely obtained. The "pregnancy rate” is always less, because many variables besides sperm presence are involved. The longer time interval to determine pregnancy or not loses many patients from follow-up. There are unrealistic claims by more than just a few reversal surgeons, like a "90% Baby Rate", that are absurd. Presumed normal couples without sterilization to overcome don’t do that well statistically!
Some surgeons will give another surgeon’s or a medical center’s published patency rate. That indicates either they have not personally
performed very many reversals, or their personal results have not been very good. Only a surgeon’s personal statistics deserve any consideration at all.
Unfortunately, it’s not uncommon for statistics to be stated somewhat deceptively. An example is that some surgeons report 97-98 % success rates for
returning sperm to a patient’s semen by simply re-connecting the upper and lower vas ends after removing the vasectomy blockage. This procedure is called “vasovasostomy”
(VV). This is incredibly good, until you discover that they have excluded all their patients with poor or bad findings at surgery by performing on them the difficult bypass
operation called “vasoepididymostomy” (VE), instead of vasovasostomy. Valid statistics require consecutive cases, not selected cases after some are
excluded. Some report obtaining “98-99% success rates with patients having live sperm in either vas at the time of surgery”. This really isn't exceptionally good and it excludes more than half of all
patients, because 50-60% of all reversal patients do not have live sperm seen at the time of their reversals. You simply have to be careful, perhaps a little cynical, when
reviewing statistics, because the actual results are often not as they initially seem.
ACCOUNTABILITY
Does the surgeon you are considering provide any significantly tangible ($$$$) accountability for his surgical results? Why not?
You need to ask!
Although accountability for results is not possible and/or practical in medicine generally, it has a perfect application for both vasectomy and vasectomy reversal.
A vasectomy without subsequent complete disappearance of sperm from the semen is a failure.
After a patient experiences a vasectomy failure almost all urologists will either refund the surgical fee or repeat the vasectomy without additional surgical charge.
A reversal without sperm being restored to the semen is a similar failure.
However, vasectomy reversals are much more difficult and expensive and they are much less successful.
Consequently, many vasectomy reversal surgeons still prefer to criticize the accountability of other surgeons, rather than provide their own surgical accountability.
A Tribute to DONALD R. POHL, M.D.
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The founder and the microsurgeon for Vasectomy Reversals of Texas was Donald R. Pohl, M.D. He graduated from Southwestern Medical School (University of Texas) and did his internship and four years of urology speciality training in the USAF. He is certified by the prestigious American Board of Urology. He received his formal microsurgical training at Johns Hopkins University School of Medicine in Baltimore, MD in 1980. He discontinued general urology and limited his practice to only vasectomies and microsurgical vasectomy reversals in 1983. Since April 1999 his practice was devoted exclusively to microsurgical vasectomy reversals by vasovasostomy.
Dr. Pohl performed during his career well over 2,300 microsurgical vasectomy reversals. Excluding vacation weeks, he averaged more than 3 reversals each week for the past ten years. He had a career patency rate of approximately 85 by vasovasostomy with no patients excluded for any reason.
His patiency rate in 2005 was 85 of (90.4%) and in 2006 it was 85 of 93 (91.4%).The 2007 results on 109 patients will be available on 06/30/2008.
He had provided all of his patients with a unique pre-operative prognosis determined MONEY BACK GUARANTEE ( MBG ) up to $5000.00 since 1990.
His surgical technique is carefully described and compared on the Vasovasostomy Techniques page.
Dr. Pohl owned and routinely uses a ZEISS (West Germany) Model OPMI MDM operating microscope with ZOOM magnification enhancement to place every vas re-connection suture. He documented from experience that this microscope is significantly superior to those microscopes which are shared with other specialists at most hospitals and ambulatory surgical centers. Obviously, better magnifying optics permit better vas re-connections.
The Legacy Continues
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