title: Factors and practice patterns that affect the decision for vasoepididymostomy.
abstract: BACKGROUND
  To determine the factors used to make the decision between vasovasostomy (VV) and vasoepididymostomy (VE) by leaders performing microsurgical vasectomy reversal using a questionnaire.
  
  
  METHODS
  An online questionnaire was sent to all members of the Society for the Study of Male Reproduction (SSMR), a male reproduction subspecialty society of the AUA, using the SurveyMonkey platform.
  
  
  RESULTS
  Sixty-seven surgeons responded to the questionnaire (27% of SSMR members). Of which 72% of members performed less than 50 vasectomy reversals per year. Also, 71% of members stated that less than 20% of their vasectomy reversals are vasoepididymostomies. When evaluating epididymal fluid at the time of reversal, 87% would perform a VE for pasty fluid, 66% with creamy fluid without sperm heads and 55% with no or scant fluid. With respect to banking sperm, 36% take sperm or testicular tissue at the time of VE while 37% sometimes take sperm mostly depending on the couple's preference. The Berger end-to-side with intussusception VE technique is used by the majority of members (78%). The presence of intact sperm or sperm parts determined the location in the epididymis for anastomosis for 55% and 19% of members respectively. Postoperative semen testing after a VE is evaluated first between 6 weeks to 3 months for 64%. The procedure is considered a failure between 6 to 12 months for 34% and 12 to 18 months for another 48% if no sperm is seen on semen analysis.
  
  
  CONCLUSIONS
  Most members perform a VE with pasty fluid or creamy fluid without sperm heads. Three out of four members are using the Berger end-to-side intussusception technique to perform their VE. More studies are needed to determine the optimal circumstances to perform a VE as there is significant variation in responses even among members of the SSMR.
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ostrowski
authors.forename: Nicholas N
authors.initials: NN
authors.lastname: Tadros
authors.forename: A Scott
authors.initials: AS
authors.lastname: Polackwich
authors.forename: R Dale
authors.initials: RD
authors.lastname: McClure
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Fuchs
authors.forename: Jason C
authors.initials: JC
authors.lastname: Hedges
mesh_terms: D000714:Anastomosis, Surgical; D000066491:Clinical Decision-Making; D004822:Epididymis / Q000601:surgery*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D055101:Semen Analysis; D013048:Specimen Handling; D013094:Spermatozoa; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D014649:Vas Deferens / Q000601:surgery*; D014669:Vasovasostomy