Introduction: Approximately 3-6% of the 300,000 vasectomy patients per year will eventually seek a reversal, which is a technically demanding cash-pay operation requiring microsurgical expertise to achieve optimal outcomes. In this study, we first sought to
summarize the current public search patterns for vasectomy reversal information. Next, we studied internet advertising information provided by vasectomy reversal clinic websites to better understand the training patterns, geographical distribution, technical details, reported success rates, and cost for providers in the United States.
Methods: Google trends was used to identify search trends over the preceding 10 years. Web search engines were queried using the term "+(vasectomy reversal OR vasovasostomy OR vasoepididymostomy) +[state]” and assessed by clinicians for inclusion and relevance.
Results: First, vasectomy reversal searches represented 6% of the searches for vasectomy during the same interval. There was no strong trend in search frequency or seasonal variation over the 10-year search period. Oklahoma and Wyoming showed the highest enrichment for vasectomy reversal searches relative to population.
Next, A total of 251 unique clinics were identified. Providers were 98% male and graduated from residencies in urology (97%), obgyn (1%), general surgery, 1%), orthopedics (1%), and family medicine (1%). 44% of urologists had completed fellowship training in andrology. 10% of providers explicitly did not perform vasoepididymostomy even if indicated. 42% of websites reported success rates, which varied from 77% to 100%, and there was no relationship between success and cost. 17% of websites reported total cost ranging from $1990 to $14175 (median $6318). The highest density of reversal providers per million patients occurred in the Northeast (1.63) and the lowest density was in the west (1.04). There was no statistical difference in cost by region.
Conclusions: Vasectomy reversals are performed using a variety of techniques by surgeons with a wide breadth and depth of training. Costs vary by an order of magnitude, and reported success rates vary significantly. Only a minority of clinic websites discuss complications, and not all providers offer vasoepididymostomy when indicated. This information underscores the difficulty that patients may face when choosing their surgeon and suggests efforts towards standardization and transparency may be of benefit to the public.
.jpg)
.jpg)