title: Analysis of international practice patterns regarding postvasectomy fertility options.
abstract: OBJECTIVE
  To review the management of postvasectomy fertility options by urologists with vs without andrology fellowship and compare the features of practice in the USA vs UK.
  
  
  METHODS
  We conducted an audit of all American Urological Association-affiliated urologists regarding their practice in managing men requesting vasectomy reversal (VR). Standards of practice were assessed against 10 index parameters deemed, by 1 UK study, to reflect best practice. Fisher exact test was used to test the hypothesis that management of postvasectomy fertility options and practice of VR are no different when undertaken by urologists with vs without andrology training and no different in the USA vs UK.
  
  
  RESULTS
  Three hundred twenty-five of 645 US respondents (50.4%) practiced VR vs 178 of 213 (83.6%) in the UK; only 11.9% in the US and 10% in the UK performed >25 and >15 (P <.0001) VR/year, respectively. Compared with the UK urologists the US urologists offered more detailed information on all fertility options and/or outcomes, used microsurgical techniques more often, but less frequently counseled couples together, and referred patients to specialist centers for in vitro fertilization with intracytoplasmic sperm injection (P <.0001-.05). Only 74 of the US and 61 of the UK urologists were fellowship-trained in andrology. Most non-fellowship-trained urologists, in both the countries, performed <5 VR/year and were, statistically, significantly less likely to counsel couples about all fertility options, be conversant in in vitro fertilization with intracytoplasmic sperm injection, provide individualized outcomes data, and use microsurgical techniques (P <.0001-.05).
  
  
  CONCLUSIONS
  Significant differences exist in the standards of practice between both the US and UK urologists performing VR. Concordance with the indices of "best practice" improves with andrology training and increasing number of procedures performed.
authors.affiliation: Department of Urology, Royal Sussex County Hospital, Brighton, United Kingdom; Department of Urology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: ola.blach@googlemail.com.
authors.forename: Ola
authors.initials: O
authors.lastname: Blach
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Anand N
authors.initials: AN
authors.lastname: Shridharani
authors.affiliation: Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Jay I
authors.initials: JI
authors.lastname: Sandlow
mesh_terms: D003430:Cross-Sectional Studies; D005298:Fertility; D006801:Humans; D038622:Internationality; D008297:Male; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014481:United States; D014669:Vasovasostomy / Q000592:standards* / Q000706:statistics & numerical data